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.2019 Feb;25(2):220-228.
doi: 10.3201/eid2502.171974.

Trends of Human Plague, Madagascar, 1998-2016

Trends of Human Plague, Madagascar, 1998-2016

Voahangy Andrianaivoarimanana et al. Emerg Infect Dis.2019 Feb.

Abstract

Madagascar is more seriously affected by plague, a zoonosis caused by Yersinia pestis, than any other country. The Plague National Control Program was established in 1993 and includes human surveillance. During 1998-2016, a total of 13,234 suspected cases were recorded, mainly from the central highlands; 27% were confirmed cases, and 17% were presumptive cases. Patients with bubonic plague (median age 13 years) represented 93% of confirmed and presumptive cases, and patients with pneumonic plague (median age 29 years) represented 7%. Deaths were associated with delay of consultation, pneumonic form, contact with other cases, occurrence after 2009, and not reporting dead rats. A seasonal pattern was observed with recrudescence during September-March. Annual cases peaked in 2004 and decreased to the lowest incidence in 2016. This overall reduction occurred primarily for suspected cases and might be caused by improved adherence to case criteria during widespread implementation of the F1 rapid diagnostic test in 2002.

Keywords: Madagascar; Yersinia pestis; bacteria; bubonic plague; case-fatality rate; fleas; human plague; plague; pneumonic plague; rats; trends; zoonoses.

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Figures

Figure 1
Figure 1
Diagnostic flowchart for suspected cases of plague, Madagascar, 1998–2016.
Figure 2
Figure 2
Classification of reported plague cases and confirmation rate, Madagascar, 1998–2016.
Figure 3
Figure 3
Yearly (A) and monthly (B) distributions of bubonic and pneumonic plague and their CFR, Madagascar, 1998–2016. CFR, case-fatality rate.
Figure 4
Figure 4
Geographic distributions of bubonic plague (A), pneumonic plague (B), and infection clusters (C), Madagascar, 1998–2016.
Figure 5
Figure 5
Predictive mortality rate according to clinical form and day of consultation for cases of plague, Madagascar, 1998–2016. Error bars indicate 95% CIs.
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