In August 2017, Madagascar began experiencing a large outbreak of plague affecting major cities and other non-endemic areas. By the end of October 2017, a total of 1801 confirmed, probable and suspected cases of plague, including 127 deaths, were reported by the Ministry of Health of Madagascar to the World Health Organization (WHO), and 51 of 114 of Madagascar's districts were affected. WHO was producing new outbreak reports every few days.
Historically, plague was responsible for widespread pandemics with high mortality. It was known as the "Black Death" during the fourteenth century, causing more than 50 million deaths in Europe. Nowadays, plague is easily treated with antibiotics and the use of standard precautions to prevent acquiring infection. In recent history, it is interesting to note that from 2010 to 2015 there were 3248 cases reported worldwide, including 584 deaths.
Plague is an infectious disease caused by the bacteria Yersinia pestis, a zoonotic bacteria, usually found in small mammals and their fleas. It is transmitted between animals from their fleas. Humans can be contaminated by the bite of infected fleas, through direct contact with infected materials or by inhalation. There are two main clinical forms of plague infection: bubonic and pneumonic. Bubonic plague is the most common form and is characterized by painful swollen lymph nodes or 'buboes'.
Plague can be a very severe disease in people, particularly in its septicemic and pneumonic forms, with a case-fatality ratio of 30%-100% if left untreated. The pneumonic form is almost always fatal unless treated early. It is especially contagious and can trigger severe epidemics through person-to-person contact via droplets in the air.
It should also be mentioned that plague is considered a possible agent for use in a bioattack.
As the threat of plague may be on the horizon for many other countries, SBC efforts will be expanded to address cultural practices and norms, help inform the public about how to avoid becoming infected, signs of infection, and treatment options. Health officials will need to focus on strategies for prevention and treatment; service providers will need to be educated about the threat, how to detect the illness, how to counsel patients, and how to report cases to the proper authorities.
In this Trending Topic we present several tools and basic communication materials to help in these efforts.
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Banner photo: A father and son in Madagascar, where a plague outbreak occurred in August 2017: © 2014 Mohamad Syar/CCP , Courtesy of Photoshare