The outbreak of bubonic plague in Madagascar has been making headlines. People immediately compare it to the Black Death that killed up to 60 percent of Europe’s population in the 14th century. But while the Madagascar outbreak is concerning, the nature of the disease and Madagascar’s ability to treat it should be reassuring. Containment is expected to happen soon. Here are 12 things you didn’t know about the plague in Madagascar, and how the country is dealing with it.
Sources: NYTimes.com, HealthMap.org, NYDailyNews.com, Stuff.co.nz, FoxNews.com, BBC.co.uk, NPR.org
Known as the Black Death, the plague killed 50 million people across Europe, Asia, and Africa during the 1300s. Historic accounts suggest that the disease spread to Europe through biological warfare by the Mongol army. They allegedly catapulted plague-infected cadavers into the Crimean city of Caffa.
According to the World Health Organization, seven countries – Brazil, the Democratic Republic of Congo, Myanmar, Peru, Vietnam, the U.S., and Madagascar – have reported being affected by the plague in some manner “virtually every year” for the last 44 years. In fact, the U.S. records an average of seven plague cases every year. In 2014, four cases were reported in Colorado, believed to have been caused by an infected dog. No fatalities were recorded as a result of the U.S. cases.
Source: Stuff.co.nz
The first case of plague, diagnosed on Aug. 31, 2014, was a man living in a village a two-hour drive (200 kilometers) from the nation’s capital, in a village known as Soamahatamana in the district of Tsiroanomandidy. The man died days after being diagnosed.
Since the Madagascar Health Ministry identified the first case of plague in late August, there have been at least 119 confirmed cases. The nature of collecting information on disease makes it difficult to get a fully accurate number, so there may be more cases. There have been 40 deaths thus far from the outbreak.
On average, Madagascar reports 300-to-600 plague cases per year, 80 percent of the world’s bubonic plague cases overall. The disease reemerged in the country in the 1990s, and is thought to continue to be a problem due to poor health and sanitation. Health and sanitation problems worsened after Madagascar’s coup in 2009. In 2013, Madagascar had a smaller outbreak of plague, recording 20 cases in December. The outbreak was contained quickly, and no deaths were recorded. In 2012, however, Madagascar reported 60 deaths to bubonic plague.
The plague is spread when humans are bitten by fleas carrying the plague bacteria, known as yersinia pestis. The bubonic form of the plague causes enlarged lymph nodes, known as buboes. Once the plague bacteria reach the lungs, they causes pneumonic plague, which is contagious between humans and a much larger concern with regard to containment efforts. Both versions of the plague are treatable with antibiotics if caught early enough.
Health services in Madagascar are working overtime to catch the plague before it spreads to the lungs to limit its contagious capacity. Only 2 percent of the reported cases thus far have been pneumonic plague, while the others have been the bubonic form.
Fleas, the primary spreader of the plague, continue to be a problem in Madagascar. They have developed a resistance to the normal insecticide, known as deltamethrin, used to kill them, making the disease even more problematic to contain.
The plague has been reported in seven regions (including 16 districts) of Madagascar’s 22 regions, but it wasn’t until fairly recently that two cases were reported in the nation’s capital – one of them fatal. According to an official statement from the World Health Organization, the cases in Antananarivo raise “the risk of a rapid spread of the disease due to the city’s high population density and the weakness of the health care system.”
Source: NYTimes.com
The WHO reported that a national task force was set up in Madagascar to help manage the outbreak. The task force project was estimated to cost approximately $200,000 US, and both the Red Cross and Madagascan health authorities are involved.
As the plague is carried by the fleas on rats, health experts have warned that inmates living in Madagascar’s notoriously rat-infested jails are at serious risk of contracting the disease. An extermination campaign to rid prisons of rats and fleas has been underway, with the hope of preventing future outbreaks.
Due to the low incidence of pneumonic plague — the more contagious version of the disease — the World Health Organization has not recommended any travel or trade restrictions be placed on Madagascar at this time. Containment efforts have been stepped up, and the country hopes to have this latest outbreak stopped as quickly as possible.