ArticleThe Lancet. Infectious diseases2019
Epidemiological characteristics of an urban plague epidemic in Madagascar, August-November, 2017: an outbreak report.
Article in The Lancet. Infectious diseases, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 90 papers, 4 of them syntheses that pooled it.
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90 citing papers in PubMed, 4 syntheses or guidelines pooled it, 140 citations in OpenAlex.
- A systematic review of the clinical profile of patients with bubonic plague and the outcome measures used in research settings.PLoS neglected tropical diseases · 2023Pooled it
- Antimicrobial Treatment and Prophylaxis of Plague: Recommendations for Naturally Acquired Infections and Bioterrorism Response.MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports · 2021Guideline
- Rapid diagnostic tests for plague.The Cochrane database of systematic reviews · 2020Pooled it
- Safety of Antimicrobials During Pregnancy: A Systematic Review of Antimicrobials Considered for Treatment and Postexposure Prophylaxis of Plague.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2020Pooled it
- Clinical Characterization and Outcomes of Pneumonic Plague in Madagascar: A Case Series.Open forum infectious diseases · 2026Trial
- Ciprofloxacin versus Aminoglycoside-Ciprofloxacin for Bubonic Plague.The New England journal of medicine · 2025Trial
- Contributions of persisters and the Eagle effect to survival ofMicrobiology spectrum · 2026Article
- An adenoviral-vectored vaccine protects mice against aerosol challenge with Yersinia pestis.Molecular therapy : the journal of the American Society of Gene Therapy · 2026Article
- Experimental evidence of early-phase transmission of Yersinia pestis by Synopsyllus fonquerniei and Xenopsylla brasiliensis.PLoS neglected tropical diseases · 2026Article
- Surveillance and Analysis of Plague Epidemic - China, 2010-2024.China CDC weekly · 2026Article
- Vitamin D Status and Health Indicators in the Malagasy Population: A Pilot Study.Healthcare (Basel, Switzerland) · 2026Article
- Anti-infective compounds forSustainable microbiology · 2026Review
- Article
- Influence of natural and anthropogenic drivers on plague risk in Southwest China: A multicenter cross-sectional study.One health (Amsterdam, Netherlands) · 2025Article
- Evaluating the early diversification of Yersinia pestis and its phylogeographic expansion over 96 years of evolution in Madagascar.Communications biology · 2025Article
- First assessment of plague in terrestrial small mammals and fleas from Makira Natural Park and surroundings, North-eastern Madagascar.PLoS neglected tropical diseases · 2025Article
- Plagued by the Past, Pressed by the Present: A One Health Perspective onBiomedicines · 2025Review
- What are the Main Diagnoses in Hospitalized Patients in Madagascar ? A Sentinel Surveillance in 18 Hospitals from 2014 to 2018.Journal of epidemiology and global health · 2025Article
- Development and evaluation of a triplex real-time PCR assay for enhanced plague diagnostics in Madagascar.PLoS neglected tropical diseases · 2025Article
- Opportunities and challenges for plague vector control in Madagascar.PLoS neglected tropical diseases · 2025Review
30 more citing papers are in PubMed but not listed here.
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Authors and funding
26 authors at 6 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundMadagascar accounts for 75% of global plague cases reported to WHO, with an annual incidence of 200-700 suspected cases (mainly bubonic plague). In 2017, a pneumonic plague epidemic of unusual size occurred. The extent of this epidemic provides a unique opportunity to better understand the epidemiology of pneumonic plagues, particularly in urban settings.
methodsClinically suspected plague cases were notified to the Central Laboratory for Plague at Institut Pasteur de Madagascar (Antananarivo, Madagascar), where biological samples were tested. Based on cases recorded between Aug 1, and Nov 26, 2017, we assessed the epidemiological characteristics of this epidemic. Cases were classified as suspected, probable, or confirmed based on the results of three types of diagnostic tests (rapid diagnostic test, molecular methods, and culture) according to 2006 WHO recommendations.
findings2414 clinically suspected plague cases were reported, including 1878 (78%) pneumonic plague cases, 395 (16%) bubonic plague cases, one (<1%) septicaemic case, and 140 (6%) cases with unspecified clinical form. 386 (21%) of 1878 notified pneumonic plague cases were probable and 32 (2%) were confirmed. 73 (18%) of 395 notified bubonic plague cases were probable and 66 (17%) were confirmed. The case fatality ratio was higher among confirmed cases (eight [25%] of 32 cases) than probable (27 [8%] of 360 cases) or suspected pneumonic plague cases (74 [5%] of 1358 cases) and a similar trend was seen for bubonic plague cases (16 [24%] of 66 confirmed cases, four [6%] of 68 probable cases, and six [2%] of 243 suspected cases). 351 (84%) of 418 confirmed or probable pneumonic plague cases were concentrated in Antananarivo, the capital city, and Toamasina, the main seaport. All 50 isolated Yersinia pestis strains were susceptible to the tested antibiotics.
interpretationThis predominantly urban plague epidemic was characterised by a large number of notifications in two major urban areas and an unusually high proportion of pneumonic forms, with only 23% having one or more positive laboratory tests. Lessons about clinical and biological diagnosis, case definition, surveillance, and the logistical management of the response identified in this epidemic are crucial to improve the response to future plague outbreaks.
fundingUS Agency for International Development, WHO, Institut Pasteur, US Department of Health and Human Services, Laboratoire d'Excellence Integrative Biology of Emerging Infectious Diseases, Models of Infectious Disease Agent Study of the National Institute of General Medical Sciences, AXA Research Fund, and the INCEPTION programme.
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