Madagascar reports four confirmed plague cases, five more suspected in the south-east

Madagascar's Ministry of Public Health reported four confirmed plague cases and five suspected cases on 13 October, Xinhua reported from Antananarivo. The Antananarivo daily Midi Madagasikara carried the same count on 14 October.

The four confirmed cases have been recorded since late July in three districts, Midi Madagasikara reported: Ankazobe, Anjozorobe and Ambohimahasoa. L'Express de Madagascar, another Antananarivo daily, placed Ankazobe and Anjozorobe in the Analamanga region, which includes the capital, and Ambohimahasoa in the Haute Matsiatra region. A ministry source cited by the paper said no deaths have been recorded in these areas.

The five suspected cases are in Midongy Atsimo District, in the south-east of the country, according to Xinhua. L'Express de Madagascar reported that the ministry's communicable-disease surveillance directorate received an alert from the district on 10 October, and that rapid-response teams found the five suspected cases and took samples, which are being analysed at the reference laboratory.

Three people died in Andranolalina rural commune, in Midongy Atsimo District, and two other patients are being treated at a basic health centre, L'Express de Madagascar reported, citing Dr Désiré Rakotoarimino, the ministry's Director General of Preventive Medicine. The three who died reportedly belonged to one family: a couple and their grandchild. L'Express said the deaths are probably linked to pneumonic plague and that laboratory results are still awaited.

Plague is caused by the bacterium Yersinia pestis. Rats and their fleas are its main carriers, Free Dom, a radio station in Réunion, reported. The World Health Organization (WHO) says bubonic plague is the most common form and is caused by the bite of an infected flea, and that human-to-human transmission of it is rare. It says plague has a case-fatality ratio of 30% to 100% if left untreated.

Pneumonic plague is the lung-based form. WHO calls it the most virulent: a person with it can pass the disease on through respiratory particles, and incubation can be as short as 24 hours. WHO says the pneumonic form is invariably fatal unless treated early, and that common antibiotics can effectively cure it if delivered early.

Laboratory tests have yet to confirm whether the three deaths in Midongy Atsimo were caused by plague and, if so, which form. During a vaccination campaign, health teams also found three suspected bubonic cases at Begogo, in the Iakora area, L'Express de Madagascar reported, citing a local source.

About 200 people who had contact with patients have received preventive antibiotics and are under close medical monitoring, according to Xinhua and L'Express. Teams are spraying insecticide against fleas in affected areas, looking for new suspected cases and tracing contacts.

In Iakora, some supplies, including rapid diagnostic tests, have run out, L'Express reported. The ministry announced reinforcements for local staff, shipments of medicines and rapid tests, and a mobile laboratory. In some villages, the distance to health centres delays treatment.

The ministry asked the public to stay vigilant and to report suspicious symptoms or dead rodents to local authorities at once, Midi Madagasikara reported. It said plague care and treatment are free in all health centres and that the toll-free line 115 can be used to report suspected cases.

Xinhua said Madagascar has been in a period of increased plague activity since late July. WHO says bubonic plague is recorded in Madagascar nearly every year during the epidemic season, between September and April. The local news site 2424.mg described Midongy Atsimo as one of the country's plague zones, particularly from September to December.