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[Epidemiological data on the plague in Madagascar].

M Ratsitorahina1, S Chanteau, M L Rosso

  • 1Institut Pasteur de Madagascar, Centre collaborateur OMS/Peste, BP 1274-101 Antananarivo-Madagascar.

Archives De L'Institut Pasteur De Madagascar
|March 20, 2003
PubMed
Summary

Plague re-emerged as a public health issue in Madagascar, with cases rising and spreading geographically. Improved surveillance and a new rapid test show promise in reducing plague morbidity and fatality.

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Area of Science:

  • Epidemiology
  • Infectious Diseases
  • Public Health

Context:

  • Plague was introduced to Madagascar in 1898, with a major epidemic in the highlands from 1921-1941.
  • Plague re-emerged as a significant public health problem in urban centers and rural areas starting in the 1980s.
  • The Plague National Control Program was reactivated in 1994 to enhance disease surveillance.

Purpose:

  • To update epidemiological data on human plague in Madagascar from 1980 to 2001.
  • To analyze trends in plague incidence, seasonality, affected demographics, and geographical distribution.
  • To assess changes in case fatality rates and the proportion of pulmonary plague cases.

Summary:

  • From 1980-2001, 16,928 suspected plague cases were reported, with 3,500 confirmed positives.

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  • The plague season varies by region (October-March in highlands, July-November in the northwest).
  • Young adults (5-25 years) are most affected, with a male-to-female ratio of 1.3:1. Case fatality decreased from 40% to 20%, and pulmonary plague cases dropped from 15% to <5%.
  • Geographical spread increased significantly, with plague detected in 4 districts in 1980 and 21 districts in 2001.
  • A new rapid diagnostic test introduced in 2002 aims to improve plague control in endemic areas.
  • Impact:

    • The study highlights the persistent threat of plague in Madagascar and its expanding geographical reach.
    • Decreasing case fatality rates and pulmonary plague indicate potential improvements in case management.
    • The introduction of rapid diagnostic tests in primary health centers holds promise for better early detection and control of plague.