The Black Death is killing people: Why is Madagascar facing its worst plague outbreak in years?

latimes.com | 10/3/2017 | Staff
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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.

Monday - Cases - Capital

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 - Island - Africa - East - Coast

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?

August - Man - Home - Toamasina - Town

In late August, a 31-year-old 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 - Version - Madagascar - Plague

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...
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