The Travel Health and Vaccine Specialists

Health Alert


Plague in Madagascar

Updated January 17, 2018

Released: December 07, 2017

The outbreak is now contained.

Original publication date: October 13, 2017

What is the situation in Madagascar?
From August to November 2017, Madagascar experienced a serious outbreak of pneumonic plague. On November 27, the WHO reported that this outbreak has been contained. It is expected that cases of plague will continue to be reported in Madagascar. Cases are expected to be mostly bubonic plague as bubonic plague is reported nearly every year between September and April in Madagascar.

Although the outbreak has been contained, the World Health Organization and Madagascar’s Ministry of Public Health are still monitoring and responding to this situation. To help prevent international spread of plague, they have implemented exit screening for those departing the country.

Exit screening occurs at airport, ports, and border crossings. This may include:

completing a health questionnaire
testing for the presence of fever
assessment of symptoms
Cooperation with exit screening helps to contain a disease, and prevent a larger epidemic.

What is plague?
Plague is a disease caused by the bacteria Yersinia pestis. This bacteria is usually found in small animals (including rats, squirrels and other rodents) and their fleas.

You can become infected with plague through:

the bite of a flea infected with the plague bacteria
direct contact with infectious tissues or fluids while handling an animal or human that is sick with or that has died from plague
breathing of respiratory droplets from an animal or human with pneumonic plague.
There are three types of plague:

Bubonic plague is the most common form of plague. Infection of the lymph nodes by the plague bacteria (referred to as buboes) causes them to swell and become painful. This form of plague usually occurs from bites of infected fleas.
Septicemic plague occurs when the infection spreads through the blood. It can cause bleeding, and tissue to turn black, especially on fingers, toes, and the nose. This form results from bites of infected fleas or from handling infected animals.
Pneumonic plagueis the most serious form of plague. Pneumonic plague is caused by breathing in droplets from the cough of an infected person or animal. It is also caused by untreated bubonic or septicemic plague bacteria that spread to the lungs. It is the only form of plague that can be spread from person to person via droplets in the air.
What are the symptoms of plague?
Symptoms of plague can appear one to seven days after contact and they can vary depending on the form of plague. They are usually flu-like and can include the following:

weakness and headache
shortness of breath, chest pain, cough and bloody/watery mucous
painful and swollen lymph nodes (buboes)
muscle pain
nausea, vomiting
diarrhea, abdominal pain
Is there a vaccine for plague?
There is no vaccine available for travellers.

All forms of plague can be effectively treated with antibiotics if diagnosed early. If left untreated it can progress rapidly to death.

How can you protect yourself from plague?
Before you travel you should:

Consult a health care provider or visit a travel health clinic preferably six weeks before you travel.

During your trip:

Protect yourself from flea bites while travelling to Madagascar.

Use insect repellent on exposed skin
Cover up: wear light-coloured, long–sleeved shirts and long pants
Avoid contact with:

rodent nests and burrows as these could contain fleas
sick or dead animals.
close contact with persons who are sick or persons suspected of infection with pneumonic plague.
crowded areas where pneumonic plague have been recently reported
bodies of people who died of plague or unkown illnesses, including during funeral or burial rituals.
If you have had contact with someone with pneumonic plague, you should immediately contact a health care provider. You may need antibiotics to prevent infection.

Wash your hands frequently.

Wash your hands often with soap and water for at least 20 seconds.
Use alcohol-based hand sanitizer if soap and water are not available. Keep a bottle with you when you travel.
Health care workers that may come into contact with someone with pneumonic plague:

should practise strict infection prevention and control measures including the appropriate use of personal protective equipment
take antibiotics to prevent infection
While you are in Madagascar, or returning to Canada:

Monitor your health

If you develop symptoms of plague:

See a health care provider immediately during your trip, or after you return home. Tell them about your symtoms and about your travel to Madagascar.
Tell a flight attendant or border services officer when entering Canada. They will notify a quarantine officer who can assess the symptoms.
Follow any exit screening protocols where required.
Stop the spread of germs

You should not travel if you are ill, or have been in contact with someone who shows symptoms or has been diagnosed with plague.
Avoid close contact with other people. Practise proper cough and sneeze etiquette – cover your mouth and nose with your arm, not your hand.
Registration of Canadians Abroad
Sign up for free with the Registration of Canadians Abroad (ROCA) service to stay connected with the Government of Canada in case of an emergency abroad or at home.

Related links
Plague Fact Sheet
Assistance – sickness or injury
Returning to Canada – if you get sick
Country advice and advisories
Registration of Canadians Abroad
Other Resources
World Health Organization – Facts about plague
World Health Organization – Information for international travellers
World Health Organization – Disease outbreak news