Madagascar's deadly pneumonic plague is waiting to break out of Africa, warn experts
The plague usually infects a few hundred every year. This year, the number is already in the thousands and is expected to rise further. If not contained, experts fear it could reach as far as the America and Europe as well.
Every year, Madagascar sees an outbreak of the plague that affects a few hundred people and claims a few lives. However, the infection is always contained within the island nation, with the rest of the world blissfully unaware of it. Unfortunately, this year has proven to be a different beast and scientists now believe epidemic has reached a critical point with ten countries on the African coast placed on high alert.
A few weeks ago, it was reported that the outbreak had infected 1,192 people since August and killed 124. The disease now seems to have shifted up a gear, with a 15% jump in fatalities over the past few days. It has now spread to over 2,000 people and official figures from November 9 show 165 have succumbed to the deadly disease; with that number undoubtedly having risen this past week.
Experts fear that this particular outbreak concerns a strain deadlier and more resistant than any previous one to have struck the island and that it may soon become untreatable. The worry remains that poor vigilance from the concerned authorities could mean the disease spreads to mainland Africa, and then Europe and the Americas, triggering a truly global crisis.
Countries in Africa such as Comoros, Ethiopia, Malawi, La Reunion, Kenya, Mauritius, Mozambique, Seychelles, South Africa, and Tanzania have been placed on high alert.
67% of the confirmed cases on the island is the pneumonic plague, much deadlier than its more famous cousin the bubonic plague, which wiped out nearly half of Europe's population in the 14th century. The pneumonic plague bacteria is transmitted when the infected person coughs and is fatal within a span of 24 hours if left unchecked.
Considered to be the worst outbreak in over 50 years, the fear is that the disease can't be contained and will soon spiral out of control. However, experts insist that an economically developed country would be able to contain the plague in its current iteration.
How did it begin?
While stories vary, the consensus is that the plague originated from an unnamed 31-year-old man in August. The man was reportedly traveling by bush taxi from the Central Highlands to his home in the coastal city of Toamasina passing through Antananaviro, the capital, with an illness which was initially written off as malaria. He passed away on the way and spread a large cluster of infections to his contacts who in turn spread it to their contacts.
This year's outbreak was considerably worse because it reached the island's two biggest cities, Antananarivo and Toamasina and the disease spreads faster in heavily crowded areas. Roughly 82% of cases are concentrated in Antananaviro, the heavily populated capital city of 2.7 million.
How does it spread?
The bubonic plague is first contracted through the Yersinia Pestis bacteria which is spread through the bites of infected fleas carried by rats. Forest fires drive these rats towards rural communities, which puts them directly in contact with residents, who are then bitten and infected. Without the appropriate antibiotics, it spreads to the lungs where it mutates into the more virulent pneumonic form.
The bacteria is air-borne, and can then spread from person to person when the infected person coughs or sneezes, or spits.
What are the symptoms?
Symptoms include painful, swollen lymph nodes, called buboes, as well as fever, chills, and coughing. The bacterium thrives in places with poor sanitary conditions and inadequate health services. The incubation period is short, with the infected person dying within a short span of 12-24 hours.
Why is it spreading so fast?
Two cultural traditions are arguably exacerbating the plight of the island nation further. The nation celebrates 'All Saints Day' or 'Day of the Dead' every year on November 1, where crowds gather in the nation's cemeteries. During times of outbreak, gatherings of large collections of people will present a health hazard; especially for a disease as contagious as this one.
According to Willy Randriamarotia, the Madagascan health ministry's chief of staff, said: "If a person dies of pneumonic plague and is then interred in a tomb that is subsequently opened for a Famadihana, the bacteria can still be transmitted and contaminate whoever handles the body."
It's no coincidence that the rise in fatality coincided with the celebration of the 'Day of the Dead' festival.
To prevent dead bodies from posing a risk, authorities have been attempting to single out those who they believe died from the pneumonic plague. Officers armed with chemicals are then disposed to the home to kill any bacteria on the corpse.
The authorities have also singled out an ancient ritual called Famadihana as a possible culprit for the spread. The ritual involves relatives digging up the corpses of their loved ones and dancing with them, which again provides another window for the bacterium to spread.
To limit the danger of Famadihana, rules were enacted by the government at the beginning of the outbreak which directed citizens to bury victims of the plagues in tombs which cannot be reopened. The remains were to be held in an anonymous mausoleum. However, the local media has reported cases of several bodies being exhumed without authorities' knowledge.
What is the WHO doing?
The WHO initially sent 1,190,000 doses of antibiotics to the country at a cost of $1.5 million. But that proved paltry, and as the situation got progressively worse, the World Bank decided to release an extra $5 million to control the situation.
Air Seychelles, one of the country's biggest airlines had stopped flying temporarily earlier in the month in a bid to prevent the infection from spreading out of the country. However, experts stress that the risk of such a thing happening is low because of the screening protocols that have been implemented to curb the outbreak.
Nearly 20,000 respiratory masks have also been donated to citizens. Schools and universities have been shut down and public gatherings banned by the government. Buildings have been sprayed to eradicate any fleas that may carry the plague.
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