Madagascar - Plague outbreak 2017-18

[Gert van der Hoek]

UN: Madagascar Plague Cases Top 1,000 Mark


October 19, 2017

The number of cases of plague in Madagascar has doubled during the past five days, according to the United Nations.
U.N. spokesperson Stephane Dujarric said Thursday as of Wednesday 1,032 cases were reported, 67 percent of which are pneumonic, which is more serious than bubonic plague.

So far 89 deaths have been recorded, including 13 on Tuesday.

Dujarric said the spread was "highly challenging" to control.

Medical teams in the country have stepped up efforts to combat the spread of the plague, but experts have said the situation will worsen if not rapidly funded.

Only 26 percent of the $9.5 million requested has been contributed, Dujarric said.

[Shiloh]

Source: https://reliefweb.int/report/madagas...0-october-2017 Madagascar Plague Outbreak: External Situation Report #5 - 20 October 2017

Report

from World Health Organization Published on 20 Oct 2017 ? View Original

1. Situation Update
Madagascar has been experiencing a large outbreak of plague affecting major cities and other non-endemic areas since August 2017. Between 1 August and 19 October 2017, a total of 1 297 cases (suspected, probable and confirmed) including 102 deaths (case fatality rate 7.9%) have been reported. Of these, 846 cases (65.2%) were clinically classified as pneumonic plague, 270 (20.8%) were bubonic plague, one case was septicaemic plague, and 180 cases were unspecified (further classification of cases is in process). Of the 846 cases of pulmonary plague, 91 (10.8%) have been confirmed and 407 (48.1%) were probable.
Between 1 August and 15 October 2017, a total of 793 specimens were analysed by the Institut Pasteur de Madagascar (IPM). Of these, 126 (15.9%) have been confirmed either by polymerase chain reaction (PCR) or bacteriological culture, 242 (30.5%) were probable after testing positive on rapid diagnostic tests (RDT) and 425 (53.6%) remain suspected (additional laboratory results are in process). Eleven strains of Yersinia pestis have been isolated and were sensitive to antibiotics recommended by the National Program for the Control of Plague...

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Epidemic - A Frenchman succumbs to the plague in Toamasina

23.10.2017 | 5:33 News, alaune, Social0

The plague of the lungs was right of a French, long-time resident in Toamasina, this Saturday. The remains have already been buried in a mass grave.

A French forty years bowed out in the Emergency department of the hospital Be Toamasina on Saturday morning, according to a local source. He died from complications of lung plague. "His condition was bad enough when he was admitted to the service. He was unresponsive to treatment, "said Dr. Raymond Rakotoarimanana, Regional Director of Public Health Atsinanana, reached by telephone yesterday. This stranger who lived in Toamasina for years, would have died just a few hours after admission to hospital. His body was already buried in the common grave of the cemetery of Manangareza the same day, to avoid the spread of the disease.

This would not be the first foreigner to have been a victim of this plague in Toamasina, in this season. Dr. Raymond Rakotoarimanana said that there had been another, but that was cured, as received timely treatment. In Antananarivo, the Seychelles and Comoros were among the victims. "The plague can touch everyone. It spreads easily, can kill very quickly, but is treatable when it is supported on time. We must reach a health facility in case of high fever, cough with sputum streaked possibility of blood, fatigue, chills, chest pain, "doctors recommend.

Twelfth death

This is the twelfth plague of death listed in Toamasina, from the beginning of the epidemic, in September. Ten of them have died in sanitary services and two at the community level. The first victims have contracted the bacteria in a bush taxi linking Antananarivo and Toamasina, in late August. One of the passengers of this vehicle was a leper from Ankazobe who died in Moramanga, August 28.

Yesterday, twenty patients are still under treatment in hospital in Toamasina. Two hundred and sixteen are healed, from the first cases, the report of the Ministry of Public Health, on 21 October. In Toamasina, the epidemic began to stabilize until rumors of vaccines against plague have panicked the population, last week. Residents refused to take advantage of all interventions at the community level, chasing health workers with improvised weapons.

In the Ministry of Public Health, the fear of a resurgence in the number of sick reborn. "By refusing chemoprophylaxis, people can get sick and pass the disease to others," says a source with regret. Dr. Raymond Rakotoarimanana reassures that response interventions at community level are already included, following the cooperation with local authorities.

The hundred dead bar exceeded

The bar has been exceeded a hundred dead. The Ministry of Public Health reported Saturday that one hundred and seven people have died since the beginning of the plague season in August. It is likely that there are still cases of death not listed. In the report sent by the National Bureau of Risk Management and Disaster (BNGRC) on Saturday, it was clarified that there is sixty-one unknown statutes, living or dead, and twenty-two cases currently under investigation at the community level. In Antananarivo, another child died of the disease in a children's hospital in this weekend. Twenty-nine patients were admitted to hospital on 21 October. And the thousands of cases recorded since August, six hundred and four to twenty are cured. Two hundred and twenty still undergoing treatment.

Miangaly Ralitera

http://www.lexpressmada.com/blog/actualites/epidemie-un-francais-succombe-a-la-peste-a-toamasina/

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Epidemic - Thirty interns infected by the plague

24.10.2017 | 7:00 News, alaune, Social1

Interns denounce the low protective equipment in the treatment of plague victims. They threaten to interrupt their activities.

Presentations. Thirty interns have contracted the bacteria of plague by intervening in the management of patients, since the beginning of the epidemic.

The announcement was made by Hery Perez De Cuellar, president of the National Association of Interns inside the University Hospital Joseph Ravoahangy Andrianavalona (CHU JRA) yesterday. "We are weakly protected in the care of patients. The mouth cover used are those used by surgeons. The on-blouses are changed only every 24 hours. And at the beginning of the epidemic, we bought ourselves this equipment, "said the student of the medical school, shocked.

These interns, students of 7th and 8th years of the Faculty of Medicine, are an integral part of health personnel involved in the care of plague victims. "We receive the patients at the triage, do the tubing or the puncture for the rapid diagnostic test, make the injection of the patients. Sometimes we take the sample on a corpse. So any time we are exposed to the bacteria", testified these future doctors.

If the majority of these interns with plague are already healed, some still undergoing treatment at the moment. Others are on chemoprophylaxis for contact.

Suspension of activity

These interns threaten to suspend their activities from today, if they do not have personal protective equipment. "We are not going to expose our lives to such a danger, however, knowing that other health workers receive more appropriate protection," they say.

The Ministry of Public Health denies that information.

"They exaggerate. The routing of equipment has taken a slight delay, but that's it, they arrived and were given to beneficiaries this afternoon (note: yesterday), "replies a source in the Ministry of Public Health.

These interns are not the only stakeholders victims of this disease since the beginning of the epidemic. In two months, at least two dozen doctors, paramedics and other health workers, have been affected and were cured.

One hundred and twenty four deaths

The cumulative number of deaths from August 1 to October 23 was 124 on 1192, according to the latest figures obtained from the Ministry of Health yesterday. Suspicious death was recorded in the region of Atsimo-Andrefana, another in Toamasina and the last in the region Itasy. The case fatality rate increases to 10.4% against 10.2%, about ten days ago. Eighteen new cases were reported in hospitals yesterday, and in the same day, thirty-six patients were able to return home them healed.

Miangaly Ralitera

http://www.lexpressmada.com/blog/actualites/epidemie-une%E2%80%88trentaine%E2%80%88dinternes%E2%80%88contamines%E2%80%88par%E2%80%88la%E2%80%88peste/

[Gert van der Hoek]

Plague kills 124 in Madagascar, cities most affected - report

Oct 25 , 2017

KIGALI (Reuters) - A plague epidemic in Madagascar has killed 124 people since August in an outbreak that has hit the island?s two main cities the hardest, the authorities said on Wednesday.

Plague is endemic in Madagascar, but the outbreak that has caused 1,192 suspected cases since August is especially worrying because it started earlier in the season than usual and has hit urban rather than rural areas.

In addition, two thirds of the cases are of the pneumonic plague, the deadliest form of the disease.
?The total number of cases (1,192) is already three times higher than the average annual total,? the National Office for Risk and Disaster Management said in a report on Wednesday.

Last week a World Health Organization report said the death toll stood at 94.

The capital Antananarivo and Toamasina, the two largest cities in Madagascar, an island in the Indian Ocean, were the most affected, with 55 percent of cases recorded there.

To date 54 medical staff have been infected, it said.

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...
Plague Madagascar

1 554 Cases
113 Deaths
CFR 7%


EVENT DESCRIPTION
The outbreak of plague in Madagascar continues to improve, with the number of
new cases of pulmonary plague declining in all active areas across the country. In
the past 2 weeks, 16 previously affected districts reported no new confirmed or
probable cases of pulmonary plague.

From 1 August to 27 October 2017, a total of 1 554 suspected cases of plague,
including 113 deaths (case fatality rate 7%), were reported. Of these, 985 (63%)
were clinically classified as pulmonary plague, 230 (15%) were bubonic plague,
1 was septicaemic, and 338 were unspecified (further classification of cases is
in process). Since the beginning of the outbreak, 71 healthcare workers (with no
deaths) have been affected.

Of the 985 clinical cases of pneumonic plague, 245 (25%) were confirmed, 336
(34%) were probable and 404 (41%) remain suspected (additional laboratory
results are in process). Fourteen strains of Yersinia pestis have been isolated and
were sensitive to antibiotics recommended by the National Program for the Control
of Plague.

Between 1 August and 27 October 2017, 28 districts reported confirmed and
probable cases of pulmonary plague. During the last two weeks, the number of
districts that reported confirmed and probable cases of pulmonary plague reduced
to 12.

About 78% (4 825) of 6 203 contacts identified completed their 7-day follow up and
a course of prophylactic antibiotics. A total of nine contacts developed symptoms
and became suspected cases. On 27 October 2017, 1 055 out of 1 087 (97%)
contacts were followed up and provided with prophylactic antibiotics.
...
Read the weekly bulletin on outbreaks and other emergencies - Week 43: 21 - 27 October 2017

http://www.afro.who.int/health-topics/disease-outbreaks/outbreaks-and-other-emergencies-updates

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Plague epidemic: 128 deaths and 1000 patients cured from August to October

Copywriting Midi Madagasikara November 2, 2017

Seven new cases of plague on the day of October 31, 2017.

The trend is now downward as judged by the number of people admitted to plague treatment centers in recent days. According to data from the Ministry of Public Health and published by the National Office of Risk and Disaster Management (BNGRC) on October 31, 2017, 83 plague patients are still under treatment today, October 31, in hospitals and plague treatment centers throughout the national territory. The Analamanga region has the largest number with 36 patients including 13 at CHAPA (Ambohimiandra anti-plague hospital), followed by the Haute Matsiatra region with 16 patients still under treatment.

Since the beginning of August, the plague epidemic has killed 128 people, 62 of whom have died outside the hospital. No deaths, however, have been reported this day of 31 October. Currently, the mechanisms already in place to reduce the risk of spreading the epidemic are still maintained or even reinforced in some localities where new cases have been recorded during the week. This is the case for the Analamanga, Vakinankaratra, Atsinanana and Haute Matsiatra regions.

In schools, the series of measures applied in private schools that have already returned to school remain in place. These include the establishment of an isolation room in the event of a suspected case, and a vigilance committee to implement other measures recommended by the Ministry of Health, including temperature measurement and hand washing with disinfectant gel at the entrance of the establishments for all students, teachers and any other person entering the institution. These measures will be maintained until the declaration of the end of the epidemic.

Hanitra R.

http://www.midi-madagasikara.mg/societe/2017/11/02/epidemie-de-peste-128-deces-et-1000-malades-gueris-daout-a-octobre/

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Antananarivo - Three deaths suspected of plague in the community

02.11.2017 | 8:34 AM News, Social0

The calm of the plague has been broken by the suspicious death of three people in Antananarivo, Tuesday and Wednesday. Unlike the cases reported recently, they all died at the community level with a rapid diagnostic test (RDT) positive for plague, as reported by the Municipal Bureau of Health (BMH) of the Urban Commune of Antananarivo (AUC), which supports the deceased outside health facilities and burial of plague victims in the city of Antananarivo. These deaths were recorded in Andohamandry Manjakamiadana at Andrainarivo and Ampahibe. The first two happened Tuesday and the last, Wednesday. The Ministry of Health has not yet confirmed the cases in Andrainarivo and Amparibe.

The one in Andrainarivo would be homeless. "He bowed out on the street," reports a source at the BMH. It would be, thus, the first homeless victim of the plague in the capital. "If the response is not reinforced, the disease will spread quickly to his family and all those who came into contact with him," says a doctor. The BMH took his body for burial in the grave of Anjanahary last night.

Blocking

An hour before that, the remains of the deceased in Andohamandry Manjakamiadana remains were buried in Anjanahary. The burial of the remains blocked agents BMH in its activities. Relatives of the victim have accepted neither the finding of the doctors nor the result of the TDR, and have refused to give the body. "We understand that it's hard. But would not it be better to accept to prevent the disease makes other victims? "says a doctor.

The deaths at community level should be alarming indicators for the Department of Public Health. People probably think that the danger is past, with the decline of the victims. So, they will not join the health facilities, despite the presence of symptoms, namely high fever, chills, fatigue, chest pain, cough with sputum streaked with blood. The active case, awareness and all response activities should be strengthened.

Lost in nature

Yesterday, the Secretary General of Public Health, Dr. Jos?a Ratsirarson emphasized that the plague victim who escaped the anti-plague hospital in Ambohimiandra (CHAPA), last Thursday, has not been found. "We do not know what has become of him. The last time we joined him on the phone, he agreed to come back to the hospital for treatment, so far he has not pointed his nose, "he says. We do not know until yesterday, it is one of those died in Antananarivo. On 31 October, eighty-three people were under treatment at the facility level, a thousand people have been cured since the beginning of the epidemic and seven new cases were recorded throughout Madagascar. With these three cases, the number of deaths would amount to a hundred and twenty nine.

Miangaly Ralitera

http://www.lexpressmada.com/blog/actualites/antananarivo-trois-morts-suspects-de-peste-dans-la-communaute/

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Eliane Naika: "The figure of 128 deaths related to the plague is below reality"

LINFO.RE - created the 2.11.2017 at 13h13 - updated on 2.11.2017 at 16h29- Manuel Yepes
...
To talk about the plague in Madagascar, former Malagasy senator Eliane Naika is on the set of Antenne R?union.

According to the latest assessment on October 24, 1,133 people were infected with the plague, and 128 died. But for Eliane Naika, these figures do not reflect reality.

"There has not been an in-depth census of the reality, there are a lot of people in the bush who have died and I think have not been counted in. I do not recognize that figure of 128 deaths. I can put a number on the number of affected areas, of the 22 regions, 17 regions are affected, that's a huge number, which is a figure that came out of the cases that came out everywhere. This number is real. On the other hand, I can not give an exact number of deaths. "

...

http://www.linfo.re/la-reunion/societe/729789-eliane-naika

[Sharky]

"The deadly airborne plague spreading rapidly across Madagascar is now at 'crisis' point as cases have rocketed by 37 per cent in just five days, official figures reveal.

The outbreak, the 'worst in 50 years', is being fueled by a strain more lethal than the one which usually strikes the country off the coast of Africa.

The World Health Organization (WHO) now states there are 1,801 suspected cases - significantly higher than the 1,309 it reported last Thursday."

(continues)
http://www.dailymail.co.uk/health/ar...rocket-40.html

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Plague – Madagascar

Disease outbreak news

2 November 2017

Since August 2017, Madagascar is experiencing a large outbreak of plague affecting major cities and other non-endemic areas.

From 1 August through 30 October 2017, a total of 1801 confirmed, probable and suspected cases of plague, including 127 deaths, have been reported by the Ministry of Health of Madagascar to WHO. Of these, 1111 (62%) were clinically classified as pneumonic plague, including 257 (23%) confirmed, 374 (34%) probable and 480 (43%) suspected cases. In addition to the pneumonic cases, 261 (15%) cases of bubonic plague, one case of septicaemic plague and 428 cases (24%) where the type has not yet been specified, have been reported (Figure 1). As of 30 October, 51 of 114 districts of Madagascar have been affected (Figure 2 and 3). Since the beginning of the outbreak, 71 healthcare workers have had illness compatible with plague, none of whom have died.

Laboratory confirmation of plague is being conducted by the Institut Pasteur of Madagascar. Twenty-three isolates of Yersinia pestis have been cultured and all are sensitive to antibiotics recommended by the National Program for the Control of Plague.

Since the second week of October 2017, there has been a decline in the number of new cases (Figure 4). There is also a decrease in the number of patients hospitalized due to suspicion of plague. Due to enhanced surveillance and ongoing investigations the cumulative number of cases continues to increase, however, some of the cases are not recently infected.

In Madagascar, the number of cases of plague is highest during the period of September through April. It is therefore important that control measures continue
through to the end of April 2018.

Eighty-three percent of 6492 individuals identified as contacts of a person suspected of having plague have completed follow-up monitoring, which includes a seven day follow-up and a course of prophylactic antibiotics. On 30 October 2017, 95% of the 972 contacts currently under follow-up were reached by field teams and have been provided with antibiotics as precautionary measure.

Figure 1. Confirmed, probable and suspected plague cases reported in Madagascar by clinical classification and date of illness onset, from 1 August through 30 October 2017 (n=1506)1




1 Date of onset is missing for 295 cases.
Figure 2. Geographical distribution of confirmed, probable and suspected bubonic plague cases reported in Madagascar, from 1 August through 30 October 2017




Figure 3. Geographical distribution of confirmed, probable and suspected pneumonic plague cases reported in Madagascar, from 1 August through 30 October 2017




Figure 4. Epidemic curve of reported confirmed, probable and suspect pneumonic plague by date of illness onset in Madagascar, from 1 August through 30 October 2017 (n=1053)2




2 Date of onset is missing for 58 cases.

Public health response

The Ministry of Public Health of Madagascar is coordinating the health response, with the support of WHO, and other agencies and partners.

The Ministry of Public Health of Madagascar has activated crisis units in Antananarivo and Toamasina and all cases and contacts have been provided access to treatment or prophylactic antibiotics at no cost.

Public health response measures include:

• Investigation of new cases
• Isolation and treatment of all pneumonic cases
• Enhanced case finding
• Active finding, tracing and monitoring of contacts and provision of free prophylactic antibiotics
• Strengthened epidemiological surveillance in the all affected districts
• Disinsection, including rodent and vector control
• Raising public awareness on prevention for bubonic and pneumonic plague
• Raising awareness among health care workers and providing information to improve case detection, infection control measures and protection from infection
• Providing information about infection control measures during burial practices.

Enhanced measures for exit screening have been implemented at the International Airport in Antananarivo. These measures include: filling a special departure form at the airport (to identify passengers at risk); temperature screening of departing passengers, and referring passengers with fever to airport physicians for further consultation; passengers with symptoms compatible with pneumonic plague are immediately isolated at the airport and investigated using a rapid diagnostic test and notified according to the response alert protocol. Symptomatic passengers are not allowed to travel. A WHO GOARN team (US Centers for Disease Control and Prevention (CDC) and L'Institut de veille sanitaire/ Sant? publique France (InVS/SPF) is providing technical support at the airport.

Nine countries and overseas territories in the African region (Comoros, Ethiopia, Kenya, Mauritius, Mozambique, La R?union (France), Seychelles, South Africa, and Tanzania) have been identified as priority countries for plague preparedness and readiness by virtue of their trade and travel links to Madagascar.

These countries are implementing readiness activities including increased public awareness of plague, enhancing surveillance for the disease particularly at points of entry and prepositioning of equipment and supplies.

WHO risk assessment

While the declining trend in new plague case reports and reduction in hospitalizations due to plague is encouraging, WHO expects more cases of plague to be reported from Madagascar until the typical plague season ends in April 2018. Sustaining ongoing operations, including active case finding and treatment, comprehensive contact identification, follow-up and antibiotic treatment, rodent and flea control, and safe and dignified burials is crucial during the outbreak and through the plague season as it is critical to minimize bubonic plague infections and human-to-human transmission of pneumonic plague.

Based on available information and response measures implemented to date, WHO estimates the risk of potential further spread of the plague outbreak at national level remains high. The risk of international spread is mitigated by the short incubation period of pneumonic plague, implementation of exit screening measures and advice to traveller to Madagascar, and scaling up of preparedness and operational readiness activities in neighbouring Indian Ocean islands and other southern and east African countries. The overall global risk is considered to be low. WHO is re-evaluating the risk assessment based on the evolution of the outbreak and information from response activities.

Advice on prevention and control measures, treatment options have been provided to Madagascar and to priority countries in the region.

For further information on plague and the latest information about the plague outbreak in Madagascar please see WHO Plague website and the Madagascar Plague Outbreak Situation Reports website.

• WHO Plague website
• Madagascar Plague Outbreak Situation Reports website

WHO advice on travel

Based on the available information to date, the risk of international spread of plague appears very low. WHO advises against any restriction on travel or trade on Madagascar based on the information available.

International travellers arriving in Madagascar should be informed about the current plague outbreak and the necessary protection measures. Travellers should protect themselves against flea bites, avoid contact with dead animals, infected tissues or materials, and avoid close contact with patients with pneumonic plague. In case of sudden symptoms of fever, chills, painful and inflamed lymph nodes, or shortness of breath with coughing and/or blood-tainted sputum, travellers should immediately contact a medical service. Travellers should avoid self-medication, even if for prophylaxis. Prophylactic treatment is only recommended for persons who have been in close contact with cases, or with other high risk exposures (such as bites from fleas or direct contact with body fluids or tissues of infected animals). Upon return from travel to Madagascar, travellers should be on alert for the above symptoms. If symptoms appear, travellers should seek medical care and inform their physician about their travel history to Madagascar.

http://www.who.int/csr/don/02-novemb...madagascar/en/

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Epidemic - A little girl succumbs to the plague

04.11.2017 | 7:32 AM News, Social0

A 2 year old little girl succumbed to suspected pneumonic plague at the university hospital mother-child in Ambohimiandra yesterday. "She arrived here in a very serious condition. We had to revive her, even if we were not to receive plague patients in our establishment. Despite our intervention, the little girl did not survive, "says a doctor at the hospital. The municipal office of hygiene of the urban commune of Antananarivo was able to retrieve the body for burial in the grave of Anjanahary.

This little girl lived in the rural town of Tanjombato. Last week, the body of a plague victim, who died in Befelatanana on October 25, had a wake for three days and two nights at her home in Ankady Tanjombato, after her family took her away. Their neighbors rallied to prevent personnel from the Ministry of Health to recover the body and buried in a mass grave. It is, however, essential to prevent the spread of the disease. It is likely that there is connection between the two cases.

The family of the little girl would have treated her at a traditional practitioner before taking her to a health facility. This is what probably would have caused her death...

M. R.

http://www.lexpressmada.com/blog/actualites/epidemie-une-fillette-succombe-a-la-peste/

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Antananarivo-Ville - A sick man in the street succumbs to the plague

09.11.2017 | 8:33 AM News, Social0

The plague is still talked about in the city of Antananarivo. A man would have died at a large hospital in Antananarivo after pneumonic plague, according to the result of his sample from a rapid diagnostic test (RDT). This is the Municipal Bureau of Health (BMH) of the Antananarivo urban district that made the report later in the evening. "Some people brought this man to our service this morning (note: yesterday). They would have found him in the street, sick. We performed first aid, he was then taken to a large hospital for further treatment. He died shortly after, "says our source.

Before this last case, the Minister of Public Health, Professor Mamy Lalatiana Andriamanarivo welcomed the "Zero deaths for ten days in Toamasina and for five days in Antananarivo". In the latest report of the general situation of the plague, sent by the National Office of Risk Management and Disaster (BNGRC) yesterday, there were no reported deaths despite the rise of the deceased, from one hundred thirty-one to one hundred thirty-two, between 7 and 8 November. This hundred and thirty-second case registered in the report is not new, according to a source with the Ministry. By counting the dead man yesterday, the number of plague deaths increases to one hundred and thirty three.

This man was reportedly buried by agents of BMH in the common grave of Anjanahary, yesterday.

M. R.

http://www.lexpressmada.com/blog/actualites/antananarivo-ville-un-malade-dans-la-rue-succombe-a-la-peste/

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• WHO external Situation report 10 - 14 November 2017

Date of issue: 14 November 2017

Grade
2
Cases
2 119
Deaths
171
CFR
8%

WHO continues to support the Ministry of Public Health and other national authorities in Madagascar to monitor and
respond to the outbreak of plague. From 7 to 10 November 2017, 86 confirmed, probable and suspect cases of plague
were reported.

From 1 August to 10 November 2017, a cumulative total of 2 119 confirmed, probable and suspected cases of plague,
including 171 deaths (case fatality rate 8%), have been reported from 55 of 114 (48%) districts in Madagascar.
Analamanga Region has been the most affected, with 72% of all recorded cases.

Since the beginning of the outbreak, 1 618 (76%) of reported cases have clinically been classified as pulmonary
plague, 324 (15%) as bubonic plague, one was septicaemic, and 176 have not yet been classified (further
classification of cases is in process). A total of 82 healthcare workers (with no deaths) have been affected.

Of the 1 618 clinical cases of pneumonic plague, 365 (23%) have been confirmed, 573 (35%) are probable and 680
(42%) remain suspected (additional laboratory results are in process). Twenty-five isolates of Yersinia pestis have
been cultured and are sensitive to all antibiotics recommended by the National Plague Control Program.

About 95% (6 729) of 7 122 contacts identified thus far have completed their 7-day follow up and a course of
prophylactic antibiotics. Since the beginning of the outbreak, a total of eleven contacts developed symptoms and
became suspected cases. On 10 November 2017, 218 out of 243 (90%) contacts under follow-up were reached and
provided with prophylactic antibiotics.
...

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Plague ? Madagascar

Disease outbreak news
15 November 2017

Since 1 August 2017, Madagascar has been experiencing a large outbreak of plague. As of 10 November 2017, a total of 2119 confirmed, probable and suspected cases of plague, including 171 deaths (case fatality rate: 8%), have been reported by the Ministry of Health of Madagascar to WHO.
From 1 August through 10 November 2017, 1618 (76%) cases and 72 deaths have been clinically classified as pneumonic plague, including 365 (23%) confirmed, 573 (35%) probable and 680 (42%) suspected cases. In addition to the pneumonic cases, 324 (15%) cases of bubonic plague, one case of septicaemic plague, and 176 unspecified cases (8%), have been reported to WHO (Figure 1). Eighty-two healthcare workers have had illness compatible with plague, none of whom have died.
Figure 1: Number of confirmed, probable and suspected plague cases in Madagascar reported by date of illness onset from 1 August through 10 November 2017 (n=2119)1




1 Date of onset is missing for 295 cases
From 1 August through 10 November, 16 (out of 22) regions of Madagascar have reported cases. Analamanga Region has been the most affected, reporting 72% of the overall cases (Figures 2 and 3).
Figure 2: Geographical distribution of confirmed and probable pneumonic plague cases in Madagascar from 1 August through 12 November 2017




Figure 3: Geographical distribution of confirmed and probable bubonic plague cases in Madagascar from 1 August through 12 November 2017




As of 10 November 2017, 218 out of 243 (90%) contacts under follow-up were reached and provided with prophylactic antibiotics. Since the beginning of the outbreak, a total of 7122 contacts were identified, 6729 (95%) of whom have completed their 7-day follow up and a course of prophylactic antibiotics. Only nine contacts developed symptoms and became suspected cases.
Laboratory confirmation of plague is being conducted by the Institut Pasteur of Madagascar, National WHO Collaborating Center for plague in Madagascar. Twenty-five isolates of Yersinia pestis have been cultured and all are sensitive to antibiotics recommended by the National Program for the Control of Plague.
The number of new cases and hospitalizations of patients due to plague is declining in Madagascar. The last confirmed bubonic case was reported on 24 October and the last confirmed pneumonic case was reported on 28 October.
Since plague is endemic to parts of Madagascar, WHO expects more cases to be reported until the end of the typical plague season in April 2018. It is therefore important that control measures continue through to the end of the plague season.
Public health response

The Ministry of Public Health of Madagascar is coordinating the health response, with the support of WHO and other agencies and partners.
The Ministry of Public Health of Madagascar has activated crisis units in Antananarivo and Toamasina and all cases and contacts have been provided access to treatment or prophylactic antibiotics at no cost to themselves.
Public health response measures include:

• Investigation of new cases
• Isolation and treatment of all pneumonic cases
• Enhanced case finding
• Active finding, tracing and monitoring of contacts and provision of free prophylactic antibiotics
• Strengthened epidemiological surveillance in the all affected districts
• Disinsection, including rodent and vector control
• Raising public awareness on prevention for bubonic and pneumonic plague
• Raising awareness among health care workers and providing information to improve case detection, infection control measures and protection from infection
• Providing information about infection control measures during burial practices.

Enhanced measures for exit screening have been implemented at the International Airport in Antananarivo. These measures include: filling a special departure form at the airport (to identify passengers at risk); temperature screening of departing passengers, and referring passengers with fever to airport physicians for further consultation; passengers with symptoms compatible with pneumonic plague are immediately isolated at the airport and investigated using a rapid diagnostic test and notified according to the response alert protocol. Symptomatic passengers are not allowed to travel. A WHO GOARN team, consisting of US Centers for Disease Control and Prevention (CDC) and L'Institut de veille sanitaire/ Sant? publique France (InVS/SPF), is providing technical support at the airport.
Nine countries and overseas territories in the African region (Comoros, Ethiopia, Kenya, Mauritius, Mozambique, La R?union (France), Seychelles, South Africa, and Tanzania) have been identified as priority countries for plague preparedness and readiness by virtue of their trade and travel links to Madagascar. These countries are implementing readiness activities, including increased public awareness of plague, enhancing surveillance for the disease (particularly at points of entry), and prepositioning of equipment and supplies.
WHO risk assessment

Since mid-October, the number of new cases of plague, the number of hospitalizations of patients due to plague, and the number of geographic districts reporting plague has decreased. While the declining trend in new plague case reports and reduction in hospitalizations due to plague are encouraging signs, WHO expects more cases of plague to be reported from Madagascar until the typical plague season ends in April 2018.
The decline in case reports suggests that the epidemic phase of the outbreak is ending, however sustaining ongoing operations is critical to minimize bubonic plague infections and human-to-human transmission of pneumonic plague.
The trend in the number of new cases of plague has been declining for more than a month, indicating that measures taken to contain the outbreak have been effective. WHO is working with the Ministry of Health in Madagascar and other partners to maintain ongoing outbreak control efforts, including active case finding and treatment, comprehensive contact identification, follow-up and antibiotic treatment, rodent and flea control, and safe and dignified burials through this outbreak and the plague season into 2018, and to outline a longer term strategy for plague preparedness and control.
Since the beginning of this outbreak, the vast majority of cases, and more than 7000 contact persons, have been treated and have recovered. As of 15 November 2017, only 12 people are hospitalized for plague. There has been no international spread outside the country.
Based on available information and response measures implemented to date, WHO estimates the risk of potential further spread of the plague outbreak at national level remains high. The risk of international spread is mitigated by the short incubation period of pneumonic plague, implementation of exit screening measures and advice to travellers to Madagascar, and scaling up of preparedness and operational readiness activities in neighbouring Indian Ocean islands and other southern and east African countries. The overall global risk is considered to be low. WHO is re-evaluating the risk assessment based on the evolution of the outbreak and information from response activities.
Advice on prevention and control measures and treatment options has been provided to Madagascar and to priority countries in the region.
WHO travel advice

Based on the available information to date, the risk of international spread of plague appears very low. WHO advises against any restriction on travel or trade on Madagascar. To date, there are no reported cases related to international travel.
International travellers arriving in Madagascar should be informed about the current plague outbreak and the necessary protection measures. Travellers should protect themselves against flea bites, avoid contact with dead animals, infected tissues or materials, and avoid close contact with patients with pneumonic plague. In case of sudden symptoms of fever, chills, painful and inflamed lymph nodes, or shortness of breath with coughing and/or blood-tainted sputum, travellers should immediately contact a medical service. Travellers should avoid self-medication, even if for prophylaxis. Prophylactic treatment is only recommended for persons who have been in close contact with cases, or with other high risk exposures (such as bites from fleas or direct contact with body fluids or tissues of infected animals). Upon return from travel to Madagascar, travellers should be on alert for the above symptoms. If symptoms appear, travellers should seek medical care and inform their physician about their travel history to Madagascar.

http://www.who.int/csr/don/15-novemb...madagascar/en/

[Pathfinder]

Source:

• WHO external Situation report 12 - 20 November 2017

Date of issue: 20 November 2017
1. Situation update
Grade 2
Cases 2 267
Deaths 195
CFR 9%

WHO continues to support the Ministry of Public Health and other national authorities in Madagascar to monitor and
respond to the outbreak of plague. From 6 to 17 November 2017, 216 cases of plague (1 confirmed, 20 probable and
195 suspect) were reported to WHO. The date of onset of the last case of bubonic plague was 7 November 2017 and
the last confirmed case of pneumonic plague was reported on 14 November 2017.

From 1 August to 17 November 2017, a cumulative total of 2 267 confirmed, probable and suspected cases of plague,
including 195 deaths (case fatality rate 9%), have been reported from 55 of 114 (48%) districts in Madagascar.
Analamanga Region in central Madagascar has been the most affected, with 68% of all recorded cases. Since the
beginning of this outbreak, the vast majority of cases have been treated and have recovered. As of 17 November
2017, only 6 people were hospitalized for plague. There has been no international spread outside the country.

The majority of the reported cases (1 732, 76%) have been clinically classified as pneumonic plague, 327 have been
classified as bubonic plague (14%), one was septicaemic, and 207 have not yet been classified (further classification of
cases is in process). Eighty-one healthcare workers have had illness compatible with plague, none of whom have died.
Of the 1 732 clinical pneumonic cases, 389 (22%) have been confirmed, 612 (35%) are probable and 731 (42%) remain
suspected (additional laboratory results are in process). Thirty isolates of Yersinia pestis have been cultured and are
sensitive to all antibiotics recommended by the National Plague Control Program.

Of the 7 270 contacts identified during this outbreak, about 99% (7166) have completed their 7-day follow up and a
course of prophylactic antibiotics, and eleven contacts have developed symptoms compatible with plague and became
suspected cases. On 17 November 2017, all 33 contacts currently under follow-up were reached and provided with
prophylactic antibiotics.
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