The extensive outbreak of plague in Madagascar, which started in August 2017, attracted world-wide attention. Sensational headlines speculating on the return of the ‘Black Death’ of medieval times, reflected general lack of awareness that plague is endemic in Madagascar, and indeed, in a number of other African countries. Madagascar records up to 400 cases of plague, mainly bubonic, in its highland plateau region annually between September and April. 1 The current major outbreak of urban pneumonic plague is an unusual occurrence, amplified by rapid dissemination of highly infectious patients by public transport. The outbreak was declared as ‘contained’ by the Madagascar Ministry of Health at the beginning of December 2017. Between 1 August and 26 November 2017, 2 417 confirmed, probable and suspected cases were reported from 57 of 114 (50%) districts in Madagascar. There were 209 deaths, with a case fatality rate of 9%. Most cases (1 854, 77%) were clinically classified as pneumonic plague, 355 (15%) were bubonic, one was septicaemic, and the remainder have not yet been classified. There has been no international spread outside Madagascar, risk of spread at regional and global level is low, and no travel or trade restrictions were recommended by the World Health Organization. 2
展开▼
