Move over Ebola, Island nation fears bubonic plague epidemic

The island nation of Madagascar is fighting to keep an outbreak of bubonic plague from becoming an epidemic. According to health officials, 138 people have been affected, and 47 have died from the bacterial infection, with reports suggesting the disease is quickly spreading toward the capital Antananarivo.

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The health ministry’s secretary general, Philemon Tafangy, indicated the death toll is expected to rise over the next few months, and more than 200 households had been disinfected in an attempt to prevent disease spread. Officials have also initiated pest control protocols since bubonic plague spreads through infected fleas.

“Cases have been reported in 16 districts of seven regions,” stated the World Health Organization (WHO) in a press release. “Antananarivo, the capital and largest city in Madagascar, has also been affected with 2 recorded cases of plague, including 1 death. There is now a risk of a rapid spread of the disease due to the city’s high population density and the weakness of the healthcare system. The situation is further complicated by the high level of resistance to deltamethrin (an insecticide used to control fleas) that has been observed in the country.”

Unfortunately, a complex mixture of environmental and cultural factors have made management of bubonic plague difficult in the country for many years. A report from VICE notes that the humid environment of Madagascar allows for plague to persist in much of the animal population, and grain storage to prevent human theft encourages a thriving rodent population.

In addition to the environmental factors at play, burial practices in the country contribute to recurrence of the plague. traditional Malagasy funereal practices involve interment in vaults so bodies can be exhumed from time to time for the Famadihana ceremony, or “the turning of the bones.” Enough of a surge in bubonic plague cases occurs after these ceremonies that the Ministry of Health has recently recommended instituting a seven-year period between the death and exhumation of plague victims.

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At the moment, WHO does not recommend any travel or trade restriction based on the current information available. The organization indicates: “In urban areas, such as Antananarivo, the surveillance of epidemic risk indicators is highly recommended for the implementation of preventive vector control activities.”

The bubonic plague is a bacterial disease, caused by Yersinia pestis, which primarily affects wild rodents. Though primarily transmitted through the bite of infected fleas, approximately 2 percent of bubonic plague cases in Madagascar are pneumonic plague, meaning the bacteria have entered the lungs and can be transmitted to other humans through droplets from sneezing and coughing.

Not only is pneumonic plague considered highly contagious, it is also the most deadly form of the disease, with many patients passing away within 24 hours of contraction.