Bubonic plague scan

For those of you thinking the fearsome plague died along with the Middle Ages, think again. Madagascar has reported over 200 infections and at least 33 deaths since August 1 due to a deadly pneumonic plague outbreak, The New York Times reports.

These numbers were confirmed by the World Health Organization (WHO). An article published in Newsweek, citing Madagascar’s Ministry of Public Health, reports the total number of deaths at 45. Science Magazine cites the Ministry as well, stating that a release on 7 October detailed there were at least 343 reported infections and 42 deaths.

The centuries-old disease has been active in poorer countries like Madagascar frequently. Plague season on the island normally starts in September each year and finishes up in April. The country experiences an average of 400 cases of plague each year during that time frame.

Usually, the plague is restricted to the nation’s rural central highland areas in its lesser form, bubonic plague, spread by rats carrying the infections via biting fleas.

What makes the current outbreak unusual is that it has started rapidly, early, and is the more lethal form of plague, pneumonic, which can be spread by coughing. Because of its ease in spreading, pneumonic plague kills much faster than its bubonic form. This season, pneumonic plague has reached the more populous areas of the country, which has contributed to its rapidity as well.

Both forms of the lethal disease, bubonic and pneumonic, contributed to the now famous Black Death in Europe’s Middle Ages. One of the most horrific pandemics in human history, the Black Death claimed the lives of between 75 and 200 million people throughout Europe in the mid-14th century. Decimating nearly 60 percent of Europe’s population, the Black Death caused major social upheaval.

There are, altogether, three plague strains: bubonic, septicaemic and pneumonic. They are caused by the bacteria Yersinia pestis. Generally, all forms can be cured by antibiotics. Some strains have developed in Madagascar that are resistant to antibiotics; this is not thought to be a factor in the latest outbreak.

The outbreak seems to have started in August when a 31-year-old man traveled by bush taxi, a form of public transportation, from the central highlands on his way home. Traveling to the coastal city of Toamasina, the man first had to pass through the nation’s populous capital, Antananarivo.

Suffering from malaria-like symptoms, the man died in the course of his travels. Shortly after, the outbreak spread along the route he traveled along, unwittingly spreading the deadly disease in his wake. Those who came in contact with him have since passed the disease along to others.

The plague wasn’t confirmed as the cause of death until blood samples were taken from a 47-year-old woman who died on September 11. The woman’s cause of death was believed to be pneumonia. The Ministry of Public Health confirmed the outbreak two days later on September 13.

The fast-spreading epidemic has caused WHO to send almost 1.2 million doses of antibiotics to the African island country. They will send an additional 250,000 doses to the country in the coming days as well.

“Plague is curable if detected in time,” Dr. Charlotte Ndiaye, WHO Representative in Madagascar, said in a WHO release on October 6. “Our teams are working to ensure that everyone at risk has access to protection and treatment. The faster we move, the more lives we save.”

The antibiotics sent are enough to treat 5,000 patients and protect another 100,000 who have not yet contracted the disease. They are being distributed through the Ministry of Health to hospitals and mobile clinics throughout the country.

Protective gear and disinfection equipment will also be sent for health professionals and burials. WHO will use their estimated $1.5 million emergency funds sent to the country to help train local health workers on how to best identify and aid the sick.