Plague Outbreak: August-November 2014, Madagascar

Risk assessment
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Citation Link

European Centre for Disease Prevention and Control. Plague outbreak, August–November 2014, Madagascar – 4 December 2014. Stockholm: ECDC; 2014.

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​An outbreak of plague has been evolving since 31 August 2014 in Madagascar; as of 16 November 2014, 40 people have died from the disease. Despite the risk of further spread, the risk of contracting plague for EU travellers to the affected area is considered to be very low.

Executive summary

In Madagascar an outbreak of plague has been evolving since 31 August 2014; as of 16 November 2014, 40 people have died from the disease.

The ongoing plague outbreak in Madagascar with 119 cases reported to the World Health Organization (as of 16 November 2014) was not an unexpected event. However, the recent occurrence of two cases in Antananarivo, Madagascar’s capital, poses a potential risk of a rapid spread of the disease due to the city’s high population density, poor sanitation, deficient garbage collection, and the overall weakness of the healthcare system.

Despite the risk of further spread, the risk of contracting plague for EU travellers to the affected area in Madagascar is considered to be very low. 

The local authorities are experienced in responding to plague outbreaks and have set up a control coordination committee with dedicated funding to support response measures. There is no restriction of movement in and out of Antananarivo, where the two urban cases occurred, which is consistent with the standard response to plague outbreaks in Madagascar.

Resistance of Y ersinia pestis to antibiotics seems very limited. However, circulating strains are monitored to provide accurate public health information on Y. pestis antimicrobial susceptibility. WHO does not recommend any travel or trade restrictions based on the current information available for this outbreak.