# 9416
A couple of weeks ago, in WHO: Plague Returns To Madagascar, we looked at what has become an annual occurrence – a spike in plague cases on that island country of 22 million people. Plague (Yersinia Pestis) is a bacterial infection transmitted by fleas, carried by infected rats.
The most common presentation is Bubonic plague, however in rare cases, Pneumonic Plague may develop, where the victim develops severe pneumonia and may spread the disease from human-to-human by coughing.
Yesterday the ECDC published a Rapid Risk Assessment on the most recent outbreak in Madagascar, which has begun earlier in the fall than usual. As we’ve come to expect, it provides excellent historical context and background information on the disease.
The risk beyond Madagascar is considered low, and the risk on that island is primarily in the higher elevations (above 800 m), where the disease has become well entrenched in the local rat population. There have been at least two recent cases reported in the heavily populated capital of Antananarivo, which has increased concerns.
First, a look at the latest ECDC Communicable Disease Threat’s update, then a link to the Rapid Risk Assessment.
Plague outbreak - Madagascar – 2014
Opening date: 24 November 2014 Latest update: 27 November 2014Epidemiological summary
Since January 2014 and as of 5 December, 138 cases of plague including 47 deaths (CFR 34%) have been reported. Two percent of the reported cases have been of the pneumonic form. Sixteen districts of seven regions of Madagascar are affected.
Two cases including one death have been reported in the capital, Antananarivo, from two densely populated neighbourhoods.
Web sources: WHO | Media |ECDC assessment
Cases of bubonic and pneumonic plague are not unexpected events in Madagascar. However, the recent occurrence of cases in the capital city highlights the risk of a rapid spread of the disease when occuring in densely populated areas with poor sanitation and a weak healthcare system.
Based on information currently available to ECDC, the risk of contracting plague for EU travellers to the affected area in Madagascar is considered to be unchanged and very low. The risk to visitors is very limited if they limit the risk of contact with rats and fleas.
ActionsECDC published a rapid risk assessment on 5 December 2014.
RAPID RISK ASSESSMENT
Plague outbreak, August–November 2014, Madagascar
4 December 2014Main conclusions and recommendations
In Madagascar an outbreak of plague has been evolving since 31 August 2014; as of 16 November 2014,
40 people have died from the disease.
The ongoing plague outbreak in Madagascar with 119 cases reported to the World Health Organization (as of
16 November 2014) was not an unexpected event. However, the recent occurrence of two cases in
Antananarivo, Madagascar’s capital, poses a potential risk of a rapid spread of the disease due to the city’s high population density, poor sanitation, deficient garbage collection, and the overall weakness of the healthcare
system.
Despite the risk of further spread, the risk of contracting plague for EU travellers to the affected area in
Madagascar is considered to be very low.
The local authorities are experienced in responding to plague outbreaks and have set up a control coordination committee with dedicated funding to support response measures. There is no restriction of movement in and out of Antananarivo, where the two urban cases occurred, which is consistent with the standard response to plague outbreaks in Madagascar.
Resistance of Yersiniapestisto antibiotics seems very limited. However, circulating strains are monitored to
provide accurate public health information on Y. pestis antimicrobial susceptibility.
WHO does not recommend any travel or trade restrictions based on the current information available for this
outbreak.
