Madagascar wins plague war

With the number of new pneumonic plague cases reportedly decreasing in Madagascar, there is caution to be “too optimistic” about the news due to the vast amount of resources required to control the outbreak.

“We are still obviously aware that there may be a chance that someone comes back with the plague. That’s the scenario that we are prepared for,” South Africa’s National Institute for Communicable Diseases’ Professor John Frean said.

“But the risk is decreasing in Madagascar. The latest figures I have from the WHO (World Health Organisation) show very clearly the epidemic curve has come right down.With this being good news for now, the plague however is not over yet.

“The WHO is cautious about being too optimistic because there are resource issues. A huge amount of effort has gone into this in terms of controlling and limiting the extent of the spread in Madagascar,” said Frean.

“So the Madagascan health authorities and everyone else who is assisting are not saying it’s over yet. There are still concerns about maintaining the momentum because of the enormous resources required.”

Since August 1 to October 30, a total of 1 801 suspected cases of plague, including 127 deaths, have been reported. This amounted to a case fatality rate of 7%. Of these cases, 1 111 were clinically classified as pulmonary plague, 261 were bubonic plague, one was septicaemic, and 428 were unspecified.

All isolates of the Yersinia pestis bacterium – which is carried by rat fleas and thus infecting humans – have been susceptible to the recommended antibiotics.

Frean added that for any ordinary traveller to Madagascar, the risk of infection has always been low.

“The average tourist or businessperson is unlikely to be at much risk. Travellers from Madagascar are far more likely to contract malaria or gastroenteritis. And there has been no confirmed cases of plague in travellers leaving Madagascar to other countries.

“There has been one suspect case going to the Seychelles, but that has not been confirmed by laboratory tests. So, at this point, we are not aware of any spread outside of Madagascar.”

People should also not panic as the WHO further pointed to a “moderate risk” for certain countries in the region that have direct links with Madagascar – South Africa being one of them.

“The risk of regional spread is moderate due to the occurrence of frequent travel by air and sea to neighbouring Indian Ocean islands and other southern and east African countries,” said the NICD.

“The risk of international spread is mitigated by the short incubation period of pneumonic plague, implementation of exit screening measures and advice to travellers to Madagascar, and scaling up of preparedness and operational readiness activities in neighbouring Indian Ocean islands and other southern and east African countries, including South Africa. The overall global risk is considered to be low.”