‘We are de­feated’: Black Death rages in Mada­gas­car

Why the is­land coun­try is fac­ing its worst plague out­break in years

Los Angeles Times - - NEWS - By Robyn Dixon robyn.dixon@la­times.com Twit­ter: @RobynDixon_LAT

JO­HAN­NES­BURG, South Africa — Mada­gas­car sees cases of plague nearly ev­ery year in the rainy sea­son.

This year is dif­fer­ent. In­stead of cases in the hin­ter­lands where plague is en­demic, the dis­ease — which is ini­tially spread by flea bites and was known as the Black Death in me­dieval times — has spread to the cap­i­tal, Antananarivo, and other densely pop­u­lated cities for the first time, killing 45 peo­ple and spark­ing panic.

By Mon­day, 387 cases had been re­ported, in­clud­ing 167 in the densely pop­u­lated cap­i­tal.

The big­gest prob­lem for au­thor­i­ties try­ing to con­trol the out­break is that it took two weeks af­ter the first case to de­tect it, and that most cases — 277 so far — have been a par­tic­u­larly vir­u­lent form of the dis­ease.

Mada­gas­car, an is­land off Africa’s east coast, is the coun­try most se­ri­ously af­fected by plague, but oth­ers, in­clud­ing the United States, Rus­sia, China, Peru, Bo­livia and sev­eral African na­tions, reg­u­larly re­port cases.

How did the dis­ease spread so fast?

In late Au­gust, a 31-yearold man trav­eled from his home in Toa­masina, a town on Mada­gas­car’s east coast, to the cen­tral high­lands town of Anka­zobe, in a re­gion where plague is en­demic. When he came down with fever, a headache and fa­tigue, he prob­a­bly as­sumed he had malaria, a com­mon ill­ness through­out Africa.

But plague has many of the same symp­toms. Bubonic plague is eas­ily treated with an­tibi­otics, but if un­treated it can reach the lungs, de­vel­op­ing into pneu­monic plague, which can kill a pa­tient within 24 hours.

Pneu­monic plague, the ver­sion that is spread­ing rapidly in Mada­gas­car, is more vir­u­lent and dan­ger­ous than bubonic plague, be­cause it is swiftly spread through in­fected droplets coughed into the air.

Four days af­ter he be­came ill, the man boarded a bush taxi, or com­muter minibus, and made the jour­ney home, pass­ing through the cap­i­tal. On the way, he de­vel­oped res­pi­ra­tory symp­toms, in­di­cat­ing the dis­ease had spread to his lungs. He died shortly af­ter he reached home.

His body was pre­pared for burial at the near­est hospi­tal in Mo­ra­manga district, which, like Toa­masina, does not or­di­nar­ily see cases of plague, so the staff took no pre­cau­tions to pre­vent in­fec­tion.

The sick man came into con­tact with dozens of peo­ple, at least 31 peo­ple of whom fell ill, four of whom died.

Au­thor­i­ties didn’t re­al­ize they were deal­ing with the more vir­u­lent form of plague un­til Sept. 11, when a 47-year-old wo­man with pneu­monic plague died in a hospi­tal in Antananarivo.

The de­lay was dis­as­trous.

In re­cent days, the dis­ease has spread more quickly. On Oct. 5, there were 258 cases, ac­cord­ing to the Health Min­istry. By Mon­day the num­ber was 387, in­clud­ing 312 in Antananarivo and Toa­masina.

By late last month, cases of pneu­monic plague were pop­ping up in 20 dis­tricts across the coun­try, in­clud­ing the far north and the west coast. Au­thor­i­ties fear the dis­ease will con­tinue to spread.

How dan­ger­ous is the plague out­break?

Plague sea­son in Mada­gas­car is just get­ting started and hun­dreds have al­ready fallen ill, pos­ing the threat that the num­ber of deaths this year could far sur­pass last year’s to­tal of 52.

The sea­son of plague in Mada­gas­car usu­ally runs from Septem­ber to April — spring to fall in the South­ern Hemi­sphere. Health au­thor­i­ties are con­cerned the dis­ease could spread fur­ther, with cases of pneu­monic plague al­ready be­ing re­ported around the coun­try.

Plague is dan­ger­ous if left un­treated. The dis­ease is spread by a bac­te­ria, Yersinia pestis, and ini­tially spread by fleas car­ried by rats, prairie dogs and other small mam­mals.

“Plague is a dis­ease of poverty. It thrives in places with poor san­i­tary con­di­tions and in­ad­e­quate health ser­vices. It can kill quickly if left un­treated, but can also be cured by an­tibi­otics if de­liv­ered early,” the World Health Or­ga­ni­za­tion said in a state­ment.

In Mada­gas­car’s cap­i­tal, the wards in the main hospi­tal are full and two tents have been erected on the grounds to treat pa­tients, ac­cord­ing to lo­cal me­dia.

The out­break has caused panic, with re­ports of peo­ple buy­ing an­tibi­otics from drug­stores, un­aware whether they were get­ting the cor­rect drug.

The par­ents of one small boy sus­pected of hav­ing pneu­monic plague took him from the hospi­tal and fled, pos­ing a risk to his life, them­selves and any other peo­ple he might come in con­tact with, Dr. Man­i­tra Rako­toarivony told lo­cal me­dia.

At least two par­tic­i­pants in an in­ter­na­tional bas­ket­ball com­pe­ti­tion in Antananarivo last week con­tracted the ill­ness, in­clud­ing a South African sports of­fi­cial who tested pos­i­tive Tues­day and a Sey­chel­lois coach who died late last month.

The WHO fears other par­tic­i­pants may have con­tracted the dis­ease, and all par­tic­i­pants are be­ing mon­i­tored to pre­vent the spread of the dis­ease over­seas.

What is be­ing done to stop the plague from spread­ing?

In Antananarivo, the govern­ment has tem­po­rar­ily closed uni­ver­si­ties and schools for dis­in­fec­tion and has banned pub­lic gath­er­ings to try to pre­vent the dis­ease from spread­ing fur­ther.

Peo­ple are buy­ing masks to pro­tect them­selves and au­thor­i­ties have warned mem­bers of the pub­lic to seek swift treat­ment if they ex­pe­ri­ence flu-like symp­toms.

District and neigh­bor­hood lead­ers have been warned to keep track of peo­ple en­ter­ing their ar­eas and en­sure that cases of plague are re­ported.

But Mada­gas­car’s poorly equipped health sys­tem is one of the many chal­lenges in over­com­ing the spread of the dis­ease. In lo­cal health cen­ters, staff lack ba­sic pro­tec­tive gar­ments to guard against in­fec­tion.

The coun­try is im­pov­er­ished, with many peo­ple un­able to af­ford ba­sic ex­penses such as trans­porta­tion. Peo­ple of­ten tend to self-med­i­cate, buy­ing cheap medicines at shops, rather than go­ing to a hospi­tal or clinic.

The mayor of Toa­masina, El­y­see Rat­sir­aka, said last week that the out­break had over­whelmed the state and called on the govern­ment to seek more in­ter­na­tional help.

“Let’s be prag­matic. Let’s be re­al­is­tic. We are de­feated by the plague. You can leave your house to­day and catch the plague to­mor­row,” Rat­sir­aka said.

The WHO has de­liv­ered 1.2 mil­lion doses of an­tibi­otics and will spend $1.5 mil­lion to con­trol the spread of the dis­ease.

How widely could the plague spread?

Ac­cord­ing to the WHO, the risk that the plague will spread through­out Mada­gas­car is high.

“Pneu­monic plague is a form of plague that is trans­mis­si­ble from per­son to per­son, with a po­ten­tial to trig­ger se­vere epi­demics if in­ad­e­quately con­trolled,” the or­ga­ni­za­tion said in a state­ment.

It said there was also a mod­er­ate risk the dis­ease could spread to other coun­tries in Africa, be­cause there are fre­quent flights to nearby coun­tries and In­dian Ocean islands.

But ac­cord­ing to the WHO, the dan­ger of the plague spread­ing around the globe is low.

Ri­ja­solo AFP/Getty Im­ages

HEALTH MIN­ISTRY work­ers spray pes­ti­cide to kill plague-car­ry­ing f leas at a pri­mary school in Antananarivo, Mada­gas­car’s cap­i­tal. More than 380 cases of plague have been re­ported in the coun­try this year.

Alexan­der Joe As­so­ci­ated Press

MASKS are put on chil­dren in Antananarivo. Pneu­monic plague, the ver­sion that is rag­ing in Mada­gas­car, can spread through in­fected droplets from coughs.

Newspapers in English

Newspapers from USA

© PressReader. All rights reserved.