It is plague season again in Madagascar and I wanted to reflect on the previous epidemic. In 2017, Madagascar experienced one of the worst bubonic and pneumonic plague epidemics with over 2300 confirmed cases and more than 200 deaths. The disease spread into urban areas making it more challenging to control. The epidemic which started in August was successfully controlled by the end of November 2017.
Humans are infected by plague following a bite from infected fleas which introduce the bacteria Yersinia pestis in the body. There are three forms of plague infections , the first is bubonic plague, if left untreated it can spread into the blood stream resulting into septicemic plague. The only form of plague spread from person to person is pneumonic plague which spreads through droplets and has a shorter incubation period. Pneumonic plague is almost always fatal without swift antibiotic treatment.
Efforts to Control the Outbreak
During the outbreak, the Madagascar government applied the following efforts to control the outbreak:
- Focus on strengthening the identification and treatment of patients and their contacts
- Increased control of rodents and fleas
- Practiced safe and dignified burials
Comparing cases during August to September 2017 and the same period in 2018, there were already 54 confirmed cases in 2017 compared to 5 confirmed cases (with 13 suspected cases and 4 deaths) in 2018 http://outbreaknewstoday.com/plague-reported-eight-madagascar-districts-46345/.
Infectious diseases that were once confined to certain regions are now appearing in places people never expected to see or hear about them.
In the UK, two cases of imported Monkey pox disease have been reported. Both patients had traveled to Nigeria and were returning to the UK https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2018.23.38.1800509. These two cases highlight how easy and quickly infectious diseases can be imported from one part of the world to another. A number of health care workers were exposed to the disease before it was confirmed to be monkeypox. One of the healthcare workers has contracted the disease and is undergoing treatment http://www.cidrap.umn.edu/news-perspective/2018/09/uk-monkeypox-case-exposed-health-workers-officials-say.
Infectious diseases can be imported from one part of the world to another
Rapid diagnosis using multiple molecular assays and confirmation by sequencing were used. Direct and indirect contacts are being traced both in the UK and outside the UK with active and passive surveillance in place.
The period between suspicion and diagnosis/confirmation of a case is a window of exposure for healthcare workers, and the community.
The two scenarios above on plague and monkey pox incidence highlight a number of factors to consider when tackling outbreak prone infectious diseases.
For countries where certain infectious diseases are endemic, keeping a watchful eye on a possible case, following up the case and taking all precautionary measures necessary to control and prevent the spread of the disease is paramount. Monitoring vectors and identifying cases as early as possible could reduce the risk of spread of disease.
Sharing information between public health agencies around the globe is essential in following up cases, contact tracing as well as ensuring up to date information is shared to all stakeholders involved in infectious disease control and prevention.
3. Think outside the box:
As the world is more connected than ever through travel and migration, infectious diseases that were once confined to certain regions are now appearing in places people never expected to see or hear about them. Hence keeping an open mind and careful consideration of history of travel and activities before the onset of symptoms is valuable.