Abstract
Background: Plague remains a major public health problem in Madagascar. Faced with reports of plague cases and deaths in Tsiroanomandidy district, we performed an investigation in October 2014.List of Abbreviations: BHCS: Basic Health Center; CDC: Control and prevention Diseases Center; DHS: District Health Service; IPM: Institut Pasteur de Madagascar; MOH: Ministry of Health; SMZ-TMP: Sulfamethoxazole Trimethoprim; WHO: World Health Organization Methods: We used the National plague control program case definition. We identified cases from outpatient registers and collected socio-demographic and clinical information. Plague circulation was determined through a retrospective environmental survey of rodents and vectors. Results: From August 1st to October 12th 2014, we identified 30 cases of which 13 deaths in 7 out of 17 municipalities; 18 were confirmed, 6 probable, and 6 suspected cases. The sex ratio (M/F) was 4:1. Yersinia pestis was isolated from Rattus rattus in one municipality. Flea index was 2.3. We collected 45 fleas through a trap set in a house 6 hours after insecticide spraying. Our aim was to describe the plague outbreak and to improve the national plague control strategies. Conclusion: The presence of infected flea and rodent maintain the persistence of plague in the municipalities investigated. There is a high risk of plague transmission to humans. This study showed that rodent and flea information are important for plague control strategies.
Highlights
Yersinia pestis was isolated from Rattus rattus in one municipality
The presence of infected flea and rodent maintain the persistence of plague in the municipalities investigated
Plague is a zoonotic disease caused by the bacillus Yersinia pestis, rodents are reservoirs and the disease is transmitted by infected fleas or by direct exposure
Summary
Plague is a zoonotic disease caused by the bacillus Yersinia pestis, rodents are reservoirs and the disease is transmitted by infected fleas or by direct exposure. 3248 cases of plague in humans were reported from 2010 to 2015, resulting in 584 deaths [4]. Plague is endemic in Madagascar with the number of reported human cases ranging from 312 to 648 per year between 2010 and 2014 [4]. Plague season usually starts in September and ends in April. It primarily affects the central highlands, with an elevation over 800 m [5,6]. Plague is a mandatory notification disease with an individual form provided by the Ministry of health National plague control program [7]. Faced with reports of plague cases and deaths in Tsiroanomandidy district, we performed an investigation in October 2014.
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