Navigation and service

Fighting pneumonic plague on Madagascar
in autumn 2017

RKI infectious disease clinician Bettina Ruehe on the way to the hospital in Antsirabe. Source: Ariane Halm/RKI

To the photo story

In August 2017, Madagascar saw the beginning of a major outbreak of pneumonic plague. The disease is caused by Yersinia pestis bacteria which are transmitted from rodents to humans via fleas. Madagascar is one of the few countries in the world where plague still occurs on a regular basis. During the rainy season from September to April, cases of plague are repeatedly registered, usually bubonic plague. However, the outbreak in autumn 2017 was different due to an unusually high number of pneumonic plague cases – a form of the disease which can easily be passed from one human to another and ends in death if untreated. Moreover, the plague infections were not only reported in the far-flung parts of the island’s central highlands as they usually are but in the capital Antananarivo and the largest harbour city of Toamasina. For a long time, the potential for further spread of the outbreak was unclear, but people were very scared that the epidemic could get out of control.

In response to a request from the World Health Organization’s (WHO) Global Outbreak Alert & Response Network (GOARN), two RKI experts travelled to Madagascar to support the WHO Country Office team in fighting the outbreak. From the end of October to the end of November 2017, the infectious disease clinician Bettina Ruehe and the infectious disease epidemiologist Ariane Halm visited the Haute Matsiatra and Vakinankaratra regions: together with their African colleagues they trained doctors and nurses to recognise the signs and symptoms of pneumonic plague, investigated cases of suspected plague and tracked down contact persons. They also helped to distribute medicines, personal protective equipment and rapid diagnostic tests for plague.

As of end of November 2017, the outbreak is under control. According to WHO, more than 2,400 suspected plague cases (bubonic and pneumonic plague) were counted, just over 200 patients died. More than 7,000 contact persons were traced and given antibiotics as a precautionary measure. The last confirmed case of pneumonic plague in Madagascar to date was reported on 19 November 2017. However, the current plague season only ends in April and experts expect further occasional bubonic and possibly pneumonic plague cases in the country until then - not only this season but in the coming years, as well.

Date: 09.01.2018