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Pneumonic Plague Transmission, Moramanga, Madagascar, 2015

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ABSTRACT

During a pneumonic plague outbreak in Moramanga, Madagascar, we identified 4 confirmed, 1 presumptive, and 9 suspected plague case-patients. Human-to-human transmission among close contacts was high (reproductive number 1.44) and the case fatality rate was 71%. Phylogenetic analysis showed that the Yersinia pestis isolates belonged to group q3, different from the previous outbreak.

No MeSH data available.


Related in: MedlinePlus

Map of pneumonic plague outbreak (n = 14) in the commune of Ampasipotsy Gara in Moramanga, Madagascar, 2015. The index case-patient (case-patient 1) was infected with Yersinia pestis at Antsahatsianarina and spread the bacterium to Beravina (burial site of case-patient 1), Ambilona (case-patient 10’s home), and Ambatoharanana (burial site of case-patient 2 and home of case-patient 14). Each pie chart indicates the proportions of plague cases (red), seropositive contacts (blue), seronegative contacts (green), unsampled contacts (yellow), and noncontacts (brown) among the total inhabitants of each site. Pie chart details are given in the Technical Appendix).
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Figure 2: Map of pneumonic plague outbreak (n = 14) in the commune of Ampasipotsy Gara in Moramanga, Madagascar, 2015. The index case-patient (case-patient 1) was infected with Yersinia pestis at Antsahatsianarina and spread the bacterium to Beravina (burial site of case-patient 1), Ambilona (case-patient 10’s home), and Ambatoharanana (burial site of case-patient 2 and home of case-patient 14). Each pie chart indicates the proportions of plague cases (red), seropositive contacts (blue), seronegative contacts (green), unsampled contacts (yellow), and noncontacts (brown) among the total inhabitants of each site. Pie chart details are given in the Technical Appendix).

Mentions: Before illness onset, case-patients 2–14 had social or spatial contact with a symptomatic person who could be traced back to case-patient 1. Two of the deceased case-patients (2 and 10) were visitors to Antsahatsianarina who had returned home to their respective communities Ambatoharanana and Ambilona (Figure 2), potentially spreading the bacterium to others. To investigate the extent of pathogen spread, we identified 123 case-patient contacts in 4 communities connected with case-patient 1 (Technical Appendix Table). On August 24, 2015, an outbreak investigation protocol was applied by the Institut Pasteur de Madagascar and the Malagasy Ministry of Health, whose ethics committee approved the study (068-MSANP/CE). Verbal consent was obtained from 71 contacts to test their serum for plague antibody with a capsular antigen fraction 1 (F1) IgG ELISA (10,11); 7/20 (35%) contacts from Antsahatsianarina, 12/20 (60%) from Beravina (the burial site of case-patient 1), 9/10 (90%) from Ambilona, and 7/21 (33%) from Ambatoharanana were seropositive (Figure 2; Technical Appendix Table). The 35 contacts positive for F1-specific antibody were given chemoprophylaxis, and their infections remained subclinical.


Pneumonic Plague Transmission, Moramanga, Madagascar, 2015
Map of pneumonic plague outbreak (n = 14) in the commune of Ampasipotsy Gara in Moramanga, Madagascar, 2015. The index case-patient (case-patient 1) was infected with Yersinia pestis at Antsahatsianarina and spread the bacterium to Beravina (burial site of case-patient 1), Ambilona (case-patient 10’s home), and Ambatoharanana (burial site of case-patient 2 and home of case-patient 14). Each pie chart indicates the proportions of plague cases (red), seropositive contacts (blue), seronegative contacts (green), unsampled contacts (yellow), and noncontacts (brown) among the total inhabitants of each site. Pie chart details are given in the Technical Appendix).
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Related In: Results  -  Collection

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Figure 2: Map of pneumonic plague outbreak (n = 14) in the commune of Ampasipotsy Gara in Moramanga, Madagascar, 2015. The index case-patient (case-patient 1) was infected with Yersinia pestis at Antsahatsianarina and spread the bacterium to Beravina (burial site of case-patient 1), Ambilona (case-patient 10’s home), and Ambatoharanana (burial site of case-patient 2 and home of case-patient 14). Each pie chart indicates the proportions of plague cases (red), seropositive contacts (blue), seronegative contacts (green), unsampled contacts (yellow), and noncontacts (brown) among the total inhabitants of each site. Pie chart details are given in the Technical Appendix).
Mentions: Before illness onset, case-patients 2–14 had social or spatial contact with a symptomatic person who could be traced back to case-patient 1. Two of the deceased case-patients (2 and 10) were visitors to Antsahatsianarina who had returned home to their respective communities Ambatoharanana and Ambilona (Figure 2), potentially spreading the bacterium to others. To investigate the extent of pathogen spread, we identified 123 case-patient contacts in 4 communities connected with case-patient 1 (Technical Appendix Table). On August 24, 2015, an outbreak investigation protocol was applied by the Institut Pasteur de Madagascar and the Malagasy Ministry of Health, whose ethics committee approved the study (068-MSANP/CE). Verbal consent was obtained from 71 contacts to test their serum for plague antibody with a capsular antigen fraction 1 (F1) IgG ELISA (10,11); 7/20 (35%) contacts from Antsahatsianarina, 12/20 (60%) from Beravina (the burial site of case-patient 1), 9/10 (90%) from Ambilona, and 7/21 (33%) from Ambatoharanana were seropositive (Figure 2; Technical Appendix Table). The 35 contacts positive for F1-specific antibody were given chemoprophylaxis, and their infections remained subclinical.

View Article: PubMed Central - PubMed

ABSTRACT

During a pneumonic plague outbreak in Moramanga, Madagascar, we identified 4 confirmed, 1 presumptive, and 9 suspected plague case-patients. Human-to-human transmission among close contacts was high (reproductive number 1.44) and the case fatality rate was 71%. Phylogenetic analysis showed that the Yersinia pestis isolates belonged to group q3, different from the previous outbreak.

No MeSH data available.


Related in: MedlinePlus