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Current Situation and Management of Plague Cases in Madagascar

Alain Marcel Rahetilahy

Madagascar is the most affected country by the plague in the world, where the disease is still endemic and epidemic. 300 to 600 cases are reported annually by the basic health centers and the lethality ranges from 20 to 30%.

The objective of this communication is to share the current situation and the management of common communicable disease and those currently emerging such as plague to the participants of the scientific days organized by the Société de Pathologie Infectieuse de Madagascar (SPIM), held at the Malagasy Academy Tsimbazaza from November 15th, 16th 2016.

In Madagascar, the fight against plague is based on: (i) epidemiological surveillance, (ii) early diagnosis and rapid response to cases; (iii) chemoprophylaxis of contacts, (iv) disinfection of the premises of the patients, (v) disinfection of the huts in and around the homes within a radius of 200 meters, (vi) control of the rats and fleas, (vii) Behavior Change Communication, as well as operational research which are also essential for the success of the program.

Principles of treatment during the case management of plague: free of charge treatment, early and correct treatment, on the spot, and according to the specific standard of the National Program of Plague Control; biological sampling of the bubo and/or sputum to be made with on-site screening using the rapid diagnosis test before implementing the treatment. Streptomycin, at a divided dose, for 4 days relayed by sulfamethoxazole-trimethoprim for 6 days from the 3rd day of treatment is the standard specific treatment for bubonic plague; whereas streptomycin alone is to be administered for 8 to 10 days for the treatment of pulmonary plague.

The plague does exist in the country for more than a century, exactly 118 years. "We are pleased to hear today that men walked on the moon. We hope that one day the plague will eradicated from this planet.