A Decade of Plague in Madagascar: A Description of Two Hot Spot Districts
Abstract Background Human plague cases, mainly the bubonic form, occur annually in the endemic regions of the central highlands of Madagascar. The aim of the study is to compare the evolution of the epidemiological features of human plague in two districts of the central highlands.Methods In Madagascar, all clinically suspected plague cases that meet clinical and epidemiological criteria specified in the World health organization standard case definition are reported to the national surveillance system. Data on plague cases reported between 2006 and 2015 in the districts of Ambositra and Tsiroanomandidy were analyzed. Statistical comparisons between the epidemiological characteristics of the two districts were conducted. Results A total of 840 cases were reported over the period studied, including 563 (67%) probable and confirmed cases (C+P). Of these C+P cases, nearly 91% (488/536) were cases of bubonic plague. Reported clinical forms of plague were significant for both districts during 2006 to 2015 (p=0.001). Plague cases occurred annually in a period of 10 years in Tsiroanomandidy district. One year of absence of cases characterized Ambositra district during the same period. Conclusion The differences in the epidemiological situation with respect to the plague from 2006 to 2015 in the two central highland districts may suggest that several factors other than biogeographical factors determine the expression of the plague and its evolution in this region. The need to take into account epidemiological situations according to the specific contexts of the districts could improve results in the fight against the plague in Madagascar.