Clinical and Public Health Microbiology

Plague in Madagascar Continues to Spread

An outbreak of plague in Madagascar that started in August and has caused 200 infections and 33 deaths so far is spreading in urban areas instead of remaining in the nation’s central highlands.  There are usually 400 cases of bubonic plague in Madagascar’s central highlands every year, spread by fleas living on rats in rice-growing areas.  The plague that is currently spreading in the cities is the pneumonic type that is spread by coughing.  Pneumonic plague kills even faster than the bubonic form and is transmitted more quickly as well.

Schools, universities, and other public buildings are closed so they can be sprayed for fleas, and the government has forbidden large public gatherings, including sporting events and concerts.  Late last month, the disease cropped up at a basketball tournament for teams from Indian Ocean countries, killing a coach from the Seychelles and infecting another from South Africa.  Malagasy health authorities told the World Health Organization (WHO) that they are monitoring the players.

The WHO has responded by sending 1.2 million doses of antibiotics to the island, and 244,000 more are on the way.  They organization says they will be enough to treat 5,000 patients and prophylactically protect another 100,000 people who may have been exposed.  The organization is also donating personal protective gear and disinfection equipment similar to the gear that was used during the recent Ebola epidemics.

The outbreak started when a 31-year old man who was originally diagnosed with malaria traveled by bush taxi from the central highlands to his home in the coastal city of Toamasina.  The taxi passed through the capital of Madagascar, Antananarivo.  The man died en route and a large cluster of infections appeared among his contacts, who passed it on to others.  Plague was finally confirmed in the blood of a 47-year old woman who died on September 11 in an Antananarivo hospital of what appeared to be pneumonia.  Her blood was sent to the Madagascar branch of the Pasteur Institute, which conducted a rapid plague test.  The test was positive, and the country notified the WHO on September 13.

Although plague conjures up terrifying visions of the Black Death that killed a third of Europe’s population in the 1400s, it can usually be cured by common antibiotics.  Antibiotic-resistant strains have been isolated in Madagascar, but officials don’t think they played a role in this outbreak.

The WHO has released $1.5 million from its emergency fund and has appealed for $5.5 million more from donors.  Although the World Bank issued bonds to create a $500 million insurance fund for fighting pandemics in June, the fund only covers pandemics of the six viruses considered the greatest threats to human beings, including Ebola, SARS, pandemic flues, Lassa fever, Rift valley fever, and Crimean-Congo hemorrhagic fever.  The World Bank is creating a reserve fund of 50 million Euros ($58 million) to fight diseases not covered by the insurance, but the monies will not be available until next year.

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