I have been following this outbreak in Madagascar for a week, and it is worsening!
231 cases, most in the main city. Many dead, case fatality rate = 17% so far.
"According to Wikipedia, the urban area of Antananarivo had a population of three million in 2012. Pneumonic plague in a big city is like Ebola in a big city."
Pulmonary bubonic plague is the same as the infamous 'Black Plague'. It is spread by sneezing, coughing and blood products. (Origination is from rat fleas, but when it gets into the lungs it has a much more virulent mode of transmission.)
Epidemic - Plague victims increase
The lifeless body of a pulmonary plague suspect was buried in Anjanahary yesterday. Eight patients were admitted to the hospital the same day, in Antananarivo.
Plague is far from being mastered. The eighth plague suspect in Antananarivo-city was buried at the Anjanahary mass grave in the late afternoon yesterday. Coming from Manandriana, in the Avaradrano district, he died on the way to get treatment at a large hospital in Antananarivo on the same day.
"Clinical signs have led us to say that it is a pulmonary plague. He would have had fever, coughs with blood-streaked sputum, chest pain. The rapid diagnostic test (TDR) confirmed this," says a reliable source.
Neither this case, nor that of the adolescent girl who died in Ilafy and buried in Ambohimailala on Tuesday, is yet indicated in the latest statistics of the Ministry of Public Health, posted yesterday at 11.30 am. district of Atsimondrano, and Tsiroanomandidy, between 3 and 4 October, were raised.
In addition, there was an increase in the number of patients admitted to the health facilities of Antananarivo-city yesterday. Six at the Soavinandriana hospital center and two at the anti-plague hospital in Ambohimiandra (CHAPA).
Between 3 and 4 October, thirty-five suspected live cases were recorded in six districts, fifteen in Antananarivo-city, thirteen in Toamasina I, three in Ambohidratrimo, according to the data of the ministry concerned.
The Ministry of Public Health welcomes the increase in the number of patients admitted to hospitals. "This means that the population begins to know the precautions to take in case of suspicious symptoms. Treated in time, they will be cured," says a source. Others interpret it as the spread of the bacteria in the capital.
That being said, all must be vigilant. In case of fever, chills, body and head pain, weakness, vomiting and nausea, burning and painful lymph nodes, shortness of breath and coughing, traces of blood on sputum, a doctor is required.
It is only now that the government, headed by Prime Minister Olivier Mahafaly Solonandrasana, seems to be aware of the magnitude of the phenomenon, multiplying the activities of fighting the disease, whereas the first case was recorded in the month of 'August.
These activities concern, among other things, the establishment of a sanitary barrage in the parking areas of the national zone, the requirement for mandatory identity declarations in these parking lots, as it is via public transport that the epidemic of pulmonary plague has spread to Toamasina and Antananarivo.
There is, moreover, a deconcentration of care in all health facilities. Yesterday, a restricted government council, together with the technical and financial partners on the plague epidemic, held at the State Palace in Mahazoarivo. And in the same day, a workshop to update and validate the plan to respond to the plague epidemic took place at the Hotel Colbert. A more precise strategy is needed to limit the number of victims.
Twenty Districts Affected by Plague
Twenty districts are now affected by the plague epidemic. Most are plague areas, but the disease has also spread to Mahajanga, Toliara, and Toamasina, non-plague areas, according to the Ministry of Public Health. In these twenty districts, the Ministry counted one hundred and ninety-four cases. Sixty-eight of them occurred in Antananarivo and forty in Toamasina. There are still six months before the end of the plague season.
WHO provides 1.2 million antibiotics to fight plague in Madagascar.
WHO has delivered nearly 1.2 million doses of antibiotics and released US$1.5 million dollars in emergency funds to fight plague in Madagascar.
"Plague is curable if detected in time. Our teams are working to ensure that everyone at risk has access to protection and treatment. The faster we move, the more lives we save," said Dr. Charlotte Ndiaye, WHO Representative in Madagascar.
WHO has delivered 1 190 000 doses of antibiotics to the Ministry of Health and partners this week, and a further supply of 244 000 doses is expected in the days ahead.
The different types of drugs will be used for both curative and prophylactic care. They are enough to treat up to 5000 patients and protect up to 100 000 people who may be exposed to the disease.
The medicines are being distributed to health facilities and mobile health clinics across the country with the support of the Ministry of Health and partners.
WHO is also filling critical shortages in disinfection materials and personal protective equipment for health professionals and safe burials.
WHO and the Ministry of Health are training local health workers on how to identify and care for patients, and how to trace people who have had close contact with symptomatic patients so that they may be given protective treatment.
Most of the 231 infections and 33 deaths that the Ministry of Health has reported since August are associated with pneumonic plague – a more dangerous form of the disease that affects the lungs and is transmitted through coughing at close range.
Both bubonic and pneumonic plague can be cured using common antibiotics if delivered early. Antibiotics can also help prevent infection among people who have been exposed to plague.
Pictures of Antananarivo, Madagascar