Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Feb;25(2):220-228.
doi: 10.3201/eid2502.171974.

Trends of Human Plague, Madagascar, 1998-2016

Voahangy Andrianaivoarimanana, Patrice Piola, David M Wagner, Fanjasoa Rakotomanana, Viviane Maheriniaina, Samuel Andrianalimanana, Suzanne Chanteau, Lila Rahalison, Maherisoa Ratsitorahina, Minoarisoa Rajerison

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.

PubMed Disclaimer

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.
See this image and copyright information in PMC

References

    1. Bertherat E. Plague around the world, 2010–2015. Wkly Epidemiol Rec. 2016;91:89–93.
    1. Andrianaivoarimanana V, Kreppel K, Elissa N, Duplantier JM, Carniel E, Rajerison M, et al. Understanding the persistence of plague foci in Madagascar. PLoS Negl Trop Dis. 2013;7:e2382. 10.1371/journal.pntd.0002382 - DOI - PMC - PubMed
    1. Duplantier JM, Duchemin JB, Chanteau S, Carniel E. From the recent lessons of the Malagasy foci towards a global understanding of the factors involved in plague reemergence. Vet Res. 2005;36:437–53. 10.1051/vetres:2005007 - DOI - PubMed
    1. Brygoo ER. [Epidemiology of the plague at Madagascar] [in French]. Med Trop (Mars). 1966;26:26–, 79.. - PubMed
    1. Migliani R, Chanteau S, Rahalison L, Ratsitorahina M, Boutin JP, Ratsifasoamanana L, et al. Epidemiological trends for human plague in Madagascar during the second half of the 20th century: a survey of 20,900 notified cases. Trop Med Int Health. 2006;11:1228–37. 10.1111/j.1365-3156.2006.01677.x - DOI - PubMed

Publication types

Substances