Announcements October 16, 2017

Plague Outbreak in Madagascar

PIVOT is currently responding to plague in Madagascar.

Although Madagascar experiences an average of 400 cases of plague annually, this year’s outbreak began earlier than usual and has spread to major cities. The majority of current cases are of pneumonic plague, which is transmitted from person to person and fatal when left untreated. Plague is easily treatable when quality health care is accessible. PIVOT is partnering with the Ministry of Health to respond to the current crisis, and we need your help.

Disease Background

Plague is an infectious disease that is caused by the bacterium Yersinia pestis. The two most common clinical forms of plague infection are bubonic and pneumonic. Bubonic plague is most common, typically spread through the bite of infected fleas, frequently carried by rats. Pneumonic plague, the most virulent form, is typically spread to the lungs from advanced bubonic plague. However, any person with pneumonic plague may transmit the disease via airborne droplets – coughing or sneezing – to other humans. Both forms can be treated with antibiotics, making early detection a priority.

See WHO Plague Fact Sheet.

Current Outbreak

Since August, there have been 684 reported cases of either bubonic or pneumonic plague (suspected, probable and confirmed) and 57 deaths; an 8.3% fatality rate. Given the rapid evolution of the current plague outbreak, the reported number of cases is subject to change due to factors including increased surveillance and reclassified diagnoses.

The outbreak of plague continues to evolve throughout 35 of Madagascar’s 114 government districts. Of particular concern is the fact that the epidemic has reached regions of the country historically unaffected by plague. However, with both domestic and international responders working to contain the outbreak, the overall fatality rate has dropped over the past week: of the last 61 new cases reported, there have been 0 deaths.

The response coordinated by the Ministry of Health is organized into four areas including surveillance, community response, case management, and mass communication and awareness. Other major preventative efforts include coordinated training of health system personnel, mass-disinfection of public spaces, and bans on large public gatherings.

The first-ever plague emergency treatment unit has also been deployed by the Red Cross; Médecins du Monde is setting up 5 isolation and treatment centers in the capital of Antananarivo; and Doctors Without Borders has sent 70 responders to support cases in Toamasina.

PIVOT’s Comprehensive Response    

PIVOT’s approach to fighting plague is comprehensive, integrated, and in complete alignment with the Ministry of Health and other partners. Suspected cases of plague have been identified in our district and are being treated, with our clinical personnel responding directly through isolation and antibiotic treatment for patients and their families. We are working to curb the spread through both preventative measures and treatment, equipping the district’s facilities and clinicians, and maximizing the awareness of the disease through community mobilization district-wide.

Specifically, our response includes:

  • Initiating a district-wide mass information campaign about the plague outbreak
  • Training clinicians, community health workers, and community leaders to respond effectively to plague, and to make safe referrals
  • Creating a district emergency response committee in place to coordinate partners, government leaders, and community stakeholders
  • Providing strategic, logistical, and financial support the Ministry of Health and the local government.
  • Equipping health facilities to treat suspected cases.
  • Conducting disease surveillance, and generating information about on-the-ground needs and the state of the health system and our patients.

For most rural health centers, the lack of infrastructure to isolate cases is currently the most pressing challenge. PIVOT’s teams are doing whatever it takes to make sure we have the needed protective equipment, diagnostics and supplies in the face of a national shortage.

How You Can Help

1.) Stay informed.

We will continue to update this site with information on the current plague outbreak and PIVOT’s response activities. To receive email updates from PIVOT, subscribe here.

The WHO website also provides news alerts and up-to-date assessments on the outbreak.

2.) Support our work.

Madagascar remains susceptible to plague and many other easily treatable but deadly diseases because it one of the poorest countries in the world with one of the weakest health systems. In Ifanadiana District, PIVOT has been working to provide universal access to care and to build long-term systems that are ready to fight plague and all diseases that disproportionately affect the poor and vulnerable.

PIVOT is committed to staying until health care works for everyone and diseases like plague are truly a thing of the past. Please make a gift to support our response to this crisis and ongoing work to help save lives today and in the future.

Press Contact: Meg McCarty (