During the month of December, the island nation of Madagascar reported cases of both bubonic and pneumonic plague. Mandritsara, a remote village in northeast Madagascar, reported 20 deaths in a single week in early December. Since September 84 cases and 42 deaths have been reported in 4 of Madagascar’s 112 districts, of which 60 cases were suspected to be pneumonic plague. The affected locations include Mandritsara, Soanierana Ivongo, Ikongo, and Tsiroanomandidy.
Plague, also known as the Black Death, is caused by the bacterium Yersinia pestis. It is typically transmitted to humans through the bite of an infected flea. Fleas from rats and other rodents, such as squirrels, chipmunks, and prairie dogs, can carry and transmit the Yersinia pestis bacteria. The three most common manifestations of plague are bubonic, septicemic, and pneumonic. Bubonic plague is characterized by enlarged lymph nodes called buboes. Septicemic plague is the result of the infection spreading through the bloodstream. Pneumonic plague is the most serious form of the disease and is the only type of plague capable of being transmitted person-to-person, which it does through infected droplets in the air. Thankfully, plague can usually be treated with antibiotics, especially if it is detected early.
While plague isn’t common in many parts of the world, Madagascar reports between 300 and 600 cases per year (80% of the world’s bubonic plague cases). Typically cases are seen between October and March. In 2012, Madagascar reported 60 deaths due to bubonic plague. Prisons have been particularly affected because of overcrowding and rat infestations. An extermination campaign, to rid prisons of rats and fleas, to hopefully prevent future outbreaks has been underway.
The online publication The Week reports concern that the current outbreak could spread to more populated towns and cities due to poor living standards and unsanitary conditions, exacerbated by political unrest ongoing since 2009. With decreased access to antibiotic medication, and living conditions where rodents are often present due to rice crops being stored in homes, many parts of Madagascar are already at heightened risk for outbreaks of plague.
The outbreak in Madagascar should be a concern to all of us worldwide, as antibiotic resistant plague, a mutation of the disease into a less treatable form, has been seen before and could occur again.
Previous Disease Daily reports on plague can be found here.