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'Unusually Severe' Plague Strikes 1,800 in Madagascar

Plague is spreading in Madagascar, WHO says, and it's likely to be a threat until April.
Image: Plague causing Yersinia pestis bacteria
A digitally-colorized image of plague causing Yersinia pestis bacteria in a flea’s digestive system. National Institute of Allergy and Infectious Diseases via CDC

An “unusually severe” outbreak of plague has made more than 1,800 people sick in Madagascar, but it’s unlikely to spread far, the World Health Organization said Friday.

WHO and the Malagasy government have stepped up screening at airports but say the infection is more likely to spread within Madagascar than it is to spread to other countries.

A digitally-colorized image of plague causing Yersinia pestis bacteria in a flea’s digestive system. National Institute of Allergy and Infectious Diseases via CDC

But still, it is plague after all.

“So it is important to strike a balance between encouraging countries in the region to be ready to act in case of an outbreak, while avoiding panic that could result in unnecessary or counterproductive measures such as trade restrictions or travel bans on affected countries,” WHO said in a statement.

“This outbreak is unusually severe, and there are still five more months to go before the end of the plague season,” it added.

The infection — easily treated with antibiotics if caught early enough — horrifies people in a way that many others do not.

“Plague is one of the oldest — and most feared — of all diseases,” WHO noted.

“Historically, plague has been responsible for widespread pandemics with high mortality. It was known as the ‘Black Death’ during the fourteenth century, causing more than 50 million deaths in Europe.”

Related: CDC Tells Doctors to Watch for Plague

Plague was called black death because it sometimes causes the lymph glands to swell up and turn black. These prominent buboes give their name to bubonic plague.

But far more dangerous and deadly is the pneumonic form, which infects the lungs and which can be spread person to person directly, rather than via flea bites.

Plague is now rare in developed countries, but it’s an ongoing problem in Madagascar.

Since August, WHO reports more than 1,800 suspected or confirmed plague cases and says 187 people have died.

“Based on available information and response measures implemented to date, WHO estimates the risk of potential further spread of the plague outbreak at national level remains high,” WHO said.

But international spread is not a big threat, because pneumonic plague shows up quickly after someone is exposed to the bacteria. Exit screening at airports — like checking for fever — can help stop people from carrying the infection abroad, the agency said.

Neighboring countries, including Comoros, Mauritius, Mozambique, Reunion and Mayotte, Seychelles, South Africa, and Tanzania have started watching for plague infections carried by travelers. “WHO has also helped Ethiopia and Kenya to raise preparedness levels because of their direct airline connections with Madagascar,” it said.

Related: How Common is Plague?

The U.S. Centers for Disease Control and Prevention has issued a level 2 travel alert. “No vaccine is available to prevent plague. But travelers can take steps to prevent plague, and plague can be prevented with antibiotics,” the CDC said.

Travelers to Madagascar should use an insect repellent that carries at least 25 percent DEET, stay away from sick or dead animals and keep their distance from sick people, especially people who are coughing.

“Travelers who have had close contact with people with plague pneumonia should immediately notify a health care provider. They may need to take antibiotics to prevent plague,” the CDC added.

“An outbreak of plague no longer unfolds in the manner portrayed by our history books,” said Dr. Sylvie Briand, director of infection management at WHO.

“Plague is an old disease, but the challenges it poses today are contemporary and fundamentally different from what we had even 40 years ago.”