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Epidemiological and diagnostic aspects of the outbreak of pneumonic plague in Madagascar

M Ratsitorahina1, S Chanteau, L Rahalison

  • 1Institut Pasteur Madagascar, WHO Collaborating Centre for Plague, Antananarivo.

Lancet (London, England)
|February 16, 2000
PubMed
Abstract

Insights

A pneumonic plague outbreak in Madagascar was documented. The F1 dipstick assay proved invaluable for diagnosing plague, and prompt treatment and chemoprophylaxis halted the epidemic.

Area of Science:

  • Epidemiology
  • Infectious Diseases
  • Microbiology

Background:

  • Plague is a re-emerging infectious disease with pneumonic plague being the most severe form.
  • A well-documented outbreak of pneumonic plague occurred in Madagascar, highlighting the need for effective control measures.

Purpose of the Study:

  • To describe a pneumonic plague outbreak in Madagascar.
  • To evaluate diagnostic tools and intervention strategies for pneumonic plague.

Main Methods:

  • Field epidemiological data collection and analysis.
  • Biological testing including microscopy, Yersinia pestis culture, and F1 antigen detection (ELISA, dipstick assays) on various sample types.
  • Serological assessment of infection rates in contacts using IgG anti-F1 ELISA.

Main Results:

  • The outbreak originated from an index bubonic case with secondary lung infection, spreading through social and traditional practices.
  • Eighteen cases of pneumonic plague were recorded, resulting in eight deaths.
  • The F1 dipstick assay detected F1 antigen in sputum early (day 2) and post-treatment, proving its diagnostic utility. 8.4% of contacts showed evidence of exposure.

Conclusions:

  • The F1 dipstick assay is a highly effective diagnostic tool for pneumonic plague.
  • Prompt patient treatment and contact chemoprophylaxis successfully contained the outbreak, demonstrating efficient epidemic control.

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