According to WHO, the plague is one of the oldest – and most feared – of all diseases. Historically, plague has been responsible for widespread pandemics with high mortality. It was known as the “Black Death” during the fourteenth century, causing more than 50 million deaths in Europe.
Nowadays, plague is easily prevented and treated with antibiotics if detected early enough, and infection can be prevented through the use of standard precautions.
Plague is endemic to Madagascar, where around 400 cases of – mostly bubonic – plague are reported annually. Contrary to past outbreaks, this one is affecting large urban areas, which increases the risk of transmission. The number of cases identified thus far is higher than expected for this time of year.
Bubonic plague is spread by infected rats via flea bite, pneumonic by person-to-person transmission. The current outbreak includes both forms of plague. Nearly half of the cases identified so far are of pneumonic plague.
According to WHO, here are some preventative measures:
The risk of infection with Yersinia pestis for international travellers to Madagascar is generally low. However, travelers in rural areas of plague-endemic regions may be at risk, particularly if camping or hunting or if contact with rodents takes place. In addition, travelers to previously non-endemic regions from where cases of pneumonic plague have been recently reported should avoid crowded areas, avoid contact with dead animals, infected tissues or materials, and avoid close contact with patients with pneumonic plague. Travelers can protect against flea bites using repellent products for personal protection against mosquitoes, which may equally be protective against fleas and other blood-sucking insects. Formulations (lotions or sprays) based on the following active ingredients are recommended by the WHO Pesticides Evaluation Scheme (WHOPES)2 : DEET, IR3535, Icaridin (KBR3023) or Picaridin.
In case of sudden symptoms of fever, chills, painful and inflamed lymph nodes, or shortness of breath with coughing and/or blood-tainted sputum, travelers should immediately contact a medical service.