Plague in Madagascar

The Madagascar Ministry of Public Health has reported 22 cases of pneumonic plague, including seven deaths. The outbreak is in Miandrandra commune, Arivonimamo district, where the first death was reported in the week of 23 August 2021. The area is now under quarantine and movements of local people within the area are restricted.

Pneumonic plague spreads through coughing and inhalation of droplets containing plague bacteria, and can also develop as a secondary condition following infection through a flea bite.

Advice for travellers

Plague is rare in international travellers. The risk is highest in those visiting endemic regions who come into close contact with local wildlife, particularly rats or other rodents, or those who are in a healthcare environment.

Activities which may increase this risk include:

• camping, or staying in very basic rural accommodation
• walking, hiking or working outdoors
• hunting or participating in activities which involve close contact with wildlife
• caring for a sick person who may be infected with pneumonic plague, which spreads from person-to-person

Travellers should be advised to:

• practice good insect bite avoidance, using insect repellents to help protect against flea bites
• avoid close contact with sick or dead animals
• avoid crowded areas in regions where pneumonic plague has recently been reported
• follow appropriate infection prevention and control guidance in a healthcare environment 
• seek prompt medical attention if they develop symptoms or if there is a risk of having been exposed to plague

No vaccine is available for plague, though progression of the disease may be prevented with appropriate antibiotic treatment.

Further advice and information on plague is available on the TRAVAX (for health professionals) website.

Source: TRAVAX, 6 September 2021