Date: 9 Aug 2019
Source: RFI [in French, machine trans. edited]
In Madagascar, the plague season has started. The 1st 3 cases of bubonic plague have just been recorded 50 km west of the capital. No deaths have occurred for the moment, but the Ministry of Health is watching. As every year, awareness campaigns have started. The goal: to prevent the spread of epidemics like that of 2017, the black year, which had more than 200 victims and 2400 people infected by the bacterium throughout the Malagasy territory.
"Do not repeat the mistakes of the past" is the stated ambition of the Ministry of Health. Contacted by telephone, the Director General of Preventive Medicine, Dr. Fidiniaina Randriatsarafara, said that "information and awareness activities have started. Radio clips are being broadcast on local radio stations to remind the public that the appearance of swelling, sudden fever, or chest pains require an immediate visit to the nearest health centre. Clinics are sometimes several hours walking distance away, and patients more easily consult traditional healers.
At present, health centres in plague-endemic areas are all expected to be provided with drugs, since treatment exists to treat both forms of plague on the island. However, some clinics are still awaiting them, according to a ministry official.
Another important preventive measure is the requirement for road transport companies to register the name and telephone number of all passengers during the plague season. In 2017, it was a sick traveller who transmitted the pneumonic plague to other passengers, extending the epidemic to Tamatave. However, according to a regional carrier, many companies do not register passengers and are not sanctioned.
[Plague infections in Madagascar have been relatively quiet since the dramatic outbreak in 2017.
"Between 1930 and 1990, bubonic plague had 'virtually disappeared' on the island due to efficient pest-control and good health management. However, since 1990, an annual 200 cases are being reported, and bubonic plague takes on epidemic form, especially in the port of Mahajanga, each year. In the capital city of Antananarivo, more cases are being notified each year since 1990. Madagascar (pop. 13 million) has accounted for 45% of all the cases of plague in Africa."
Fatalities related to plague usually are caused by spread of the organism from the bubo (the very painful infected lymph node that drains the area where the flea bite occurred) to the bloodstream. The bacteraemia can cause a coagulopathy, producing the purpura seen in the "black plague," and also may spread to the lungs causing a haemorrhagic pneumonia. It is the pneumonia that can facilitate person-to-person transmission.
Madagascar was the location of the isolation of multi-antimicrobial resistant _Yersinia pestis_ in 1995 (Galimand M, Guiyoule A, Gerbaud G, et al. Multidrug resistance in _Yersinia pestis_ mediated by a transferable plasmid. N Engl J Med. 1997;337(10):677-80, PMID: 9278464; available at <http://www.nejm.org/doi/full/10.1056/NEJM199709043371004
>). The strain was resistant to chloramphenicol, streptomycin, and tetracycline but sensitive to fluoroquinolones and trimethoprim as well as other aminoglycosides. This was an ominous observation; however, it is not clear whether this naturally occurring strain has persisted or spread. - ProMED Mod.LL]
[HealthMap/ProMED map available at:
Antananarivo, Analamanga, Madagascar: