Epidemiologic Features of Four Successive Annual Outbreaks of Bubonic Plague in Mahajanga, Madagascar

摘要

From 1995 to 1998, outbreaks of bubonic plague occurredannually in the coastal city of Mahajanga, Madagascar. A totalof 1,702 clinically suspected cases of bubonic plague werereported, including 515 laboratory confirmed by Yersinia pestisisolation (297), enzyme-linked immunosorbent assay, or both.Incidence was higher in males and young persons. Mostbuboes were inguinal, but children had a higher frequency ofcervical or axillary buboes. Among laboratory-confirmed hospi-talized patients, the case-fatality rate was 7.9%, although all Y.pestis isolates were sensitive to streptomycin, the recom-mended antibiotic. In this tropical city, plague outbreaks occurduring the dry and cool season. Most cases are concentrated inthe same crowded and insanitary districts, a result of close con-tact among humans, rats, and shrews. Plague remains animportant public health problem in Madagascar, and the poten-tial is substantial for spread to other coastal cities and abroad