Plague Outbreak Warning Issued for Madagascar

If your travel plans include visiting Madagascar, health officials worldwide are suggesting caution.

International travelers to Madagascar are now subject to enhanced screening measures at points of entry, to avoid the international spread of the plague.

The ongoing plague outbreak in Madagascar has lead to a Travel Alert Level 2, issued by the Centers of Disease Control and Prevention (CDC).

Additional countries at a high risk of a plague outbreak include South Africa, Mozambique, Tanzania, Mauritius, Comoros, Seychelles, and Reunion.

The port city of Tamatave in Madagascar, also known as Toamasina, is home to about 300,000 people and currently has one of the highest concentrations of cases of pneumonic plague.

Tamatave has reported 261 plague cases and 10 fatalities.

According to the CDC, travelers who have had close contact with people with plague pneumonia (pneumonic plague) should immediately notify a health care provider.

Although bubonic plague occurs nearly every year in Madagascar, this is an unusual outbreak of plague pneumonia, according to the CDC.

From August 1 through October 23, 2017, the World Health Organization (WHO) reported 1,365 possible cases of plague in Madagascar.

Of the total possible cases, 65% were clinically classified as pneumonic plague, 21% were bubonic plague, one case was septicaemic plague, and 180 cases were unspecified.

Luca Fontana, a sanitation specialist, said "Pneumonic plague is treatable and patients have a 100 percent chance of making a full recovery when treatment is started in time.”

“Moreover, people at risk of infection can take prophylaxis treatments that will prevent them from falling ill."

While the bubonic plague is spread through infected fleas from common mammals, pneumonic plague is transmitted from human to human.

"The optimal strategy for protecting people and animals against this deadly disease (plague) would be through vaccination, but there are no FDA-licensed plague vaccines available in the U.S.," said Ashok Chopra, the University of Texas Medical Branch at Galveston professor of microbiology and immunology.

"We've been working to develop a vaccine that will generate long-term immunity and protection against the plague."

There are 3 forms of plague infection, depending on the route of infection: bubonic, septicaemic and pneumonic.

• Bubonic plague is the most common form of plague and is caused by the bite of an infected flea. Plague bacillus, Y. pestis, enters at the bite and travels through the lymphatic system to the nearest lymph node where it replicates itself. The lymph node then becomes inflamed, tense and painful, and is called a ‘bubo’. At advanced stages of the infection the inflamed lymph nodes can turn into open sores filled with pus.
• Septicaemic plague occurs when infection spreads through the bloodstream, following untreated bubonic plague or manifests as the first symptom of infection with Y. pestis. It can cause bleeding, tissue necrosis (turns to black), and shock.
• Pneumonic plague, or lung-based plague, is the most virulent form of plague, and is rare. Incubation can be as short as 24 hours. Typically, the pneumonic form is spread to the lungs from advanced bubonic plague. However, any person with pneumonic plague may transmit the disease via droplets to other humans. Untreated pneumonic plague, if not diagnosed and treated early, can be fatal.

The U.S. tends to see between one and 17 human cases a year.

Most infamous of all plague outbreaks was the Black Death, a medieval pandemic that swept through Asia and Europe. It reached Europe in the late 1340s, killing an estimated 25 million people.

The Black Death lingered on for centuries, particularly in cities. Outbreaks included the Great Plague of London (1665-66), in which one in five residents died.