Bubonic Plague Outbreak Investigation in the Endemic District of Tsiroanomandidy - Madagascar, October 2014

Background: Plague remains a major public health problem in Madagascar. Faced with reports of plague cases and deaths in Tsiroanomandidy district, we performed an investigation in October 2014.List of Abbreviations: BHCS: Basic Health Center; CDC: Control and prevention Diseases Center; DHS: District Health Service; IPM: Institut Pasteur de Madagascar; MOH: Ministry of Health; SMZ-TMP: Sulfamethoxazole Trimethoprim; WHO: World Health Organization Methods: We used the National plague control program case definition. We identified cases from outpatient registers and collected socio-demographic and clinical information. Plague circulation was determined through a retrospective environmental survey of rodents and vectors. Results: From August 1st to October 12th 2014, we identified 30 cases of which 13 deaths in 7 out of 17 municipalities; 18 were confirmed, 6 probable, and 6 suspected cases. The sex ratio (M/F) was 4:1. Yersinia pestis was isolated from Rattus rattus in one municipality. Flea index was 2.3. We collected 45 fleas through a trap set in a house 6 hours after insecticide spraying. Our aim was to describe the plague outbreak and to improve the national plague control strategies. Conclusion: The presence of infected flea and rodent maintain the persistence of plague in the municipalities investigated. There is a high risk of plague transmission to humans. This study showed that rodent and flea information are important for plague control strategies.