Popular Media Review - Outbreak of Bubonic plague in Madagascar

Controlling the spread of Yersinia pestis by spraying
antibiotics while cleaning a market in Madagascar (2)

In august of this year, Madagascar faced and is continuing to face the worst outbreak of bubonic plague that it has seen in 50 years (1). According to Dr. Tim Jagatic, the outbreak began when a man who traveled to the highlands returned to the capital and then the coastal city Tamateve by bus. Dr. Jagatic states that the man's bubonic plague had progressed to pneumonic plague, which can spread through coughing and infect others with bubonic plague (1). The man was in close quarters with others on the bus ride, and entered a cities where he came into contact with many people, a combination almost guaranteed to spread disease. Since then the outbreak has spread to over 2,000 people, more than 4 times the number that have been infected in past years (2). According to the same article, health workers tracked down around 7,000 people, and in total, over 9,000 ended up taking antibiotics. Even though there were so many reported cases, the disease did not leave the country and had an unusually low case fatality rate, so the spread could have been much worse (2). 

Potential pathway of pneumonic plague transmission (6)

To me this is a really scary event. Until learning more about this disease I did not think that it was something that should ever concern me because it seems like something that we can easily control the spread of and treat with antibiotics. this article puts into perspective how one case of the plague can be extremely deadly. Bubonic plague has a 1-15% chance of being fatal even if treated, which is not high, but if the infection persists, it can turn into pneumonic plague, which not only has a 40% chance of being lethal even with treatment, but can spread bubonic plague to others extremely easily (3). This, combined with knowing that only a couple years ago it would take 5 days to even diagnose bubonic plague (4) shows how easily and quickly the disease can spread undetected.

The article also mentioned two other scary facts. The plague emerged during a season where it is not usually seen (1), and it ran rampant through cities rather than the normal rural areas that it is usually confined to (2). The thought of an illness that wiped out a third of the European population being able to work its way through the population is terrifying, especially given that two antibiotic strains of the plague-causing bacteria have been identified in the location that is currently having a massive outbreak (5).

One of the treatment centers set up in Madagascar (1)

Even though I find this disease so alarming, the response of the WHO was so massive that I still have hope that we will be able to combat diseases like plague so that they will never become pandemics again. In Madagascar the WHO was able to set up nine plague treatment centers, use 2,000 healthcare workers to scour the area for infected, distribute 1.2 million doses of antibiotics (cant be too safe), create campaigns to educate people about the disease, and finally recruit the Madagascan prime minister is a part of the strategic response group (1).  It's incredible that that there were 2,000 people willing to help stop the spread of disease in Madagascar, and that those 2,000 people could track down 7,000 at risk individuals and distribute over 9,000 doses of antibiotics (2). The bubonic plague really buts into perspective how much damage one flea bite can cause, and how much money and manpower has to be used in order to deal with one outbreak. All i know is that if there is ever an outbreak of antibiotic resistant bubonic plague, I don't care if its half way around the world, you'll find me in Antarctica.   

References
(1) http://www.bbc.com/news/health-41844625
(2) https://www.npr.org/sections/goatsandsoda/2017/11/19/564821692/how-madagascar-took-control-of-its-bubonic-plague-outbreak
*References 1 and 2 are different articles that talk about the same event
(3) http://www.pbs.org/wgbh/rxforsurvival/series/diseases/plague.html
(4) Riehm JM, et al., Detection of Yersinia pestis using real-time PCR in patients with suspected bubonic plague, Molecular and Cellular Probes (2010), doi:10.1016/j.mcp.2010.09.002
(5) http://aac.asm.org/content/50/10/3233.full?site=AntimicrobAgentsChemother&utm_source=TrendMDAntimicrobAgentsChemother&utm_medium=trendmdantimicrobagentschemother&utm_campaign=TrendMD_AACCLIN_0
(6) https://www.pinterest.com/pin/295408056784139256