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Madagascar - Plague outbreak 2017-18

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  • #46
    Source: http://www.independent.co.uk/news/wo...-a8072246.html


    Madagascar plague death toll hits 195 as outbreak reaches 'crisis' point
    More than 2,220 people have now been infected as experts struggle to stop the disease spreading

    Ben Kentish
    Thursday 23 November 2017 17:08 GMT
    The Independent Online


    The death toll from plague in Madagascar has risen to 195 as experts warn the outbreak of the disease has reached crisis point.

    A total of 2,267 people have now been infected by the illness since the outbreak began in August, according to the World Health Organisation ? a jump of three per cent in recent days.

    Experts fear the bacteria that cause the plague could become resistant to antibiotics as a result of doctors over-subscribing medication in a bid to control the spread of the illness - potentially creating a strain of plague that is far more difficult to treat.

    The outbreak is thought to be the worst in 50 years and scientists fear it could spread to mainland Africa and beyond.

    The current spread of the disease is unusual in that most of those affected have had the pneumonic form of plague, which affects the lungs and can kill within 24 hours. It can be transmitted through the air via coughing and sneezing and so spreads easily...

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    • #47
      Source: http://www.who.int/csr/don/27-novemb...madagascar/en/
      Plague ? Madagascar

      Disease outbreak news
      27 November 2017

      From the 1 August through 22 November 2017, a total of 2348 confirmed, probable and suspected cases of plague, including 202 deaths (case fatality rate 8.6 %), were reported by the Ministry of Health of Madagascar to WHO. There were 1791 cases of pneumonic plague, of which 22% were confirmed, 34% were probable, and 44% were suspected. In addition to pneumonic cases, there were reports of 341 cases of bubonic plague, one case of septicaemic plague and 215 cases with type unspecified.
      Figure 1: Number of confirmed, probable and suspected plague cases in Madagascar reported by date of illness onset from 1 August through 22 November 2017




      In total, 81 healthcare workers have had illness compatible with plague, none of whom have died.
      Since the beginning of the outbreak, cases of pneumonic and bubonic plague have been detected in 55 out of 114 districts (48%), including non-endemic areas and major cities. Analamanga Region has been the most affected, with 68% of the cumulative reported cases.
      Figure 2: Geographical distribution of confirmed and probable pneumonic plague cases in Madagascar from 1 August through 22 November 2017




      Figure 3: Geographical distribution of confirmed and probable bubonic plague cases in Madagascar from 1 August through 22 November 2017




      All contacts identified (7289) during this outbreak have completed their course of prophylactic antibiotics. Eleven contacts developed symptoms compatible with plague and were classified as suspect cases. All contacts had completed their follow up.
      The Institut Pasteur Madagascar has cultured 33 isolates of Yersinia pestis, which were all sensitive to the antibiotics recommended by the National Program for the Control of Plague.
      Plague is endemic in some areas of Madagascar and additional cases of plague may occur, at least until the end of the plague season in April 2018. It is therefore important that control measures continue through the end of the plague season.
      Public health response

      The Ministry of Public Health of Madagascar is coordinating the response, with the support of WHO, the Institute Pasteur Madagascar, and other agencies, stakeholders, and partners.
      The Ministry of Public Health of Madagascar activated crisis units in Antananarivo and Toamasina to coordinate the outbreak response efforts.
      All cases and contacts have been provided treatment or prophylactic antibiotics at no cost to themselves.
      The public health response measures have included:
      • Strengthened epidemiological surveillance in the all affected districts, and enhanced case finding
      • Rapid investigation of new cases
      • Sample collection, referral and testing
      • Isolation and treatment of all pneumonic cases, as well as treatment of bubonic cases
      • Active finding, tracing and monitoring of contacts and provision of free prophylactic antibiotics
      • 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.

      WHO has coordinated and mobilised regional and global partners in the Global Outbreak Alert and Response Network (GOARN) to support the outbreak response and will continue work with partners to ensure further rapid response support as needed.
      Working together, the Ministry of Health, WHO, GOARN, and other partners have trained more than 1800 community health workers for contact tracing, about 300 doctors as contact tracing supervisors and has established rapid response teams for case investigation. The IFRC, UNICEF and USAID have supported case management, including establishment of plague treatment centres. Laboratory confirmation of plague cases is conducted by the Institute Pasteur of Madagascar (IPM). WHO and IPM established a system for specimen collection and referral from peripheral areas to the IPM laboratory to strengthen laboratory capacity for testing and confirmation.
      Enhanced measures for exit screening have been implemented at the International Airports in Antananarivo and Nocib?, to avoid the international spread of pneumonic plague cases. These measures included: 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), provided technical support at the airport to establish exit screening. WHO and partners will support the MOH to re-evaluate the need for continuity of the exit screening and will implement appropriate recommendations.
      Nine countries and overseas territories in the African region (Comoros, Ethiopia, Kenya, Mauritius, Mozambique, La R?union (France), Seychelles, South Africa, and Tanzania) had been identified as priority countries for plague preparedness and readiness by virtue of their trade and travel links to Madagascar. These countries have been 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 will support these countries to integrate the plague preparedness and operational readiness activities into their overall multi-hazard preparedness and readiness functions.
      WHO risk assessment

      No new cases of confirmed bubonic plague have been notified after 8 November 2017 and no new cases of confirmed pneumonic have been notified since 14 November 2017. All contacts finished follow up on 19 November 2017. However, plague in Madagascar is seasonal and WHO expects additional reports of cases. It is therefore important for the Ministry of Health, WHO, and partners to sustain prevention and response activities until April 2018. A longer term strategy will be needed for plague prevention, preparedness, and response.
      Based on the current epidemiology and response capacity, WHO estimates the risk of plague at the national level is moderate. The risk at the regional and global levels is low.
      WHO travel advice

      To date, there are no reported cases related to international travel. WHO advises against any restriction on travel or trade on Madagascar. WHO recommends that travel measures put in place by neighboring countries in relation to this outbreak be discontinued, given the containment of the pneumonic plague outbreak.
      International travellers arriving in Madagascar should be informed that plague is endemic in Madagascar, and about the recent plague outbreak. 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.
      Following the visit of the Secretary General of the World Tourism Organization (UNWTO) on 3 November, the UN body expressed confidence on tourism in Madagascar and echoed the WHO advice against any travel or trade restrictions against Madagascar1.
      Information on Plague situation in Madagascar is published on weekly basis and is available at:

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      • #48
        Source: https://reliefweb.int/report/madagas...-december-2017
        Madagascar Plague Outbreak: External Situation Report #14 - 4 December 2017

        Report

        from World Health Organization Published on 04 Dec 2017 ? View Original


        Download PDF (1.4 MB)


        Due to concerted national and international response the current and unprecedented outbreak of plague in Madagascar, which started on 1 August 2017, has been contained.
        On Monday, 27 November the Ministry of Health of Madagascar officially announced the containment of the acute urban pneumonic plague outbreak. However, because plague is endemic in Madagascar and the plague season lasts from September to April, more cases of bubonic and sporadic pneumonic plague are expected to be reported until April 2018.
        WHO and other stakeholders will continue to support the Ministry of Health of Madagascar to maintain vigilance and to sustain a strong alert and response system to rapidly detect and respond to new plague cases as they emerge.
        From 20 to 26 November 2017, 72 cases of plague (1 confirmed, 6 probable and 65 suspect) were reported to WHO...

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        • #49
          Translation Google

          Ankazobe: Bubonic plague resurfaces

          Midaction Midi Madagasikara 18 January 2018

          The plague struck again. An ECAR cook from Ankazobe District contracted the disease this week.

          "The plague season is not over yet." A sentence that makes sense when you learn that a person has contracted bubonic plague in the district of Ankazobe. Asked about the issue, a source from the Ministry of Public Health to say that "the appearance of plague at the cook Ankazobe ECAR was observed this week". The source added that "response actions have been directly led by Public Health officials on the scene". Among others, the immediate care of the plague victim, disinfection and disinsection actions of the ECAR domain in question (two classrooms and other rooms). This, to "contain a possible spread of the disease" according to always our source. The situation has, however, alerted the local population as the district is one of the plague foci on the Big Island. A fact which - added to the plague season which follows its course - makes the appearance of bubonic plague not surprising.

          Recall. It should be noted that the statistics recorded during the mid-term review of the epidemic show more than 2,417 cases in all forms. The latest statistics also demonstrate that the outbreak caused more than 200 deaths (reported figures between August and end of November 2017). In addition to the facts that marked the epidemic, the hunt for plague victims observed in all regions of the country, the race Cotrim and masks preceded by a wave of panic that has more than shake the cities concerned. The episodes of unrest were then followed by the "plague holiday" which forced many schoolchildren, middle and high school students from the regions concerned to interrupt classes for five weeks. In addition, while reference is still made to the report of the mid-term review workshop of December 2017, "13 rural districts are still affected by bubonic plague". The recent case observed tends to confirm this statement. Faced with this new appearance of plague cases, review the advice and preventive principles to follow is more than recommended.

          Jos? Belalahy

          "Safety and security don't just happen, they are the result of collective consensus and public investment. We owe our children, the most vulnerable citizens in our society, a life free of violence and fear."
          -Nelson Mandela

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          • #50
            Translation Google

            Public health - The burial of plague victims changes

            13.03.2018 | 5:35 News, Social0

            The plague victims may be buried in their ancestral land. Burial is conditional.

            Change. The burial of plague victims following the Malagasy funeral traditions is now possible. The protocol for the funeral worthy and secure (EDS) was validated yesterday the Golden Peacock, attended by Minister of Health, Professor Mamy Lalatiana Andriamanarivo, the representative of the World Health Organization ( wHO), Professor Charlotte Ndiaye, heads of districts and medical inspectors who are required to comply with the protocol.

            From now therefore, if a person dies of the plague, his family can give him a funeral before and bury him in his native land. The DHS, however, requires special measures, knowing that the plague bacterium continues to live in the body of a deceased person and develops in the tomb. This protocol emphasizes, among other things, grooming and disinfection of the body are performed by a team of four, already trained for funerals. They are also involved dressing the body. The body must be placed in a body bag, previously disinfected before being wrapped in shrouds. He was immediately placed in a sealed coffin, to be sure. The funeral standby should not exceed two days after the death.

            Unbury

            For transporting the body to the native village, he must be placed in a double-walled zinc coffin and sealed timber labels with "Opening Prohibition." But it will be placed in a pit, separated from the family vault, where the surface part is cemented. His exhumation is banned for 7 years.

            The family supports all transportation expenditures. The equipment will be available, says Professor Mamy Lalatiana Andriamanarivo. International scientific teams were mobilized to achieve this, a very important detail for the Malagasy population.

            The former burial process the plague has complicated the fight against the plague that raged in the city of Antananarivo and Toamasina, in September and October 2017. Several families refused the burial of their relatives outside the family tomb . Bodies were even stolen in Toamasina and Antananarivo. Families have not accepted losing their families in mass graves. There are those who dug up the body of their family in these pits.

            Miangaly Ralitera

            "Safety and security don't just happen, they are the result of collective consensus and public investment. We owe our children, the most vulnerable citizens in our society, a life free of violence and fear."
            -Nelson Mandela

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            • #51
              Revamp of the plague detection in Madagascar yields quick and sustainable wins

              13 March 2018
              WHO has implemented drastic changes in plague detection in Madagascar that led to rapid decline in severity and scope of the outbreak, until it was declared over in late November 2017. The time between sample collection and laboratory analysis was reduced from days to just a few hours, significantly improving survival and reduction of complications in those infected.
              WHO



              During the acute phase of the plague epidemic, Mr Jose Rovira Vilaplana (WHO) and Dr Fanny Chereau (GOARN), were responsible for improving the laboratory response, encompassing collection and transportation of biological samples, development of support plan for implementation of diagnostic strategy, including traceability of samples, resupplying the Rapid Diagnostic Tests and training of couriers.
              ?Given the rapid incubation period of pneumonic plague and the possibility of death within 2-4 days, it is essential to be able to obtain laboratory diagnosis as quickly as possible,? said Jose Rovira Vilaplana, WHO. ?In Madagascar, each suspected case of plague must be clinically confirmed by the Laboratoire Central Peste (LPC), a WHO Collaborating Centre for plague control and research.?
              WHO
              Mr Jose Rovira Vilaplana, WHO (second from left) and Dr Fanny Chereau, GOARN (first from right)



              Overcoming challenges at hand

              Between 1 August and 22 November 2017, the Madagascar Ministry of Public Health reported a total 2348 cases, including 202 deaths. The outbreak was hitting densely populated urban areas, including the capital Antananarivo. On the busiest days, up to 250 samples were sent to the laboratory for confirmation. There was not enough capacity on all fronts to handle such an unexpected and unprecedented demand.
              WHO together with the national health authorities and partners worked rapidly to identify the gaps and to acquire the necessary resources to turn the tide.
              ?Everyone was working seven days a week and overtime,? said Jose Rovira Vilaplana, WHO.
              WHO
              Mr Jose Rovira Vilaplana, WHO explains to couriers how to handle infectious substances.



              A local courier company using motorbikes was hired to facilitate the implementation of the response using dedicated bikes with safe and secure containers. Couriers were trained to handle infectious substances, including temperature control and documents associated with the samples. A robust schedule of bi-daily trips was established to reduce the time between sample collection and laboratory analysis from days to just a few hours. 24-hour emergency system was put in place to collect and transport post-mortem samples, and traceability of these samples was improved 100%. In addition, a mobile laboratory was set up in Tamatave to reinforce the diagnostic capacity at regional level.
              WHO



              Keeping up the good work

              However, the plague season is not over just yet. Improved systems that were put in place during the height of the outbreak should now be used for sustained detection and response to identify new cases that are expected until the end of the plague season in April 2018.
              WHO



              Plague occurs seasonally in Madagascar, usually between September and April each year. Once the 2018 season ends, WHO will work with the Ministry of Public Health in Madagascar to carry out an after action review to identify best practices and standard operating procedures for the coming years.
              ?We assist countries in building systems that can be self-sustainable and can be used for detection of any infectious disease,? said Jose Rovira Vilaplana, WHO. ?The systems we put in place during outbreaks should be sustained at all times, even if at bare minimum, but with the capacity to expand when needed.?

              http://www.who.int/csr/disease/plagu...madagascar/en/

              "Safety and security don't just happen, they are the result of collective consensus and public investment. We owe our children, the most vulnerable citizens in our society, a life free of violence and fear."
              -Nelson Mandela

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