In DepthInfectious Disease

Echoes of Ebola as plague hits Madagascar

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Science  27 Oct 2017:
Vol. 358, Issue 6362, pp. 430-431
DOI: 10.1126/science.358.6362.430

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Hundreds of epidemiologists and technical experts are pouring into Madagascar, one of the poorest countries in the world, to help fight an unprecedented plague epidemic. By 20 October, 1297 people had been infected and 102 had died, and cases are doubling weekly. Worries are high that the outbreak will spread to nearby countries and territories in Africa and the Indian Ocean, where governments are scrambling to prepare. Madagascar is one of the few countries in the world still hard hit by plague, which decimated Europe's population during the Black Death in the Middle Ages. The disease is endemic in the central highlands, where small outbreaks occur most years. Most are bubonic plague, transmitted from rats to humans by the bite of a flea. Now, for the first time, plague is hitting urban areas, including Antananarivo, the capital, and the port city Toamasina, and it has taken an unusual and especially menacing form: pneumonic plague, which is spread from person to person through coughing or sneezing. Without treatment, pneumonic plague is 100% fatal. Infectious disease experts say the outbreak underscores one lesson of the Ebola epidemic of 2 years ago: As cities burgeon and populations become more mobile, once-isolated diseases are increasingly likely to reach cities, where they can race out of control.