At least 171 people have died in the ongoing plague outbreak in the island nation of Madagascar. The death toll, according to a World Health Organization release issued on November 15, represents 8% of the 2,119 “confirmed, probable and suspected cases of plague” reported to WHO by Madagascar health officials as of November 10.
The plague “season” in this Indian Ocean country typically runs from September through to the end of April 2018. There has been a decline in cases reported and the WHO believes the “epidemic phase” of the outbreak has passed. Medical personal are still supporting continued operations to minimize further bubonic plague infections and the more deadly pneumonic plague.
So far there have been no reports of plague transmitted outside the country.
Madagascar’s ongoing epidemic is highly unusual. First, the disease is rampant in the wetter eastern urban region near Antananarivo. In the past, plague has been typical of drier rural areas. Second, the high number of cases has caught health officials by surprise. And there are far more cases of the more deadly pneumonic plague, rather than the regionally expected normal bubonic form of the illness (Yersinia pestis) contracted when humans are bitten fleas that travel on rats.
In the past pneumonic plague—most frequently spread by breathing in airborne droplets (from a sneeze or cough) from another person—was said to have an incubation period, when symptoms develop, of 3 to 7 days after exposure. While symptoms of bubonic plague, the Black Death plague of medieval times would onset within 1 to 7 days.
Pharmacies and health workers are working to provide antibiotics to treat the infection.
Many people are also wearing masks to reduce exposure. Left untreated pneumonic plague is often fatal within 24 hours. It is extraordinary for the disease to be concentrated in the two largest cities of Toamasina (pop. 208K) and the capital city of Antananarivo (pop. 1.3M).
World health officials also insist global risk is considered “to be low” and, therefore, they have not imposed travel restrictions to or from Madagascar. Some additional now in place include screening of travelers at exit points and readiness measures in nearby east African countries. This seems a little lax, given the situation was considered out of control only six weeks ago.
While the WHO is—one hopes—doing their best frontline work to keep this boxed in, it is important to note that a tenth country is now officially on plague alert. Malawi joins the list of east African countries on alert including; South Africa, Tanzania Kenya, Ethiopia, Mauritius, Mozambique, Seychelles, La Reunion and Mayotte, and Comoros
According to the WHO, there remains a high risk of more cases in Madagascar.
Health workers in mainland Africa will be the only barrier to Europe and beyond. If the plague takes hold in Africa it might be as a match on tinder. Remember that the World Health Organization admits the disease might spread to beyond Africa.
Everything about Madagascar will quickly be forgotten if the disease transits the Indian Ocean. A hapless traveler steps off a merchant ship to wonder the port city of Dar es Salaam, Tanzania. Or the more nightmarish possibility presented by international air travel. And there are frequent direct flights from Antananarivo to international airports in both Ethiopia and Kenya.
From Nairobi’s Jomo Kenyatta Intl Airport, fly straight to Paris or Amsterdam.
Screening people at checkpoints is (we are told?) common, a nurse takes bus passenger’s temperatures with an infrared scan. Doctors are now telling people the untreated sickness will kill in 3 hours.
Infection expert Dr. Matthew Avison described the situation as a “crisis.”
Avison expects the plague will become even more serious. He fears the disease has been resilient to antibiotics and characterized this plague as “extremely rare.”
Coupled with poor “health infrastructure” limiting timely medical aid, the airborne spread of pneumonic plague, which accounts for over 60% of all cases, and the WHO saying this outbreak is “different” there are real concerns the situation may yet get out of control.
This Madagascar situation has been called the “worst outbreak in 50 years.” And we can imagine the disease reaching the African continent. If it does, and travel from infected countries is not prevented, this “unusual” epidemic could quickly escalate.