WHO Update On Plague In Madagascar: 1554 Suspected Cases & 113 Deaths

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The tally from Madagascar’s outbreak of (primarily pneumonic) plague continues to rise with the WHO regional office for Africa’s weekly bulletin on outbreaks and other emergencies – Week 43: 21 – 27 October 2017 now placing the number at 1554 cases and 113 deaths.

This represents a steep increase (245 cases and 20 deaths) over what was just reported by the WHO on Friday (current thru the 26th), and is considerably higher than anything being reported by the Madagascar MOH.

Given the wide spread of numbers we’re seeing, isn’t entirely clear whether everybody is reading from the same page. 

With the caveat that these numbers continue to shift back and forth, here is today’s update from the WHO.

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The outbreak of plague in Madagascar continues to improve, with the number of new cases of pulmonary plague declining in all active areas across the country. In the past 2 weeks, 16 previously affected districts reported no new confirmed or probable cases of pulmonary plague.

From 1 August to 27 October 2017, a total of 1 554 suspected cases of plague, including 113 deaths (case fatality rate 7%), were reported. Of these, 985 (63%) were clinically classified as pulmonary plague, 230 (15%) were bubonic plague, 1 was septicaemic, and 338 were unspecified (further classification of cases is in process). Since the beginning of the outbreak, 71 healthcare workers (with no deaths) have been affected.


Of the 985 clinical cases of pneumonic plague, 245 (25%) were confirmed, 336 (34%) were probable and 404 (41%) remain suspected (additional laboratory results are in process). Fourteen strains of Yersinia pestis have been isolated and were sensitive to antibiotics recommended by the National Program for the Control of Plague.

Between 1 August and 27 October 2017, 28 districts reported confirmed and probable cases of pulmonary plague. During the last two weeks, the number of districts that reported confirmed and probable cases of pulmonary plague reduced to 12.

About 78% (4 825) of 6 203 contacts identified completed their 7-day follow up and a course of prophylactic antibiotics. A total of nine contacts developed symptoms and became suspected cases. On 27 October 2017, 1 055 out of 1 087 (97%) contacts were followed up and provided with prophylactic antibiotics.

         PUBLIC HEALTH ACTIONS

A high level inter-Ministerial coordination forum, chaired by the Prime Minister, has been established to provide strategic and policy directions to the plague outbreak response. Similarly, the Country Humanitarian Team of the United Nations system established a strategic coordination platform for partners, chaired by the Resident Coordinator.

The health response is coordinated by the Ministry of Public Health, co-led by WHO and supported by agencies and partners directly involved in the health response. The health sector response is organized into four major committees: (i) surveillance, (ii) community engagement and education, (iii) case management, and (v) communication; with the logistics committee crosscutting all committees.

Coordination of partners in the Health cluster has been strengthened to ensure effectiveness, avoid duplication in the field and ensure efficient coverage of the affected areas. The Health cluster is having weekly meetings, with some partners participating in the national coordination platforms.

Cross sectoral non-Health actors (media, transport, defence, education, etc.) are being coordinated by the National Risk and Disaster Management Office (BNGRC).

Nine plague treatment centres have been established, of which six are in Antananarivo. The treatment centres are supported by IFRC, MSF, MdM, UNICEF, and WHO.

USAID provided six mobile clinics to transport patients to hospitals within Antananarivo.

UNICEF supported production of field-tested public awareness/education materials (posters, brochures, radio/television spots). A total of 69 000 posters and brochures have been produced and distributed, including to partners in the Ministries of Transport and Tourism, church groups and other key influencers.

SITUATION INTERPRETATION

While progress has been made in response to the plague outbreak in Madagascar, sustainability of ongoing operations (during the outbreak and through the plague season usually from September to April) remains critical.

Funds for operations are running low, given the fact that only 26% of the multisector response plan has been funded. Additional response logistics such as temperature monitoring equipment (infrared thermometers), rapid diagnostic tests, personal protective equipment, infection prevention and control supplies, and medicines (antibiotics) need to be provided. Efforts to strengthen outbreak control measures should continue. To that effect, partners and the donor community are called upon to provide additional resources (funds, logistics and human capacity) to ensure continuity of the response operations and eventual containment of the outbreak.