With the epidemiological reports posted by Madagascar's MOH becoming increasingly convoluted - and falling even farther behind the WHO's tally of cases and deaths - it has become increasingly difficult to use them to gauge the full extent of their pneumonic plague outbreak.
Exactly what is behind the stark (40%+) difference in cases totals being reported by the MOH and the WHO is unknown, although differences in what each consider `suspected' cases might be a factor.Today the WHO has updated their numbers again, through October 20th, which shows an increased of 68 cases, and 4 deaths over the last 24 hours of reporting. Once again we are seeing a large increase in the number of HCWs reported as infected (n=54).
Some excerpts from today's report follow:
Madagascar has been experiencing a large outbreak of plague affecting major cities and other non-endemic areas since August 2017. Between 1 August and 20 October 2017, a total of 1 365 cases (suspected, probable and confirmed) including 106 deaths (case fatality rate 7.8%) have been reported. Of these, 915 cases (67%) were clinically classified as pneumonic plague, 275 (20.1%) were bubonic plague, one case was septicaemic plague, and 174 cases were unspecified. Of the 915 cases of pulmonary plague, 160 (17.5%) have been confirmed, 375 (50%) were probable and 380 (41.5%) were suspected (further classification of cases is in process). A total of 54 healthcare workers have contracted plague since the beginning of the outbreak.
Of 1 087 cases with age and sex information available, 58% (544) were children and young people aged less than 21 years, while 36% (387) were adults aged between 21 and 40 years. Male were the most affected, accounting for 57% of all cases, and have experienced a slightly higher case fatality rates in comparison to females, 9.4% to 7.7%, respectively.
Of the 1365 cases, 219 were confirmed, 520 were probable and 626 remain suspected (additional laboratory results are in process). Eleven strains of Yersinia pestis have been isolated and were sensitive to antibiotics recommended by the National Program for the Control of Plague.
Overall, 40 out of 114 (35.1%) districts in 14 of 22 (63.6%) regions in the country have been affected by pulmonary plague. The district of Antananarivo Renivohitra has been the most affected, accounting for 41.4% of all reported cases.
On 20 October 2017, 1 385 out of 2 293 (60.4%) contacts were followed up and provided with prophylactic antibiotics. A total of 141 contacts completed the 7-day follow up without developing symptoms.
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