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Published Date: 2019-08-14 21:22:48
Subject: PRO/AH/EDR> Plague - Madagascar (02): (AV) bubonic
Archive Number: 20190814.6622982
PLAGUE - MADAGASCAR (02): (ANTANANARIVO) BUBONIC
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Date: 9 Aug 2019
Source: RFI [in French, machine trans. edited]
http://www.rfi.fr/afrique/20190809-madagascar-peste-bubonique-saison-pesteuse-premiers-cas


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 center. Clinics are sometimes several hours walking distance away, and patients more easily consult traditional healers.

At present, health centers 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 traveler 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.

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[Plague infections in Madagascar have been relatively quiet since the dramatic outbreak in 2017.

The following paragraph is from Chanteau S, Ratsifasoamanana L, Rasoamanana B, et al. Plague, a reemerging disease in Madagascar. Emerg Infect Dis 1998;4(1):101-4, PMID: 9452403; available at http://wwwnc.cdc.gov/eid/article/4/1/98-0114_article.htm:

"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 bacteremia can cause a coagulopathy, producing the purpura seen in the "black plague," and also may spread to the lungs causing a hemorrhagic 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. - Mod.LL

HealthMap/ProMED map available at:
Antananarivo, Analamanga, Madagascar: http://healthmap.org/promed/p/9420]

See Also

Plague - Madagascar 20190312.6361715
2018
---
Plague - Madagascar (06) 20181002.6065963
Plague - Madagascar (05) 20180924.6048975
Plague - Madagascar (04) 20180921.6043410
Plague - Madagascar (03) 20180919.6039244
Plague - Madagascar (02): 2017-2018 20180502.5780275
Plague - Madagascar: (AV) bubonic 20180122.5572973
2017
---
Plague - Madagascar (37): fatal 20171221.5518585
Plague - Madagascar (36): fatal 20171205.5482572
Plague - Madagascar (35): fatal, WHO 20171127.5467648
Plague - Madagascar (34): fatal, decreasing caseload 20171120.5453966
Plague - Madagascar (32): fatal, WHO 20171116.5448645
Plague - Madagascar (31): fatal 20171111.5438233
Plague - Madagascar (30): fatal 20171106.5427532
Plague - Madagascar (29): fatal 20171104.5422504
Plague - Madagascar (28): fatal, WHO 20171102.5420572
Plague - Madagascar (27): fatal, revised numbers 20171101.5417971
Plague - Madagascar (26): fatal, revised numbers, transportation 20171031.5415688
Plague - Madagascar (25): fatal, revised numbers, health care transmission 20171026.5405650
Plague - Madagascar (24): fatal 20171021.5395549
Plague - Madagascar (23): fatal 20171020.5394246
Plague - Madagascar (22): fatal 20171020.5392390
Plague - Madagascar (21): fatal, numbers growing, WHO, MOH 20171019.5389292
Plague - Seychelles (06): NOT, WHO results 20171018.5388827
Plague - Madagascar (20): fatal, numbers growing 20171017.5386317
Plague - Mauritius: ex Madagascar, NOT 20171017.5384887
Plague - Seychelles (05) 20171015.5382291
Plague - Madagascar (19): Seychelles ex Madagascar cases 20171014.5380658
Plague - Seychelles (04): poss. local spread 20171013.5379530
Plague - Madagascar (18): fatal 20171013.5378893
Plague - Madagascar (17): South Africa (ex Madagascar) RFI 20171012.5375932
Plague - Madagascar (16): fatal 20171011.5374264
Plague - Seychelles (02): poss. local spread, RFI 20171011.5373068
Plague - Seychelles: ex Madagascar, RFI 20171010.5371382
Plague - Madagascar (15): fatal 20171009.5369168
Plague - Madagascar (14): fatal 20171009.5367613
Plague - Madagascar (13): fatal, more cases, exportations 20171008.5367506
Plague - Madagascar (12): fatal 20171007.5366522
Plague - Madagascar (11): fatal, WHO 20171006.5363591
Plague - Madagascar (10): fatal 20171004.5361339
Plague - Madagascar (03): fatal 20170912.5311663
Plague - Madagascar (02): 2nd cluster 20170122.4784059
Plague - Uganda: 2011-2014, ciprofloxacin efficacy 20170217.4846917
Plague - Madagascar: fatalities 20170110.4754927
.................................................sb/ll/msp/lxl

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