Plague is endemic in Madagascar, with the country reporting about 400 cases annually, mainly the bubonic form of the disease. This is transmitted from rodent hosts to humans by fleas and generally affects people in poor, rural areas. The current outbreak is unusual, in that spread has occurred to some urban areas in the eastern, wetter side of the country, and also that about half of the cases have been the more contagious pneumonic form of disease. This has the ability to spread rapidly via droplets from infected people, and has a high mortality if not treated promptly.
To date, over a hundred cases with more than 70 being of the pneumonic form, and 21 deaths, have been reported. Ten towns and cities have been affected, most seriously neighbourhoods of the capital, Antananarivo, as well as Toamasina and Furatshio. The risk for travellers to Madagascar is generally low, but those camping or hunting in rural areas where plague is endemic may be at risk, as well as those visiting places where the current outbreak is occurring.
Travellers should avoid crowded areas, contact with rodents and dead animals, and close contact with patients with respiratory infections. Insect repellents, as used for mosquito bite prevention, will also discourage flea bites.