Plague in Madagascar: not good, but not unusual either

Microbiology in the news again. This time it’s an outbreak of the plague in Madagascar, and it’s causing a bit of a stir.
Now, don’t get me wrong – an outbreak of plague is never a good thing – but once again, a little perspective is called for here. Surprise (and if I may be so bold) “surprise”.

Plague is one of those diseases which captures the public’s imagination, with historical tales about the Black Death sweeping across Europe in the Middle Ages and killing an awful lot of people in its path. And because of that history, plague has a cool nickname and a “superstar” disease status, and news outlets – desperate for clicks – are getting overly excited about it, just like they did with Ebola.

But the fact is that plague is not just a historical disease: yes, it was infamously around a few hundred years ago, but it never really went away. As with many diseases, its prevalence has merely declined due to better hygiene, better education, better pest control and better medical treatment. But even in (supposedly) developed countries like the USA, there are still up to 20 documented cases of plague each year. Worldwide, there are a few hundred reported cases each year, with a mortality rate of around 25%. However, it’s likely that there are many more unreported cases, given that it is now primarily a disease found in rural areas of less developed countries.

The bad news is that Madagascar is a less developed country than the USA (albeit that its gun control laws are somewhat better), and this makes outbreaks of plague (or any other infectious disease) more likely to occur there and more difficult to control once they do.

The better news is that while this is a terrible and potentially disastrous situation, at this point, it’s certainly not unusual. Madagascar is the plague capital of the world (look, it’s not a claim that they stick on their tourism posters) with around 80% of the world’s cases each year, and outbreaks occur almost annually around this time of year, as the temperatures start to rise and the rat and flea populations – vectors of the disease – start to increase.
Additionally, because of this recent history, the authorities will be better set up to deal with the outbreak, despite the challenges mentioned above. And as we saw with Ebola in West Africa in 2014, that’s really important. Also, as long as you can get treated promptly, as a bacterial disease, plague is eminently treatable with simple, basic, cheap antibiotics.

I’m in no way belittling a very serious situation, but if you didn’t get all panicky and excited about the plague outbreaks in Madagascar in, say, 2014 and 2015, then right now there’s really no reason to get carried away about this one either.

Two more ways microbiology is going to kill you

Well, I say two “more”, but in fact we’ve covered one of these on more than one occasion previously. That’s the issue of antibiotic resistance and the fact that we’re all – at some point or other – going to die a horrible infected death.

But we won’t be the first. Not by a long shot. Because The Centers for Disease Control and Prevention (CDC) in the US revealed (just before the Federal Shutdown) that of the 2 million plus Americans affected by antibiotic resistant bugs each year, around 23,000 will die. This is news because it’s the first time they’ve put a hard number on the number of deaths. And they’ve done it as objectively as possible:

The number of deaths is substantially lower than previous estimates, in part because researchers from the Centers for Disease Control and Prevention stripped out cases in which a drug-resistant infection was present but not necessarily the cause of death.

Which isn’t great, but does at least set down the ground rules – and therefore a baseline – for future calculations. Those future calculations are unlikely to be pretty:

“We are getting closer and closer to the cliff,” said Dr. Michael Bell, a CDC official who presented the data.

Yes, we know. Sally already told you that.

However, should you currently be in Madagascar (and especially in its prisons), antibiotic resistance is probably not going to worry you.

Yes, really.

Also known as The Black Death, this is exactly the same disease the swept through Europe in the 17th Century, killing about half the population of the continent. I remember a scare back in the lab in Oxford in the late 90s when one of our ID tests gave a result that could have indicated Y.pestis (the bug that cause bubonic plague) and everyone crapped themselves.
Fortunately, it turned out not to be the case and anyway, crapping oneself is not a symptom.

But now experts have warned that Madagascar is on the point of a major epidemic unless it slows the spread of the disease:

The Red Cross and Pasteur Institute say inmates in the island’s dirty, crowded jails are particularly at risk. The number of cases rises each October as hot humid weather attracts fleas, which transmit the disease from rats and other animals to humans. Madagascar had 256 plague cases and 60 deaths last year, the world’s highest recorded number.

Because this is a bacterial disease, it can easily be treated with antibiotics – and fortunately there are very few resistance problems in this case. For the moment at least.

The major issues with getting people treated are socioeconomic ones:

a lack of facilities and traditional shame over the disease made this tricky in outlying parts of Madagascar

Look, I’m not saying “don’t go to Madagascar”. It’s got a lot to offer: lemurs… and… stuff. But if you do go to Madagacar, it’s probably best to not end up in one of their prisons.

I’m sure you knew this already. I’m just saying that right now, it could be even worse than you expected.