title: Epidemiologic features of four successive annual outbreaks of bubonic plague in Mahajanga, Madagascar.
abstract: From 1995 to 1998, outbreaks of bubonic plague occurred annually in the coastal city of Mahajanga, Madagascar. A total of 1,702 clinically suspected cases of bubonic plague were reported, including 515 laboratory confirmed by Yersinia pestis isolation (297), enzyme-linked immunosorbent assay, or both. Incidence was higher in males and young persons. Most buboes were inguinal, but children had a higher frequency of cervical or axillary buboes. Among laboratory-confirmed hospitalized patients, the case-fatality rate was 7.9%, although all Y. pestis isolates were sensitive to streptomycin, the recommended antibiotic. In this tropical city, plague outbreaks occur during the dry and cool season. Most cases are concentrated in the same crowded and unsanitary districts, a result of close contact among humans, rats, and shrews. Plague remains an important public health problem in Madagascar, and the potential is substantial for spread to other coastal cities and abroad.
authors.affiliation: Institut Pasteur, World Health Organization Collaborating Cernter for Plague, Antananarivo, Madagascar. pascal.boisier@wanadoo.fr
authors.forename: Pascal
authors.initials: P
authors.lastname: Boisier
authors.forename: Lila
authors.initials: L
authors.lastname: Rahalison
authors.forename: Monique
authors.initials: M
authors.lastname: Rasolomaharo
authors.forename: Maherisoa
authors.initials: M
authors.lastname: Ratsitorahina
authors.forename: Mahafaly
authors.initials: M
authors.lastname: Mahafaly
authors.forename: Maminirana
authors.initials: M
authors.lastname: Razafimahefa
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Duplantier
authors.forename: Lala
authors.initials: L
authors.lastname: Ratsifasoamanana
authors.forename: Suzanne
authors.initials: S
authors.lastname: Chanteau
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D015994:Incidence; D008270:Madagascar / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010930:Plague / Q000175:diagnosis / Q000453:epidemiology*; D017678:Sex Distribution; D014505:Urban Population; D015010:Yersinia pestis / Q000302:isolation & purification