Madagascar, which has annual outbreaks of plague, is currently suffering from the worst plague epidemic in recent history. As of 7 October, the Madagascar Health Ministry reported that 343 people had been infected and 42 had died, and numbers are rising rapidly.

Not only are the numbers of the affected a cause for concern, the more worrying element of the epidemic is the fact that Madagascar is seeing increasing numbers of people suffering from the deadliest form of plague: pneumonic plague. The island nation has managed its bubonic plague outbreaks since it arrived from India in 1898, but is now struggling to stamp the pneumonic plague out.

Plague is an infectious disease caused by the bacterium Y. pestis, usually found in small mammals and their fleas. It is transmitted between animals and humans by the bite of infected fleas, direct contact with infected tissues, and inhalation of infected respiratory droplets. It is a very severe disease in people, with a case-fatality ratio of 30%-100% when left untreated.

Usually, plague infections arise as bubonic plague, spread by flea bites. In this case, Y. pestis moves from the site of a flea bite on a human to the lymphatic system, taking up residence and inflaming a lymph node. This causes a painful swelling called a bubo, where the infection gets its name. If it’s left untreated, the infection can spread to the blood, causing septicaemic plague, or the lungs, causing pneumonic plague.

Pneumonic plague is the most severe form. It can become a life-threatening situation in just 24 hours.

The World Health Organisation (WHO) has announced the distribution of 1,2 million dosages of antibiotics to treat the symptoms and reduce fatalities in Madagascar, as well as releasing $1.5 million in emergency funds. The government has forbidden public gatherings, including sporting events, and schools have closed for insecticide treatments, in an attempt to stop the spread of the disease.

However, while Madagascan authorities are trying to bring the epidemic under control, people are still travelling to and from the island. Only the national carrier of the Seychelles has stopped flights “temporarily”. This means that the plague could spread to neighbouring countries, including Mauritius and South Africa.

Border authorities do screen arriving passengers, but because of the rapid spread of the disease – and the rapid fatality of the plague – this is no guarantee that other countries will not be affected. In the 21st Century, the Black Death is once again a real concern.

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