WHO briefing notes on plague

Pneumonic plague has been detected in several cities in Madagascar since August 2017. It is a form of plague that is highly transmissible and quickly causes death without treatment. Contrary to past outbreaks of plague, this one affects large urban areas, including the capital and port cities.

The overall risk of further spread at the national level is high, at the regional level is moderate due to frequent flights to neighbouring Indian Ocean islands, and at the global level is low.

KEY MESSAGES

WHO is rapidly scaling up its response to an outbreak of plague in Madagascar that has spread to the capital and urban areas, infecting more than 100 people in just a few weeks. From 1 August to 1 October, 133 cases[1] and 24 deaths – 73 of which were pneumonic plague – have been reported from 19 health districts.[2]

WHO is concerned that plague could spread further because it is already present in several cities and this is the start of the epidemic season, which usually runs from September to April. The outbreak is affecting Antananarivo, Toamasina and Mahajanga, as well as other areas. Antananarivo is the capital with more than 2 million inhabitants, and the latter two are port towns.

Pneumonic plague can kill quickly, 18-24 hours of disease onset if left untreated, but common antibiotics can effectively cure it if they are delivered early. Most people will recover if they are treated in time. Because the window is short (typically 12 to 24 hours), people with respiratory symptoms who are in an affected area or who suspect they have been exposed should go to their health center immediately for treatment. Treatment is being provided for free.

The risk of international spread is assessed to be low. WHO advises against any restriction on travel or trade on Madagascar.

WHO teams are on the ground in Madagascar providing technical guidance, conducting assessments, supporting disease surveillance, and engaging with communities. We are doing everything we can to support the Government’s efforts, including by coordinating.

Further deployments of WHO staff and through response partners in the Global Outbreak Alert and Response Network (GOARN) are underway, as well as increased supplies of antibiotics, personal protective equipment and other supplies. WHO has released US$450,000 in emergency funds, as well as critical supplies, to quickly scale up operational efforts, and is appealing for US$1.5 million to support the response.

Plague is endemic to Madagascar, where around 400 cases of – mostly bubonic – plague are reported annually.[3] Contrary to past outbreaks, this one is affecting large urban areas and port cities, which increases the risk of person-to-person transmission. The number of cases identified thus far is higher than expected for this time of year.

Bubonic plague is spread by infected rats via flea bite, pneumonic by person-to-person transmission. The current outbreak includes both forms of plague, and nearly 55% of all cases identified are pneumonic.  People suspecting plague, especially if in connection to a cluster of deaths or death of rats, are advised to alert health authorities immediately and go to a health centre.

The last reported outbreak in December 2016 was mainly bubonic plague occurring in remote areas. It infected 68 people and caused 27 deaths.

Original source: WHO.
Posted on 3 October 2017