Good news: Madagascar hasn’t seen a new plague case in 3 weeks

Of all the public health stories I’ve covered in the past few years, the plague epidemic that’s been brewing in Madagascar since the summer frightened me most.

While the Indian Ocean island battles plague outbreaks every year, this one, which began about four months ago, was much larger than usual — spreading to more than 2,000 people in the capital and other cities. It also involved pneumonic plague, a rare and more dangerous form of the disease that attacks the lungs and passes from person to person through droplets from coughing.

Untreated pneumonic plague is always deadly, typically within 24 hours of disease onset — unless you’re lucky enough to get antibiotics in time.

But it now seems like Madagascar is turning a corner, according to the World Health Organization. “The number of new cases and hospitalizations of patients due to plague is declining in Madagascar,” the agency reported this week.

A potential global health disaster appears to be averted, at least for now, thanks to basic public health measures — and a few lessons learned from the infamous 2013–’16 Ebola epidemic.
Number of confirmed, probable, and suspected plague cases in Madagascar reported by date of illness onset from August 1 through November 10, 2017. World Health Organization
The WHO was widely criticized for responding to the recent Ebola epidemic in West Africa too slowly. But the agency changed course, rapidly helping Madagascar control what could have been a very deadly outbreak.

As soon as it became clear Madagascar’s plague season was unusually forceful this year, the WHO delivered 1.2 million doses of free antibiotics to treat the infected and prevent disease in people who might have been exposed to the bacteria.

From the beginning of this epidemic, the WHO along with health officials in Madagascar identified more than 7,000 potential plague cases — the friends, families, and contacts of people who were suspected of having the disease — and, incredibly, helped 95 percent of them follow a seven-day course of preventive antibiotics. “Only nine contacts developed symptoms and became suspected cases,” the WHO reported.

The UN agency also supported the Ministry of Public Health of Madagascar in a response that included strategies like:

Training more than 4,400 “contact tracers” who followed up with people who may have been exposed to someone infected with plague
Boosting the epidemiological surveillance in all of Madagascar’s affected districts
Controlling rodents and other vectors that carry plague bacteria
Raising public awareness through campaigns about how to prevent the spread of plague
Doing exit screening from the airport to make sure people with plague aren’t traveling to other countries
Helping the nine countries and territories with travel and trade links to Madagascar prepare for potential plague cases by enhancing their surveillance for the disease, and getting supplies like antibiotics ready
“We are now better equipped to work with countries to prepare for emergencies, to detect warning signs early and to respond quickly,” said WHO spokesperson Tarik Jasarevic.

For now, the public health response is working. The last confirmed bubonic case was reported on October 24, and the last confirmed pneumonic case was reported on October 28. So several weeks have passed with no new cases.

That’s excellent news — both for the people of Madagascar and for the nine neighboring countries and territories that were at risk of outbreaks. Still, it’s early in Madagascar’s plague season, which typically runs to April, so the outbreak may not be snuffed out just yet.