Plague epidemic in Madagascar. Plague in Madagascar: patients are more afraid of injections than of the deadly disease Plague epidemic in Madagascar in
Since August 2017, Madagascar has been experiencing a major plague outbreak affecting major cities and other non-endemic areas.
From 1 August to 30 October 2017, Madagascar's Ministry of Health reported a total of 1,801 confirmed, probable and suspected cases of plague to WHO, of which 127 were fatal. Of these, 1111 (62%) cases were clinically classified as cases of pneumonic plague, including 257 (23%) confirmed, 374 (34%) probable, and 480 (43%) suspected cases. In addition to cases of pneumonic plague, there were 261 (15%) cases of bubonic plague, one case of septicemic plague and 428 (24%) cases of unspecified plague. this moment type (Figure 1). As of October 30, 51 of Madagascar's 114 districts are affected by the outbreak (Figures 2 and 3). Since the outbreak began, 71 health care workers have developed illness consistent with the plague. None of them died.
Laboratory confirmation of the plague is carried out at the Pasteur Institute of Madagascar. Bacterial culture of 23 isolates of Yersinia pestis was carried out, and all of them turned out to be sensitive to the antibiotics recommended National program to fight the plague.
Since the second week of October 2017, the number of new cases has been decreasing (Figure 4). The number of patients hospitalized with suspected plague is also decreasing. As a result of enhanced surveillance and ongoing investigations, the cumulative number of cases continues to increase, but some cases are not recent infections.
Largest number Cases of plague in Madagascar occur between September and April. It is therefore important that control measures continue until the end of April 2018.
For 83% of the 6492 identified contacts of suspected or confirmed plague patients, monitoring was completed, including 7 days of observation and a prophylactic course of antibiotics. On October 30, 2017, 95% of the 972 contacts of patients currently under surveillance received antibiotics provided by field teams as a precaution.
Figure 1. Confirmed, probable and suspected cases of plague reported in Madagascar, by clinical classification, and date of symptom onset, from 1 August to 30 October 2017 (n=1506) 1
1 In 295 cases, there was no date for the onset of symptoms.
Figure 2. Geographic distribution of confirmed, probable and suspected cases of bubonic plague reported in Madagascar from 1 August to 30 October 2017.
Figure 3: Geographical distribution of confirmed, probable and suspected cases of pneumonic plague reported in Madagascar from 1 August to 30 October 2017.
Figure 4. Epidemic curve of reported confirmed, probable and suspected cases of pneumonic plague by date of symptom onset in Madagascar, from 1 August to 30 October 2017 (n=1053) 2
2 In 58 cases, there was no date for the onset of symptoms.
Public health response
Madagascar's Ministry of Health is coordinating the health response, with support from WHO and other agencies and partners.
Madagascar's Ministry of Health has activated crisis teams in Antananarivo and Toamasina, and free treatment or prophylactic antibiotics are being provided to all patients and their contacts.
The public health response includes the following:
- Investigation of new cases of disease
- Isolate and treat all patients with pneumonic plague
- Enhanced case search
- Active contact tracing, contact tracing and monitoring and provision of prophylactic antibiotics free of charge
- Enhanced surveillance in all affected areas
- Disinfection, including control of rodents and other vectors of infection
- Raising public awareness regarding the prevention of bubonic and pneumonic plague
- Raising awareness among healthcare workers and providing information to improve case detection, infection control measures and protection against infection.
- Providing information about infection control measures during funerals.
IN International airport Antananarivo has introduced enhanced screening measures upon departure. These measures include: filling out a special departure form at the airport (to identify passengers at risk); screening the temperature of departing passengers and referring passengers with elevated temperatures to airport doctors for additional consultations; Passengers with symptoms consistent with pneumonic plague are immediately isolated at the airport, assessed using rapid diagnostic tests and registered in accordance with protocol. Passengers with symptoms will not be allowed to fly. The WHO GOARN team (US Centers for Disease Control and Prevention (CDC) and L'Institut de veille sanitaire/Santé publique France (InVS/SPF)) is providing technical assistance at the airport.
Nine countries and overseas territories in the African region (Comoros, Ethiopia, Kenya, Mauritius, Mozambique, Reunion (France), Seychelles, South Africa and Tanzania) are identified as priority countries for plague preparedness due to their trade and tourism links with Madagascar. These countries are taking preparedness measures, including increasing public awareness of plague, strengthening disease surveillance, especially at points of entry, and pre-positioning equipment, supplies and supplies.
WHO risk assessment
Despite an encouraging downward trend in the number of reports of new cases of plague and the number of hospitalizations due to plague, WHO expects that Madagascar will continue to report new cases of plague until the end of the regular plague season in April 2018. A sustainable response, including active case finding and treatment of patients, contact tracing with follow-up and provision of antibiotics, rodent and flea control, and provision of safe and dignified burials, are critical during the outbreak and ongoing plague season to minimize cases of bubonic plague and reduced levels of human-to-human transmission of pneumonic plague.
Based on available information and the response to date, WHO continues to assess the risk of potential further spread of the plague outbreak nationally as high. The risk of international spread is limited due to the short incubation period of pneumonic plague, exit screening and counseling measures for travelers to Madagascar, and increased training and operational preparedness measures on neighboring islands Indian Ocean and in other countries of Southern and Eastern Africa. The overall global risk is considered low. WHO is revising the risk assessment based on the evolution of the outbreak and information from response sites.
Advice on preventive and control measures and treatment options has been provided to Madagascar and priority countries in the region.
Additional information about the plague and latest information information about the plague outbreak in Madagascar can be found on the WHO plague website and on the Madagascar plague outbreak situation reports website.
Based on currently available information, the risk of international spread of plague is considered to be very low. Based on available information, WHO does not recommend any travel or trade restrictions on Madagascar.
Foreign tourists arriving in Madagascar should be informed about the ongoing outbreak of plague and the necessary protective measures. Travelers should protect against flea bites, avoid contact with dead animals and infected tissues and materials, and avoid close contact with patients with pneumonic plague. If you suddenly develop symptoms such as fever, chills, tender and inflamed lymph nodes, or shortness of breath with cough and/or blood-stained sputum, you should contact medical services immediately.
Travelers should avoid self-medication, even for preventive purposes. Prophylactic treatment is recommended only for people who have had close contact with patients or other high-risk exposures (such as flea bites or direct contact with bodily fluids or tissues of infected animals). Upon returning from Madagascar, you must remain vigilant for the above symptoms. If symptoms occur, travelers to Madagascar should seek medical attention and inform their doctors about their trip.
More than 120 people have already died and more than 1,300 are infected with the deadly pneumonic plague that is ravaging Madagascar, according to UN reports. The media are already writing that this epidemic could easily spread to other countries. The situation is particularly difficult in the country's capital, Antananarivo.
The epidemic is reportedly being blamed on climatic anomalies dubbed "Godzilla" associated with El Niño, which caused temperatures to rise and rat numbers to skyrocket in Madagascar in 2016. Subsequent forest fires drove hordes of rats, which were carrying fleas - carriers of the plague bacillus, to human cities.
The main difference between pneumonic plague and bubonic plague, which killed people in the Middle Ages, is the presence of pneumonia. Pneumonic plague is spread through coughing. According to doctors, today's outbreak of plague kills a person within 24 hours if he is not injected in time sufficient quantity antibiotics.
The African health department is trying to contain the spread of pneumonic plague, but local authorities fear that the disease could soon spread beyond the continent.
The arrows indicate how the plague from Madagascar may spread to other regions. The Seychelles, Reunion, South Africa, Mozambique, Tanzania, Kenya, Ethiopia, Comoros and Mauritius are at risk.
It is reported that among the infected are about 50 people from various humanitarian organizations. The WHO Africa branch says 93 people have died from the plague, while official UN reports list 124 deaths.
A WHO official said in an interview that the risk of the disease spreading is very high at the national level because the plague is present in several cities at once, and this is just the beginning of the outbreak.
There have been three great plague pandemics in human history. The first, the Plague of Justinian, began in 542 and lasted 50 or even 60 years. The regions most heavily affected by it were the center and east of Africa (where it probably came from), as well as the coast Mediterranean Sea. First, the plague began to rage in the ports, and then the infection made its way deep into the countries. Judging by the stories from those times, the disease could have claimed the lives of 100 million people.
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Doctors fighting the plague epidemic in Madagascar are also forced to deal with the fears of their patients. Residents of the contaminated area are not used to hospitals and are terrified of injections. Doctors fear that the islanders' lack of awareness of the deadly disease will lead to its rapid spread.
Dr. Marielle Zaramisy shared her experiences in an interview with the publication. According to her, patients stubbornly do not admit the fact of infection, even when they discover characteristic symptoms.
The head of medical services at the Central Anti-Plague Hospital Ambohimindra added that many people run away from hospitals at the sight of syringes: “People here are not used to hospitals.”
Jean Benoit Manhes, Unicef's deputy spokesman, said: "The mere presence of medicines and hospitals will not help stop the plague. What good are hospitals if people don't go to them?"
Doctors trying to stop a deadly disease also have to deal with the fears of their patients. Many islanders believe that a visit to the hospital will lead to death: if you are not sick, you will definitely catch the disease there. They prefer local shamans and healers to certified doctors.
Rumors have also spread on the island that the plague is a government plot to obtain donations for elections scheduled for next year.
165 people have already died and the deadly disease is spreading rapidly. Doctors called the epidemic outbreak in Antananarivo and Toamasina the largest in the last 50 years.
In most cases, doctors diagnose a particularly dangerous pneumonic plague, which is transmitted by airborne droplets: coughing, sneezing or spitting.
For reference. In order to prevent the possible spread of the disease to other regions and countries, Antananarivo International Airport has introduced enhanced screening measures for passengers upon departure. Passengers with symptoms consistent with those of pneumonic plague are immediately isolated at the airport and are not allowed to depart. The WHO GOARN team (US Centers for Disease Control and Prevention (CDC) and L'Institut de veille sanitaire/Santé publique France (InVS/SPF)) is providing technical assistance at the airport.
Nine countries and overseas territories in the African region (Comoros, Ethiopia, Kenya, Mauritius, Mozambique, Reunion (France), Seychelles, South Africa and Tanzania) are identified as being at greatest risk of disease spread due to their trade and tourism links with Madagascar. The governments of these countries are taking measures to ensure preparedness for a possible outbreak of the epidemic. Epidemiological surveillance has been strengthened and citizens are being thoroughly screened at points of entry and exit.