[Recrudescence and geographic extension of the plague in Madagascar from 1980 to 1999].

Abstract

Plague was introduced to Madagascar in 1898, and it has been characterized by a predominant distribution to the central highlands in the following decades. An increase of plague cases has been observed in the past 20 years, in particular in the capital, Antananarivo, and in the coastal town, Mahajanga, after long periods of silence in 28 and 63 years, respectively. A total of 2,982 confirmed or presumptive cases were reviewed in order to describe the changes in the epidemiological pattern of the disease from 1980 through 1999. The mean annual number of plague cases has increased from 33 during the 1980-1984 period to 298 during the 1995-1999 period. A similar trend of distribution has been observed from the first period to the second by an increase of endemic districts above 800 m altitude from 17 to 37. However, the lethality rate has in the same 20 years observation period decreased from 41.6% to 20.7%, probably due to re-enforcing measures as part of the national control program.