Madagascar: 2021 Plague

[Shiloh]

Source: https://www.precisionvaccinations.co...e-turns-deadly

Madagascar's Pneumonic Plague Turns Deadly
September 11, 2021 • 10:20 am CDT
(Precision Vaccinations)

According to the European Centre for Disease Prevention and Control (ECDC) report issued on September 10, 2021, thirty cases of pneumonic plague have been reported in the Republic of Madagascar.

Pneumonic plague is one of several forms of plague and is endemic in Madagascar.

The WHO previously confirmed seven cases have been fatal, all of them in the municipality of Miandrandra.

Madagascar's last major plague outbreak was in 2017, which resulted in 209 deaths; these were classified as pneumonic plague...

[Okieman]

Here is the FluTrackers thread for the 2017 Pneumonic Plague outbreak in Madagascar:

Madagascar - Plague outbreak 2017-18

https://flutrackers.com/forum/forum/...tbreak-2017-18

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Plague 2021: Scientists Recorded Person-to-Person Transmission of Drug-Resistant Yersinia Pestis

By Rain Jordan Aug 16, 2021 11:12 PM EDT

snip

Antimicrobial Resistance


"A spontaneous point mutation has rendered the [antimicrobial resistance] AMR strain from this epidemic resistant to streptomycin, although it is still susceptible to many other antibiotics, including co-trimoxazole. Fortunately, all 19 instances were treated with co-trimoxazole in addition to streptomycin, and they all lived."

There has previously been evidence of antimicrobial-resistant plague. For example, in 2017, scientists reported the case of a 16-year-old boy in Madagascar who was infected with Y. pestis bacteria that was discovered to be resistant to eight popular antibiotics, including streptomycin, used to treat the infection. This is the first time, however, that experts have found evidence of person-to-person transfer.

snip

https://www.natureworldnews.com/arti...nia-pestis.htm

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Another FluTrackers thread:

Study: Transmission of Antimicrobial Resistant Yersinia pestis During a Pneumonic Plague Outbreak

https://flutrackers.com/forum/forum/...lague-outbreak

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Okieman Comment: We often tend to think of Plague as being primarily a major concern from the past since antibiotics can be used to treat it now. But, if a antibiotic resistant strain of Pneumonic Plague arises and gets out of Madagascar during this Covid Pandemic then we may have a world of hurt start up.

[Okieman]

Plague appears to be a seasonal thing in Madagascar between September and April. What is concerning to me is Pneumonic Plague spreading at the same time as Covid. Here is the symptoms for Pneumonic Plague:

With pneumonic plague, the first signs of illness are fever, headache, weakness, and rapidly developing pneumonia with shortness of breath, chest pain, cough, and sometimes bloody or watery sputum.

And here is a short description:

• Pneumonic plague occurs when Y. pestis infects the lungs. This type of plague can spread from person to person through the air. Transmission can take place if someone breathes in aerosolized bacteria, which could happen in a bioterrorist attack. Pneumonic plague is also spread by breathing in Y. pestis suspended in respiratory droplets from a person (or animal) with pneumonic plague. Becoming infected in this way usually requires direct and close contact with the ill person or animal. Pneumonic plague may also occur if a person with bubonic or septicemic plague is untreated and the bacteria spread to the lungs.

Both of these quotes are from this CDC factsheet: https://emergency.cdc.gov/agent/plague/factsheet.asp

[Pathfinder]

Translation google

Pulmonary plague: Four deaths including one confirmed case in Ambalavao

Redaction Midi Madagasikara September 13, 2021

The plague season has only just started but pulmonary plague has claimed yet another victim in Ambalavao. Within days, the disease killed eight people in two districts.

The pulmonary plague reappears . One person succumbed to this disease again in Ambalavao district, Haute Matsiatra region, according to the report of the Ministry of Public Health. The Director General of Preventive Medicine (DGMP), Dr Fidy Randriatsarafara, also announced the death of three other people who are none other than relatives of the victim. "They are people from the same family but one of them was confirmed to have died of pulmonary plague," he explained. The circumstances under which the victims contracted the disease remain unclear. With the seven deaths recorded in the municipality of Miandrandra, district of Arivonimamo last month, the number of deceased has thus risen to eight.

Care . Faced with the increase in deaths linked to the plague, Dr Fidiniaina Randriatsarafara called for vigilance and the prevention of this disease. He urged people who show suspicious signs to go to health centers or hospitals as soon as possible because drug care is free. "Pulmonary plague can be transmitted from person to person via tiny droplets of saliva emitted in the event of a cough, for example, which is why it is always advisable to wear masks and to wash your hands with soap. It manifests itself by a high fever, fatigue, headaches or buboes for bubonic plague ”, he stressed. To break the chain of transmission of this disease, patients are not allowed to seek treatment at home, as was already the case for plague sufferers from Arivonimamo. They cannot return to their homes until the ten days of treatment have been completed. In this period when the plague season coincides with the exhumation ceremonies, vigilance is always in order because this ritual can be a factor of transmission of the plague if ever the exhumed bodies have contracted this disease.

Narindra rakotobe

http://www.midi-madagasikara.mg/societe/2021/09/13/peste-pulmonaire-quatre-deces-dont-un-cas-confirme-a-ambalavao/

[Pathfinder]

WEEKLY BULLETIN ON OUTBREAKS
AND OTHER EMERGENCIES

Week 37: 6 - 12 September 2021
Data as reported by: 17:00; 12 September 2021
...
Pneumonic Plague Madagascar

30 Cases
7 Death
23.0% CFR

EVENT DESCRIPTION

Health Authorities in Madagascar received an alert of plague
on 29 August 2021, from the local administrative authorities of
Miandrandra, Arivonimamo district, in the Itasy region. The case was
a 23-year-old male resident of Ankararana village in the Miandrandra
community. He had an onset of illness on 23 August 2021, and later
sought medical care at the Miandrandra health center on 29 August
2021 while presenting with symptoms suggestive of pulmonary
plague (fever, headache, weakness shortness of breath, chest pain,
cough, and bloody or watery sputum).

On 31 August 2021, the preliminary results of the investigation
showed a total of 30 suspected cases of pulmonary plague,
including seven deaths (four community deaths and three health
facility-based), giving a case fatality ratio of 23%. Twenty laboratory
samples (12 blood and eight sputum) were collected and sent to the
Pasteur Institute of Madagascar for analysis. Of these 20 samples,
12 (60%) were PCR positive, confirming the outbreak of pneumonic
plague in the country.

The average age of cases is 39.6 years, with a male to female sex
ratio of 1.1. The peak of suspected cases reported was observed on
29 August 2021, with 9 cases reported in a single day. A cumulative
total of 916 contacts have been identified and are currently
monitored, all of them received chemoprophylaxis.

All the reported cases were geographically located in three
communities of Arivonimamo district (Ampahimanga, Manalalondo
and Miandrandra). Itasy region is a densely populated area and has
regularly been one of the most affected regions during previous
plague outbreaks. Arivonimamo district is located at only 51 km
from Antananarivo, the capital city of the country and traffic is
intense between those two areas. In 2017, Madagascar faced a
large-scale pneumonic plague outbreak that affected endemic and
non-endemic areas, including large urban centers like Antananarivo
and Toamasina.

PUBLIC HEALTH ACTIONS

The Ministry of health response team conducted a field
mission to the affected areas for an in-depth epidemiological
investigation as well as to support local investigation teams.
Plague control committees were activated in the affected
areas. Vector control and anti-reservoir rodent control through
environmental sanitation activities are underway.

Management of reported cases at healthcare facilities is
ongoing.

Collection of specimen samples is ongoing with rapid diagnostic
tests and shipment of samples to the Pasteur Institute of
Madagascar for further analysis and confirmation.

Teams are conducting active case finding, listing contacts and
administering chemoprophylaxis to high-risk contacts.

Sensitization of the population on plague prevention measures
in the affected areas.

SITUATION INTERPRETATION

Plague is endemic in Madagascar and cases are reported each
year in bubonic and pulmonary forms. The annual season for
increased disease transmission is between September and April
and an increase in the number of cases is expected in the coming
weeks. The risk of spread for the current outbreak to other
areas of the country, especially urban centers, is high, taking
into account the proximity of the affected areas to the country’s
capital and the frequent population movement. Though the
country has experience in managing and coordinating outbreak
response, having responded to multiple outbreaks in the past,
the existence of other concurrent health emergencies such as
COVID-19 and the humanitarian crisis (food and nutrition crisis
in the great South) in the country hamper the health system’s
ability to effectively cope with the health challenges being faced
in the country.

PROPOSED ACTIONS

It is essential that Madagascar builds on good practices that
led to the successful management of previous outbreaks and
taking into consideration some key actions recommended then.
Actions should include early identification and rapid elimination
of infection sources including vectors, and protecting health
workers by training them on infection prevention and control
measures. Health workers who are in direct contact with
pneumonic plague cases should use recommended protective
measures and take antibiotic chemoprophylaxis. Surveillance
activities should be strengthened to identify and monitor new
cases and contacts. Risk communication and community
engagement activities should be performed during and after the
outbreaks.

https://apps.who.int/iris/bitstream/handle/10665/345180/OEW37-0612092021.pdf

[Shiloh]

Source: https://www.who.int/emergencies/dise...e---madagascar

Plague - Madagascar
1 October 2021

On 29 August 2021, the Public Health, Epidemiological Surveillance and Response Department of the Ministry of Health, Madagascar received an alert from Arivonimamo health district, Itasy region, regarding a suspected community death and 15 suspected cases of pneumonic plague that occurred in the municipality of Miandrandra. All the cases presented with fever, headache, weakness, shortness of breath, chest pain and cough. Plague is endemic in Madagascar and outbreaks occur regularly, although every outbreak is cause for concern. Furthermore, pneumonic plague is a notifiable disease under the International Health Regulations 2005.

By the following day, 30 August, 25 suspected cases of pneumonic plague had been notified to the health authorities from Arivonimamo district, Itasy region, including six deaths (three community deaths and three at Miandrandra health facility), 19 of which were admitted at Miandrandra health facility for treatment. A total of 20 samples (8 sputum and 12 blood) were collected the same day for laboratory confirmation at the Pasteur Institute of Madagascar.

As of 15 September 2021, a total of 20 suspected and 22 confirmed cases of plague have been notified. The median age of cases is 36 years (range 3 to 74 years), 22 cases are males and 20 are females. Reported cases are geographically located in two non-bordering regions: Itasy (3 affected municipalities in Arivonimamo district) and Haute Matsiatra (1 affected municipality in Ambalavao district). Both regions are known plague endemic areas, and during the 2017 outbreak they were highly affected with Ambalavao being the main epicenter.

Among confirmed cases, 19 have clinically presented as pneumonic plague and three as bubonic plague. Eight deaths occurred among confirmed cases (2 among bubonic plague cases and 6 among pneumonic plague cases) leading to a case fatality ratio of 37% (8/22). Of them, 4 were males and 4 females, 3 occurred in the community level and 5 at health facilities.

Overall, 1,064 close contacts of cases have been identified, followed up, and received chemoprophylaxis with cotrimoxazole or doxycycline. Active case finding in the communities was undertaken in all the health districts reporting cases. Health authorities, in collaboration with the Pasteur Institute of Madagascar, carried out animal surveillance in Arivonimamo district during the initial investigation on 30 August. Preliminary results showed a carriage of Yersinia pestis, the causative bacterium, in 1.3% of the rats, exceeding the alert threshold of 1%, while the pulicidal index (the ratio between the total number of fleas collected from rats captured over the total number of rats captured) was 1.7, which did not exceed the alert threshold of more than 5. Analyses were also performed in Faratsiho (Vakinakaratra region) and Besarety (Analamanga region), which are part of the endemic regions, resulting in a pulicidal indexes at 3.1 and 3.2, respectively.

Public health response


Interventions against pneumonic plague outbreaks are carried out by the local teams at the community level under the supervision of the district and regional teams. These teams are supported by the central level of the Ministry of Health, the Pasteur Institute of Madagascar and a number of partners including WHO. The following are actions taken and activities carried out for the management and control of this outbreak:
Diagnosis and case management:

• Collection of samples from suspected cases; use of rapid diagnostic tests; shipment of samples for further analysis and confirmation to the Pasteur Institute of Madagascar
• Management of reported cases in healthcare facilities
• Training of health workers on the management of plague cases

Coordination:

• Activation of plague control committees in areas that have notified cases

Epidemiology and surveillance:

• Active case finding, active search for close contacts with subsequent chemoprophylactic management using cotrimoxazole as first-line and doxycycline in case of contraindication to sulphonamides
• Strengthening of community surveillance and surveillance at the level of health facilities
• Animal surveillance

Preventative measures:

• Disinfection of the homes of affected people: spraying the households of cases with HTH (calcium hypochlorite) solution as a disinfectant
• Vector control and anti-reservoirs measures

Community engagement:

• Sensitization of the population on plague prevention measures in the affected areas, what symptoms to monitor for, and when to seek care in health facilities...