Madagascar Plague Outbreak Triggers Travelers’ Alert – Pneumonic Plague

2017 – The World Health Organization (WHO) and Madagascar Ministry of Health are jointly leading a public health response to the outbreak. The U.S. Centers for Disease Control and Prevention (CDC), which has issued a level-two alert, is among partner organizations assisting with the response.

Exposure Risk

Plague is a bacterial infection that is usually spread by infected fleas and the rats that carry them. If it is not treated, the infection can spread to the lungs and cause pneumonia. Pneumonic plague is the only form of plague that can be directly transmitted from one person to another. In rare but serious cases, a person with severe plague pneumonia can spread the infection by coughing up infected droplets that become airborne and can be inhaled by others.

Symptoms and Treatment

When acquired by flea bite, bubonic plague causes symptoms of high fever, and swollen and tender lymph nodes that usually occur two to six days after the bite. Symptoms of plague pneumonia typically appear two to four days after inhaling plague bacteria. Incubation can be as short as 24 hours. Symptoms include:

• Sudden onset of high fever
• Cough
• Headache
• Chills
• Weakness

Plague can be treated with antibiotics. Recovery rates are high if detected and treated in time (within 24 hours of symptom onset). However, without prompt treatment, it can cause serious illness or death. There is no vaccine available to prevent plague.

Prevention for Travelers

According to the CDC, travelers to Madagascar should:

1. Use EPA-registered insect repellent that lists protection against fleas on the label and contains at least 25 percent DEET.
2. Avoid close contact with sick or dead animals.
3. Avoid close contact with seriously ill people, especially if they are coughing up blood.
4. Apply standard precautions when handling potentially infected materials.

WorkCare recommends that travelers to Madagascar consider packing 20 Cipro 500 mg, an antibiotic medication, as a precaution.

WHO is working closely with Madagascar’s health and security authorities to ensure control measures, such as temperature checks, are in place at departure points to prevent the spread of infection outside the country.

Travelers who are in-country and develop symptoms should immediately notify a health care provider. They may need to take antibiotics to prevent plague. After visiting Madagascar, travelers should be alert for symptoms, and if they appear, immediately seek medical care and inform the provider about their travel.