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Madagascar: Plague Outbreak - Sep 2017

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On 13 September 2017, the WHO was notified of an outbreak of pulmonary plague in Madagascar. The outbreak was detected on 11 September 2017. As of 14 September 2017, a total of 28 cases, including five deaths (case fatality rate 17.8%) have been reported since the initial case was detected on 27 August 2017. Two cases have been confirmed by rapid diagnostic test (RDT) at the Institut Pasteur de Madagascar (IPM). Thus far the outbreak is localized in Tamatave and Faratsiho in Vakinankaratra Region (100km southwest of Antananarivo). (WHO, 15 Sep 2017)

By 28 September, there were 104 cases of which 52 were confirmed pneumonic plague with 20 deaths (19.23% case fatality rate).The outbreak affected the densely populated cities in Madagascar that include Antananarivo/Analamanga with 3,724,021 inhabitants, Tamatave/ Atsinanana with 1,412,021 inhabitants, Majunga /Boeny with 889277 inhabitants, and Finanrantsoa /Haut Matsuartra with 1,333,550 inhabitants.(WHO, 29 Sep 2017)

As of 30 September, 10 cities have reported pneumonic plague cases and the three most affected districts include: the capital city and suburbs of Antananarivo (27 cases, 7 deaths), Toamasina (18 cases, 5 deaths), and Faratshio (13 cases, 1 death). (WHO, 2 Oct 2017)

From 1 August to 24 November 2017, a cumulative total of 2 384 confirmed, probable and suspected cases of plague, including 207 deaths (case fatality rate 9%), have been reported from 57 of 114 (50%) 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 24 November 2017, only 11 people were hospitalized for plague. There has been no international spread outside the country. (WHO, 27 Nov 2017)

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, 04 Dec 2017)

By the end of April 2018, some 2,671 cases of the plague had been recorded since the first case of the plague season was reported in August 2017, including at least 239 deaths. Although the plague is endemic in Madagascar, the number of cases in the 2017-2018 season is at least six times the annual average of around 400 cases, the outbreak began earlier than usual, and the predominance of pneumonic plague in urban areas this season differs from the usual trend of bubonic plague in rural areas. Since the official announcement of the containment of the urban pneumonic plague outbreak on 27 November 2017, 194 cases of plague, bubonic (60) and pneumonic (128), have been reported, including 23 deaths. The current plague season is expected to end in April 2018, with the future plague season due to start in September 2018. (OCHA, 26 Apr 2018)