Madagascar’s ‘Black Death’: Why This Deadly Plague Outbreak Is Different From the Rest

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Health officials have begun disinfecting affected areas of Madagascar to control for infected rodents and insects that can spread plague. (Photo by RIJASOLO/AFP/Getty Images)

Health officials in the Southeast African island nation of Madagascar are struggling to contain a deadly plague outbreak that has claimed the lives of 94 people this year and left several hundred others severely ill.

Madagascar’s Office of National Risk and Emergency Management Office reported Tuesday, Oct. 17, that the number of plague cases on the island had doubled to a total of 805 in just the past week. As of last week, there were only 320 suspected and confirmed cases of the infectious disease.

The pneumonic plague, also known as the Black Death, remains an endemic in Madagascar, which usually sees around 400 cases in the September–to–April outbreak season, HuffPo reported. However, world health officials are especially concerned this time, considering the major differences of this recent outbreak from outbreaks past.

The first case was reported earlier this year on August 23, and the deadly disease has since spread to infect more than 800 people on the island. A large majority of the infections — over 70 percent — have been pneumonic, meaning they’re airborne and can be spread from person to person via saliva droplets from coughing and sneezing. This makes the strain far more dangerous and infectious, as it spreads far faster than bubonic plague, which is typically passed by infected rats and fleas.

The Guardian noted that the bubonic plague, which can spread to a person’s lungs and attack their lymphatic system, can become pneumonic if left untreated. Of the 684 cases reported earlier this month, 474 were pneumonic, 156 bubonic and one septicemic, the news site said.

“It is a dangerous moment,” Elysée Ratsiraka, mayor of port city Toamasina, told the News Mada website. “You can leave your house today and catch the plague tomorrow. What are we supposed to do today … and tomorrow? That’s the question facing us.”

Among health officials’ other concerns is the fact that the pneumonic plague outbreak has hit several areas outside Madagascar’s remote impoverished communities, which typically see the deadly disease. The World Health Organization has called it a “disease of poverty” because it’s driven in part by unsanitary living conditions and a lack of health facilities.

The nation’s densely populated capital of Antananarivo is among one of the hardest hit areas, however, which is highly unusual. With an estimated 2.7 million people in the busy metropolis, the risk of transmission is dramatically increased.

“Unfortunately, we are seeing cases in urban areas,” Julie Hall, chief of staff at the Int’l Federation of Red Cross and Red Crescent Societies, told Al Jazeera. “Many of those urban areas are very crowded with poor sanitation, a lot of people living very closely next to each other. So, that makes it more of a concern when you have spread from person to person.”

While a plague program has been in place in Madagascar for decades, government efforts to help fight the disease have been “hampered by operational and managerial difficulties,” according to a recent report from the European Centre for Disease Prevention and Control. Health officials have taken a number of steps to keep the plague from spreading, including issuing travel advisories for international travelers, fumigating affected areas for insect and rodent control and raising awareness among health care workers to improve case detection and infection control procedures.

Still, not everyone is feeling safe.

Fear over rapid spread of the disease and the growing number of deaths has prompted the WHO to ship more than 1.2 million doses of antibiotics and $1.5 million in emergency relief to help quell the plague. The organization also said it is appealing for an additional $5.5 million to effectively respond to the outbreak and help save lives.

Locals grappling with the plague and in fear of contracting it themselves have resorted to buying masks or self-medicating, The Guardian reported, but health officials have tried to instill a sense of calm.

“Plague is curable if detected in time,” said Dr. Charlotte Ndiaye, WHO Representative in Madagascar. “Our teams are working to ensure everyone at risk has access to protection and treatment. The faster we move, the more lives we save.”

Officials believe the outbreak started in August when a 31-year-old man thought to have contracted malaria traveled from the central highlands through Antananarivo, according to Al Jazeera. The man actually had the pneumonic plague and wound up infecting a number of people he’d come in contact with. He ultimately died in the taxi he was travelling in, and four of the 31 people he infected died shortly afterward.

Though the plague has been commonly linked to poverty-stricken areas with unsanitary conditions, it still has a tendency to pop up in well-to-do nations — like the United States. In August of this year, fleas carrying the bubonic plague bacteria, Yersinia pestis, were found in Arizona and other parts of the American Southwest. There were also two human cases of the disease in New Mexico earlier that summer, Business Insider reported.

Still, the U.S. only sees handful of cases each year compared to the 400 on average in Madagascar.

The number of pneumonic plague cases are expected to rise in the coming weeks within Madagascar, health experts say, with little risk of spreading outside the country.

“We hope that we won’t see [more Madagascar] outbreaks,” Hall said. “With our increasing population and particularly increasing urban population, this may well be another wake-up call to really invest in proper sanitation and proper infrastructure.”

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