Since the end of August, top health care official Willy Randriamarotia has confirmed 22 cases of the pneumonic plague in Antananarivo, Madagascar; five of these cases have resulted in death. Health officials assure the public that the ministry has the outbreak under control; but over 300 people have checked themselves into local hospitals, claiming to exhibit symptoms of the plague.
The plague’s first case was reported on August 28th, when a passenger in public transit died on route to Tamatave. Two passengers, who came in direct contact with the body, have also died. The remaining two deaths were exposed in the province of Antananarivo. Still, Randriamarotia has stated that the eastern region of Tamatave should not panic since the region “has not seen the plague for 100 years.”
The pneumonic plague, a severe lung infection caused by bacterium yersinia pestis, is related to the infamous bubonic plague (the “black death”), which devastated Europe in the 14th century. Once a person is contaminated, the disease immediately affects the lung. If discovered early, the plague can be cured with antibiotics (specifically tetracyclines and gentamycin). In fact, early detection significantly improves chances of survival—but once a person is infected, the plague can result in death within the first 24 hours, making this early detection near impossible. Symptoms of the plague include lymph node swelling, severe dyspnoea, coughing, high fever, chills, nausea, and vomiting.
Since the 1980s, Madagascar has seen yearly outbreaks of this plague. In January 2017, an outbreak occurred in the mountainous area of Befotaka, where 27 out of the 68 infected individuals died. Before then, the last major outbreak occurred between September 2014 and February 2015, where the plague killed 71 out of the 263-infected people. In 2015, World Health Organization (WHO) report claims that the number of cases increased annually between 2012 and 2015.
To prevent the plague from spreading further, two things need to be done. First, the international community must join with the health ministry of Madagascar to find tangible ways of minimizing outbreaks. Officials know that the disease is spread from fleas to rats, then from rats to humans—why haven’t efforts been made to develop insecticides which will kill fleas? Indeed, it is shocking that after almost four decades, there have been few successful efforts to reduce the outbreaks of the plague.
Secondly, the Madagascan government (with the help of international donors) must improve access to healthcare. Previous reports regarding outbreaks have repeatedly claimed that inadequate health care, as well as poor hygiene, contribute to the spread of the plague. This health care should include providing public health officials with mobile units, so officials can train communities on the plague’s early symptoms.
Until these two issues are addressed, the pneumonic plague will continue to affect the Madagascar population, resulting in unnecessary and ultimately, preventable deaths.