URBAN EPIDEMIC OF BUBONIC PLAGUE IN MAJUNGA, MADAGASCAR - EPIDEMIOLOGIC ASPECTS

After an absence of 62 years, an epidemic of plague occurred in the ha rbour city of Majunga (Madagascar) from July 1995 to March 1996, follo wing sporadic cases in March and May 1995. By 15 March 1996, 617 clini cally suspected cases of bubonic plague had been notified. Laboratory testing was carried out for 394 individuals: 60 (15.2%) were confirmed to have bubonic plague and 48 (12.2%) were considered as presumptive cases. The incidence was significantly higher in males in all age grou ps and in both sexes in the 5-19 age group. Twenty-four deaths were re lated to plague, but early treatment with streptomycin has confirmed i ts effectiveness insofar as the case-fatality ratio was only 8.7% amon g confirmed and presumptive cases admitted to hospital. The difficulty of clinically diagnosing bubonic plague was affirmed. The disease met favourable conditions through the poverty and low level of hygiene pr evalent in most parts of Majunga.