Bubonic plague kills 20 in Madagascar

Once feared as the Black Death, the rodent-borne disease that wiped out one-third of the world’s population in the Middle Ages, bubonic plague has killed 20 villagers in Madagascar in one of the worst outbreaks globally in recent years, health experts have confirmed.

The confirmation that bubonic plague was responsible for the deaths last week near the northwestern town of Mandritsara follows a warning in October from the International Committee of the Red Cross that the island nation was at risk of a plague epidemic.

The Pasteur Institute of Madagascar revealed on Tuesday that tests taken from bodies in the village last week showed they had died of the bubonic plague. The institute said it was concerned the disease could spread to towns and cities where living standards have declined since a coup in 2009.

The deaths are doubly concerning, because the outbreak occurred both outside the island’s normal plague season, which runs from July to October, and apparently at a far lower elevation than usual – suggesting it might be spreading.

Bubonic plague, which has disappeared from Europe and large parts of the globe, is spread by bites from plague-carrying fleas – Xenopsylla cheopis – whose main host is the black rat.

In Europe, the threat of the Black Death pandemic, which appeared with black rats brought by merchant ships from Asia, eventually died out as black rats were displaced by brown rats and health and hygiene improved.

Victims often develop painful swelling in the lymph nodes called buboes, flu-like symptoms and gangrene.

Although the disease is treatable with antibiotics, without treatment the mortality rate is almost two-thirds of those infected, according to the US Centres for Disease Control.

Last year, about 60 people died of plague in Madagascar – the highest number globally.

The disease is prevalent in the central highlands of Madagascar, where 200-400 confirmed cases are reported each year to the World Health Organisation. The disease first appeared in the country in 1898.
– (Guardian service)