International travel and health

Plague - Madagascar

Information for international travellers

3 October 2017


An outbreak of pneumonic plaque is ongoing in Madagascar since August 2017. As of 30 September 2017, 73 cases (suspected, probable and confirmed) of pneumonic plague were reported by the country, 17 of whom have died. In addition, 58 cases of bubonic plague, including seven deaths, have been reported throughout the country. Most affected districts and cities include: Antananarivo (the capital city and its suburbs), Toamasina, and the rural district of Faratsiho. Cases were reported also from: Ambatondrazaka, Ambohidratrimo, Andramasina, Ankazobe, Anosibe An'ala, Anta-Atsimondrano, Anta-Avaradrano, Anta-Renivohitra, Arivonimamo, Faratsiho, Maevatanana, Mahajanga I, Miarinarivo, Moramanga, Toamasina I, Toamasina II, Tsiroanomandidy, Vohémar, and Ambalavao. Plague is an endemic disease in Madagascar, with cases of bubonic plague being reported nearly every year, particularly during the epidemic season between September and April. However, the ongoing pneumonic plague remains an unusual and serious event, particularly since it is occurring in densely populated coastal cities.

Advice for international travellers

Based on the available information to date, the risk of international spread of plague appears very low. WHO advises against any restriction on travel or trade on Madagascar based on the available information. International travellers should be informed about the current plague outbreak, the fact that plague is endemic in Madagascar, and should receive advice on prevention, post exposure chemoprophylaxis, and where to seek medical treatment should they develop plague related symptoms.

Travellers should also be aware that Madagascar is endemic for malaria and should consider the antimalarial prophylaxis recommended by WHO when travelling to Madagascar1 .

The risk of infection with Yersinia pestis for international travellers to Madagascar is generally low. However, travellers in rural areas of plague-endemic regions may be at risk, particularly if camping or hunting or if contact with rodents takes place. In addition, travellers to previously non-endemic regions from where cases of pneumonic plague have been recently reported should avoid crowded areas, avoid contact with dead animals, infected tissues or materials, and avoid close contact with patients with pneumonic plague. Travellers can protect against flea bites using repellent products for personal protection against mosquitoes, which may equally be protective against fleas and other blood-sucking insects. Formulations (lotions or sprays) based on the following active ingredients are recommended by the WHO Pesticides Evaluation Scheme (WHOPES)2 : DEET, IR3535, Icaridin (KBR3023) or Picaridin. WHO guidance for control of rodent fleas that transmit bubonic plague can be found below:

In case of sudden symptoms of fever, chills, painful and inflamed lymph nodes, or shortness of breath with coughing and/or blood-tainted sputum, travellers should immediately contact a medical service.

Prophylactic treatment is only recommended for persons who have been in close contact with plague cases, or with other high risk exposures (such as bites from infected fleas or direct contact with body fluids or tissues of infected animals). Travellers should immediately notify health care personnel or authority in case of contact and potential exposure to pneumonic plague patients or other high risk exposures and seek medical advice regarding chemoprophylaxis. Travellers should avoid self-administration with antibiotics as prophylaxis, unless recommended by medical professionals. Upon return from travel to Madagascar, travellers should be on alert for the above symptoms, and if symptoms appear, they should seek medical care and inform their physician about their travel history to Madagascar.

1 International Travel and Health. List of countries, territories and areas. Vaccination requirements and recommendations for international travellers, including yellow fever and malaria