Plague in Madagascar
Several cases of plague have been reported in Madagascar since the beginning of August 2026. Control methods have been deployed, and public awareness programs are in place.
More than 200 individuals have received prophylactic medication as part of contact tracing. A major outbreak is unlikely.
Plague returned to Madagascar in the 1990s after a period of good control (less than 50 cases annually). More than 2,500 cases were suspected in 1997. The increase in notifications was attributed to a breakdown in traditional measures of rodent control.
More than 2,400 cases were reported in another outbreak in 2017. Eighty percent of cases were pneumonic plague with a fatality rate of 20%. Cases were concentrated in the main urban areas of Antananarivo and the seaport of Toamasina.
Madagascar and the Democratic Republic of the Congo (DRC) are responsible for most cases of global plague.
Plague in Russia: a laboratory death in Siberia
WHO reports on a plague death associated with a scientific lab in Russia. Should this raise any concerns for the international community?
The World Health Organisation (WHO) has recently commented on the mysterious death of a laboratory worker in a Russian plague research institute in Siberia.
Plague was mentioned in the initial posting from Russia, but it was later changed to "pneumonia of unknown aetiology". This should raise questions about occupational health and safety in the first instance; not international intrigue and biological weapons.
Research on plague as a biological weapon is not permitted under international law!
We know a great deal about plague and treatment protocols. If this is plague, how was it contracted and why was it fatal? According to the report more than 200 people have been quarantined since her death.
What is plague?
Plague is an infectious disease caused by a bacterium called Yersinia pestis.
It is transmitted to humans by the bite of an infected flea. The animal reservoir is usually a rodent. In Europe during the Middle Ages, the plague was responsible for more than 200 million deaths in three major pandemics. The name still conjures fears despite the fact we now have modern antibiotics to successfully treat the disease if recognised early.
Human disease is mostly bubonic plague where the infected individual presents with swollen lymph nodes (often in the groin). Gastrointestinal symptoms are common. Pneumonic plague may follow respiratory exposure to droplets from an infected person. This form is much less common but has a higher mortality (> 50%) versus 5% for bubonic plague. The last reported occurrence of human-to-human transmission was reported in 1924. Plague exists in nature in wild rodents in Asia, Africa and the Americas. Domesticated dogs and cats may carry infected fleas into the home.
The last recorded outbreak of plague in the UK was reported in 1918 and no cases, either local or imported, have been reported since then.
Heading somewhere remote?
Speak with one of our travel medicine doctors before you go. A virtual consultation covers your itinerary, the vaccinations you need and the insect precautions that matter for rural travel.
Plague is a notifiable disease in Australia
Australia experienced two periods of plague. The first between 1900 and 1910 and the second after 1920 for another five years. More than 1,200 cases were notified in the first period with most cases occurring in NSW. The outbreaks were coastal and mostly related to port areas. More than 500 deaths were recorded.
What is the risk for travellers?
Over 1,500 cases are reported to the World Health Organisation annually with mortality rates less than 10%. Very few cases are reported in major cities. Most occur in small rural villages in agricultural areas where rodents and farm produce co-exist.
According to the WHO, the three most endemic countries globally are the Democratic Republic of Congo, Madagascar and Peru. Australia does not have endemic plague.
The risk of exposure to plague is very low for both travellers and expatriate workers. Rural activities such as camping, trekking or hunting might increase your risk. Protection measures used for insects (clothing and repellents) can help to reduce bites.
Plague is occasionally diagnosed in the USA. For more information on prevention in the USA, see the CDC's plague prevention advice.
Information on plague and bioterrorism can be found on the CDC website.
