Plague total grows in Madagascar as response builds

The World Health Organization (WHO) said today in an update on Madagascar's plague outbreak that the number of infections as of yesterday has climbed to 684, an increase of 297 cases since its last update on Oct 9.

Also, health officials in Seychelles are closely monitoring 11 people in hospital isolation, a step that follows the announcement 3 days ago of a probable imported case in a man who had traveled to Madagascar.

Of Madagascar's new cases, 197 are pneumonic, putting that total at 474. Twelve more deaths have been reported, lifting that number to 57. The WHO said the latest totals reflect an overall reduction in the case-fatality rate, which over the past few days has dropped from 11.6% to 8.3%.

Outbreak nears 700 cases

Illnesses have now been reported in 35 of Madagascar's 114 districts, 8 more since the previous update, the WHO said. The hardest-hit area is Antananarivo Renivohitra District, a large urban area surrounding the country's capital.

Of the 684 cases, 63 are confirmed, 271 are probable, and 350 are suspected. In addition to the 474 pneumonic cases, 156 are bubonic, 1 is septicemic, and 54 are unspecified.

So far 11 Yersinia pestis strains have been isolated, and tests show that all are sensitive to antibiotics recommended for treatment.

The WHO has said that the overall threat of disease spread within Madagascar is high, while the regional risk is moderate and the overall global risk is low.

Madagascar and its global health partners have scaled up surveillance and contact tracing, and the Pasteur Institute has sent 1,918 rapid diagnostic tests to outbreak hot spots and to the health ministry.

The International Federation of Red Cross and Red Crescent Societies (IFRC) announced today that it is deploying its first-ever plague treatment center in Madagascar. It said the 50-bed facility will include a full medical team, using national health staff to isolate and treat patients sick with plague. It is also releasing about $1 million from its disaster relief emergency fund to scale up the local Red Cross medical treatment capacity.

Fatoumata Nafo-Traore, MD, IFRC regional director for Africa, said in a statement, "Our past experience in outbreak response had underlined the importance of responding quickly and effectively."

Medicine du Monde is setting up five isolation and treatment centers, and Doctors without Borders has deployed 70 people to help support the response in Toamasina, another hot spot that is also Madagascar's main seaport. The WHO has delivered personal protective equipment (PPE) and antibiotics, and the United States Agency for International Development (USAID) has donated PPE and vehicles to help the country's health officials.

Seychelles monitoring, testing more people

In a Facebook update yesterday, the Seychelles Ministry of Health (MOH) said there have been a few more hospital admissions linked directly or indirectly to the initial probable case. One is a foreign national who had not had contact with any other known cases and presented with fever and mild respiratory symptoms on Oct 10, which prompted isolation. The rapid screening test was weakly positive for plague, but the finding hasn't been confirmed yet by the Pasteur Institute.

Yesterday, a 26-year-old woman was transferred to the hospital with symptoms, where she was isolated and put on antibiotics while testing is under way. The ministry said a total of 12 people have been admitted and are receiving treatment as a precaution. One is a child who may have had contact with some children at a school, and health officials will offer the students antibiotic prophylaxis.

Today the MOH said all of the patients, apart from the index case, are stable and are on treatment with no respiratory distress.

More than 320 people who had contact with the imported probable case have been prescribed antibiotic prophylaxis.

Earlier this week, Air Seychelles cancelled all flights to and from Madagascar, and health officials there are isolating everyone entering from Madagascar and are temporarily advising against travel to Madagascar.

The WHO has said it advises against any restriction on travel or trade to Madagascar, is aware of the Seychelles measure restricting travel from Madagascar, and is in contact with authorities to confirm the information and learn the public health rationale and scientific evidence, based on the International Health Regulations.

See also:

Oct 12 WHO situation update

Oct 13 IFRC statement

Oct 12 Seychelles MOH Facebook post

Oct 13 Seychelles MOH Facebook post

Oct 11 CIDRAP News scan "Seychelles reports imported plague in Madagascar traveler"

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