Madagascar receives almost 1.2 million doses of antibiotics to fight plague

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Authorities banned visits to prisons as well in two of the areas that are most affected to prevent the disease from spreading.

Recently there has been criticism of a perceived slow reaction by the government to the plague outbreak.

People infected with plague usually develop "flu-like" symptoms after an incubation period of three to seven days, according to World Health Organization and typical symptoms include the sudden onset of fever, chills, head and body-aches and weakness, vomiting and nausea.

"We have plague cases every year out west", says Small.

What's particularly alarming now is that pneumonic plague is easily transmitted person to person by coughing, and the outbreak has reached relatively densely populated urban areas, including the capital, Antananarivo, commonly known as Tana. This kind of plague is far more deadly. Fleas pick up the plague-causing bacteria Yersinia pestis from small mammals like rodents. One hospital has been set up in the capital of Antananarivo is struggling trying to cope with the number of ill people arriving with long lines outside the hospital for medicine and face masks.

This year urban areas have been affected, a development that has anxious aid agencies in a country not renowned for a robust healthcare system.

Though the outbreak was sparked by one large cluster of pneumonic plague, since then, illnesses without apparent links have been detected in 14 of Madagascar's regions. Our teams are working to ensure that everyone at risk has access to protection and treatment.

When did the latest outbreak begin?

The WHO is also supporting preparedness activities in seven high-risk countries that took part in a recent basketball tournament and have trade and travel connections to Madagascar: South Africa, Mozambique, Tanzania, Mauritius, Comoros, Seychelles, and Reunion.

Which areas are affected?

The outbreak has now hit 20 districts in 10 regions.

On 30 September, Prime Minister Olivier Mahafaly Solonandrasana in a televised statement announced that all public gatherings would be banned in Antananarivo to prevent the spread of the disease following the death of the basketball coach. Since our last report on 4 October 2017, a total of 230 new suspected cases including 17 deaths (case fatality rate 7.4%) were reported.

The outbreak of plague in Madagascar continues to evolve. The WHO and Madagascar's health ministry are screening departing passengers at the country's worldwide airport.