The story of plague today should not be one of panic and fear.

A treatment is widely available that not only cures people affected with the disease, but is also used as a prophylaxis to prevent those at risk of falling ill.

From 2010 to 2015 there were 3,248 cases reported worldwide, including 584 deaths which did not all occur in the most endemic countries. The United States had 16 cases of bubonic plague in 2015, resulting in four deaths.

Currently, the three most endemic countries are Democratic Republic of Congo, Madagascar and Peru.

Current outbreak in Madagascar

Plague, Madagascar
Local MSF staff talking with a patient at the Health Center in Tamatave (also known as Toamasina) where MSF supports the MoH in the emergency response to the plague. Photo by: Riva Press

Doctors Without Borders (MSF) is currently responding to an outbreak of plague in Madagascar.

A team of international staff, including an epidemiologist, medical personnel, health promotion personnel, logisticians, water and sanitation specialists, are working alongside the Ministry of Health to curb the impact of the outbreak.

“The plague is understandably a scary disease, but quick, hands-on action can drastically lower the number of fatalities and bring the outbreak to an end,” says Luca Fontana, MSF water and sanitation specialist.

“Pneumonic plague is treatable and patients have 100 percent chance of making a full recovery."

By 21 October 2017 there were:

  • 846 cases of pneumonic plague in Madagascar
  • 270 cases of bubonic plague in Madagascar
  • 1 case of septicemic plague in Madagascar





  • What causes plague?

    The Yersina pestis bacteria can be found in about 200 species of mammals that live on every continent except for Oceania.

    As it lives in an animal host it is virtually impossible to eradicate.

    Bubonic plague

    Bubonic plague is transmitted to humans through infected fleas.

    It infects your lymphatic system (the immune system), causing inflammation.

    Untreated, it can move into the blood and cause septicemic plague, or to the lungs, causing pneumonic plague.

    When there is no contact with animals that carry plague-spreading fleas (most commonly rats), there is no cycle of infection.

    Bubonic plague outbreaks cannot therefore occur in places where there is no animal vector.

    Pneumonic plague

    Pneumonic plague is highly contagious and can be transmitted from person to person.

    It occurs when the bacteria infects the lungs, causing pneumonia.

    It is contracted when the bacteria are inhaled (primary infection) or develops when bubonic or septicemic plague spreads to the lungs (secondary infection).

    Pneumonic plague It is highly communicable under appropriate climate conditions, overcrowding and cool temperatures. Untreated pneumonic plague is frequently fatal.

    Septicemic plague

    Septicemic plague occurs when bacteria enter and multiply in the bloodstream directly. Left untreated, both bubonic and pneumonic plague can lead to septicemic plague.

  • Symptoms of plague

    Bubonic plague: sudden onset of fever, headache, chills and weakness. One or more swollen, tender and painful lymph nodes.

    Pneumonic plague: fever, headache, weakness, and a rapidly developing pneumonia with shortness of breath, chest pain, cough and sometimes bloody or watery mucous.

    Septicemic plague: Fever, chills, extreme weakness, abdominal pain, shock, possible bleeding into the skin and other organs. Skin and other tissues may turn black and die, especially fingers, toes and the nose.

  • Diagnosing plague

    Bubonic plague is diagnosed through a fluid sample from the lymph nodes.

    Pneumonic plague is diagnosed through an endoscopy, where fluid from the airways is extracted by a tube.

    A blood test can reveal if you have septicemic plague.

  • Treating plague

    Cheap, efficient and widely available antibiotics can treat plague, with 100 percent patient recovery if the treatment is started on time.

    Antibiotic treatment is also taken as a prophylaxis to provide full protection to people at risk, such as health professionals and people who have been in contact with infected patients.