Current epidemiology of human plague in Madagascar

From 1996 to 1998, 5 965 patients with suspected plague were identified in 38 districts of Madagascar (40% of the total population are exposed). Using standard bacteriology, 917 of them were confirmed or presumptive (C + P) c ases. However, more than 2 000 plague cases could be estimated using F1 ant igen assay. Two out of the 711 Yersina pestis isolates tested were resistan t to chloramphenicol and to ampicillin (both isolates found in the harbour of Mahajanga). Urban plague (Mahajanga harbour and Antananarivo city) accou nted for 37.4% of the C + P cases. Bubonic plague represented 97.2% of the cases, and the lethality rate was still high (20%). In comparing the expose d population, plague was more prevalent in males (M:F sex ratio 1.3:1)and p atients under 20 years (2.7% babies under two years). Buboes were mainly lo calised in the inguinal/femoral regions (55.8%). The epidemiological risk f actors are discussed. (C) 2000 Editions scientifiques et medicales Elsevier SAS.