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Pneumonic plague outbreak, Northern Madagascar, 2011

Vincent Richard, Julia M Riehm, Perlinot Herindrainy

    Emerging Infectious Diseases
    |December 23, 2014
    PubMed

    Insights

    A 2011 pneumonic plague outbreak in northern Madagascar, caused by Yersinia pestis, had a 100% fatality rate in untreated patients. The Madagascar-specific 1.ORI3-k genotype may contribute to larger epidemics.

    Area of Science:

    • Epidemiology
    • Microbiology
    • Public Health

    Background:

    • Yersinia pestis, the bacterium responsible for plague, is endemic to Madagascar, primarily in the central highlands.
    • Plague had not been previously documented in northern Madagascar before a 2011 outbreak.

    Purpose of the Study:

    • To investigate an unusual outbreak of pneumonic plague in northern Madagascar.
    • To characterize the Yersinia pestis strain involved in the outbreak using molecular typing.

    Main Methods:

    • Case identification and data collection over a 27-day period.
    • Molecular analysis of Yersinia pestis isolates from human survivors and rat samples.
    • Genotyping using single-nucleotide polymorphism (SNP) and clustered regularly interspaced short palindromic repeat (CRISPR) patterns.

    Main Results:

    • 17 suspected, 2 presumptive, and 3 confirmed human cases were identified.
    • All 15 untreated patients died, resulting in a 100% case-fatality rate.
    • Molecular typing revealed the Madagascar-specific 1.ORI3-k SNP genotype and four CRISPR patterns in Y. pestis isolates.

    Conclusions:

    • The 1.ORI3-k SNP genotype of Yersinia pestis may be associated with the potential for larger plague epidemics.
    • The high fatality rate underscores the virulence of the pathogen and the lack of treatment.
    • Multidrug-resistant strains and pathogen persistence in natural foci near settlements pose significant risks, necessitating robust outbreak response strategies.

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