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F Rakotomanana - One of the best experts on this subject based on the ideXlab platform.

  • epidemiological characteristics of an urban Plague epidemic in madagascar august november 2017 an outbreak report
    Lancet Infectious Diseases, 2019
    Co-Authors: Rindra Vatosoa Randremanana, Voahangy Andrianaivoarimanana, Birgit Nikolay, Beza Ramasindrazana, Juliette Paireau, Quirine Ten A Bosch, Jean Marius Rakotondramanga, Soloandry Rahajandraibe, Soanandrasana Rahelinirina, F Rakotomanana
    Abstract:

    Summary Background Madagascar accounts for 75% of global Plague cases reported to WHO, with an annual incidence of 200–700 suspected cases (mainly bubonic Plague). In 2017, a pneumonic Plague epidemic of unusual size occurred. The extent of this epidemic provides a unique opportunity to better understand the epidemiology of pneumonic Plagues, particularly in urban settings. Methods Clinically suspected Plague cases were notified to the Central Laboratory for Plague at Institut Pasteur de Madagascar (Antananarivo, Madagascar), where biological samples were tested. Based on cases recorded between Aug 1, and Nov 26, 2017, we assessed the epidemiological characteristics of this epidemic. Cases were classified as suspected, probable, or confirmed based on the results of three types of diagnostic tests (rapid diagnostic test, molecular methods, and culture) according to 2006 WHO recommendations. Findings 2414 clinically suspected Plague cases were reported, including 1878 (78%) pneumonic Plague cases, 395 (16%) bubonic Plague cases, one ( Yersinia pestis strains were susceptible to the tested antibiotics. Interpretation This predominantly urban Plague epidemic was characterised by a large number of notifications in two major urban areas and an unusually high proportion of pneumonic forms, with only 23% having one or more positive laboratory tests. Lessons about clinical and biological diagnosis, case definition, surveillance, and the logistical management of the response identified in this epidemic are crucial to improve the response to future Plague outbreaks. Funding US Agency for International Development, WHO, Institut Pasteur, US Department of Health and Human Services, Laboratoire d'Excellence Integrative Biology of Emerging Infectious Diseases, Models of Infectious Disease Agent Study of the National Institute of General Medical Sciences, AXA Research Fund, and the INCEPTION programme.

  • epidemiological characteristics of an urban Plague epidemic in madagascar august november 2017 an outbreak report
    Lancet Infectious Diseases, 2019
    Co-Authors: Rindra Vatosoa Randremanana, Voahangy Andrianaivoarimanana, Birgit Nikolay, Beza Ramasindrazana, Juliette Paireau, Quirine Ten A Bosch, Jean Marius Rakotondramanga, Soloandry Rahajandraibe, Soanandrasana Rahelinirina, F Rakotomanana
    Abstract:

    Summary Background Madagascar accounts for 75% of global Plague cases reported to WHO, with an annual incidence of 200–700 suspected cases (mainly bubonic Plague). In 2017, a pneumonic Plague epidemic of unusual size occurred. The extent of this epidemic provides a unique opportunity to better understand the epidemiology of pneumonic Plagues, particularly in urban settings. Methods Clinically suspected Plague cases were notified to the Central Laboratory for Plague at Institut Pasteur de Madagascar (Antananarivo, Madagascar), where biological samples were tested. Based on cases recorded between Aug 1, and Nov 26, 2017, we assessed the epidemiological characteristics of this epidemic. Cases were classified as suspected, probable, or confirmed based on the results of three types of diagnostic tests (rapid diagnostic test, molecular methods, and culture) according to 2006 WHO recommendations. Findings 2414 clinically suspected Plague cases were reported, including 1878 (78%) pneumonic Plague cases, 395 (16%) bubonic Plague cases, one ( Interpretation This predominantly urban Plague epidemic was characterised by a large number of notifications in two major urban areas and an unusually high proportion of pneumonic forms, with only 23% having one or more positive laboratory tests. Lessons about clinical and biological diagnosis, case definition, surveillance, and the logistical management of the response identified in this epidemic are crucial to improve the response to future Plague outbreaks. Funding US Agency for International Development, WHO, Institut Pasteur, US Department of Health and Human Services, Laboratoire d'Excellence Integrative Biology of Emerging Infectious Diseases, Models of Infectious Disease Agent Study of the National Institute of General Medical Sciences, AXA Research Fund, and the INCEPTION programme.

Rindra Vatosoa Randremanana - One of the best experts on this subject based on the ideXlab platform.

  • an open label randomized non inferiority trial of the efficacy and safety of ciprofloxacin versus streptomycin ciprofloxacin in the treatment of bubonic Plague imasoy study protocol for a randomized control trial
    Trials, 2020
    Co-Authors: Rindra Vatosoa Randremanana, Voahangy Andrianaivoarimanana, M Raberahona, Randria Mjdd., Minoarisoa Rajerison, A Legrand, T F Rasoanaivo, R Randriamparany, T Mayouyagamana, R. Mangahasimbola
    Abstract:

    BACKGROUND Bubonic Plague is the primary manifestation of infection with Yersinia pestis, accounting for 90% of all Plague cases and with 75% of global cases reported in Madagascar. All drugs in use for treating Plague are registered based on experimental data and anecdotal evidence, and no regimen currently recommended is supported by a randomized clinical trial. The IMASOY trial intends to fill this knowledge gap by comparing two 10-day regimens included in the national guidelines in Madagascar. The primary objective of the trial is to test the hypothesis that ciprofloxacin monotherapy is non-inferior to streptomycin followed by ciprofloxacin for the treatment of bubonic Plague, thus avoiding the need for injectable, potentially toxic, aminoglycosides. METHODS A two-arm parallel-group randomized control trial will be conducted across peripheral health centres in Madagascar in five districts. Males and non-pregnant females of all ages with suspected bubonic or pneumonic Plague will be recruited over the course of three Plague 'seasons'. The primary endpoint of the trial is to assess the proportion of patients with bubonic Plague who have a therapeutic response to treatment (defined as alive, resolution of fever, 25% reduction in the size of measurable buboes, has not received an alternative treatment and no clinical decision to continue antibiotics) as assessed on day 11. DISCUSSION If successful, the trial has the potential to inform the standard of care guidelines not just in Madagascar but in other countries afflicted by Plague. The trial is currently ongoing and expected to complete recruitment in 2022. TRIAL REGISTRATION ClinicalTrials.gov NCT04110340 . Registered on 1 October 2019.

  • epidemiological characteristics of an urban Plague epidemic in madagascar august november 2017 an outbreak report
    Lancet Infectious Diseases, 2019
    Co-Authors: Rindra Vatosoa Randremanana, Voahangy Andrianaivoarimanana, Birgit Nikolay, Beza Ramasindrazana, Juliette Paireau, Quirine Ten A Bosch, Jean Marius Rakotondramanga, Soloandry Rahajandraibe, Soanandrasana Rahelinirina, F Rakotomanana
    Abstract:

    Summary Background Madagascar accounts for 75% of global Plague cases reported to WHO, with an annual incidence of 200–700 suspected cases (mainly bubonic Plague). In 2017, a pneumonic Plague epidemic of unusual size occurred. The extent of this epidemic provides a unique opportunity to better understand the epidemiology of pneumonic Plagues, particularly in urban settings. Methods Clinically suspected Plague cases were notified to the Central Laboratory for Plague at Institut Pasteur de Madagascar (Antananarivo, Madagascar), where biological samples were tested. Based on cases recorded between Aug 1, and Nov 26, 2017, we assessed the epidemiological characteristics of this epidemic. Cases were classified as suspected, probable, or confirmed based on the results of three types of diagnostic tests (rapid diagnostic test, molecular methods, and culture) according to 2006 WHO recommendations. Findings 2414 clinically suspected Plague cases were reported, including 1878 (78%) pneumonic Plague cases, 395 (16%) bubonic Plague cases, one ( Yersinia pestis strains were susceptible to the tested antibiotics. Interpretation This predominantly urban Plague epidemic was characterised by a large number of notifications in two major urban areas and an unusually high proportion of pneumonic forms, with only 23% having one or more positive laboratory tests. Lessons about clinical and biological diagnosis, case definition, surveillance, and the logistical management of the response identified in this epidemic are crucial to improve the response to future Plague outbreaks. Funding US Agency for International Development, WHO, Institut Pasteur, US Department of Health and Human Services, Laboratoire d'Excellence Integrative Biology of Emerging Infectious Diseases, Models of Infectious Disease Agent Study of the National Institute of General Medical Sciences, AXA Research Fund, and the INCEPTION programme.

  • epidemiological characteristics of an urban Plague epidemic in madagascar august november 2017 an outbreak report
    Lancet Infectious Diseases, 2019
    Co-Authors: Rindra Vatosoa Randremanana, Voahangy Andrianaivoarimanana, Birgit Nikolay, Beza Ramasindrazana, Juliette Paireau, Quirine Ten A Bosch, Jean Marius Rakotondramanga, Soloandry Rahajandraibe, Soanandrasana Rahelinirina, F Rakotomanana
    Abstract:

    Summary Background Madagascar accounts for 75% of global Plague cases reported to WHO, with an annual incidence of 200–700 suspected cases (mainly bubonic Plague). In 2017, a pneumonic Plague epidemic of unusual size occurred. The extent of this epidemic provides a unique opportunity to better understand the epidemiology of pneumonic Plagues, particularly in urban settings. Methods Clinically suspected Plague cases were notified to the Central Laboratory for Plague at Institut Pasteur de Madagascar (Antananarivo, Madagascar), where biological samples were tested. Based on cases recorded between Aug 1, and Nov 26, 2017, we assessed the epidemiological characteristics of this epidemic. Cases were classified as suspected, probable, or confirmed based on the results of three types of diagnostic tests (rapid diagnostic test, molecular methods, and culture) according to 2006 WHO recommendations. Findings 2414 clinically suspected Plague cases were reported, including 1878 (78%) pneumonic Plague cases, 395 (16%) bubonic Plague cases, one ( Interpretation This predominantly urban Plague epidemic was characterised by a large number of notifications in two major urban areas and an unusually high proportion of pneumonic forms, with only 23% having one or more positive laboratory tests. Lessons about clinical and biological diagnosis, case definition, surveillance, and the logistical management of the response identified in this epidemic are crucial to improve the response to future Plague outbreaks. Funding US Agency for International Development, WHO, Institut Pasteur, US Department of Health and Human Services, Laboratoire d'Excellence Integrative Biology of Emerging Infectious Diseases, Models of Infectious Disease Agent Study of the National Institute of General Medical Sciences, AXA Research Fund, and the INCEPTION programme.

Soanandrasana Rahelinirina - One of the best experts on this subject based on the ideXlab platform.

  • epidemiological characteristics of an urban Plague epidemic in madagascar august november 2017 an outbreak report
    Lancet Infectious Diseases, 2019
    Co-Authors: Rindra Vatosoa Randremanana, Voahangy Andrianaivoarimanana, Birgit Nikolay, Beza Ramasindrazana, Juliette Paireau, Quirine Ten A Bosch, Jean Marius Rakotondramanga, Soloandry Rahajandraibe, Soanandrasana Rahelinirina, F Rakotomanana
    Abstract:

    Summary Background Madagascar accounts for 75% of global Plague cases reported to WHO, with an annual incidence of 200–700 suspected cases (mainly bubonic Plague). In 2017, a pneumonic Plague epidemic of unusual size occurred. The extent of this epidemic provides a unique opportunity to better understand the epidemiology of pneumonic Plagues, particularly in urban settings. Methods Clinically suspected Plague cases were notified to the Central Laboratory for Plague at Institut Pasteur de Madagascar (Antananarivo, Madagascar), where biological samples were tested. Based on cases recorded between Aug 1, and Nov 26, 2017, we assessed the epidemiological characteristics of this epidemic. Cases were classified as suspected, probable, or confirmed based on the results of three types of diagnostic tests (rapid diagnostic test, molecular methods, and culture) according to 2006 WHO recommendations. Findings 2414 clinically suspected Plague cases were reported, including 1878 (78%) pneumonic Plague cases, 395 (16%) bubonic Plague cases, one ( Yersinia pestis strains were susceptible to the tested antibiotics. Interpretation This predominantly urban Plague epidemic was characterised by a large number of notifications in two major urban areas and an unusually high proportion of pneumonic forms, with only 23% having one or more positive laboratory tests. Lessons about clinical and biological diagnosis, case definition, surveillance, and the logistical management of the response identified in this epidemic are crucial to improve the response to future Plague outbreaks. Funding US Agency for International Development, WHO, Institut Pasteur, US Department of Health and Human Services, Laboratoire d'Excellence Integrative Biology of Emerging Infectious Diseases, Models of Infectious Disease Agent Study of the National Institute of General Medical Sciences, AXA Research Fund, and the INCEPTION programme.

  • epidemiological characteristics of an urban Plague epidemic in madagascar august november 2017 an outbreak report
    Lancet Infectious Diseases, 2019
    Co-Authors: Rindra Vatosoa Randremanana, Voahangy Andrianaivoarimanana, Birgit Nikolay, Beza Ramasindrazana, Juliette Paireau, Quirine Ten A Bosch, Jean Marius Rakotondramanga, Soloandry Rahajandraibe, Soanandrasana Rahelinirina, F Rakotomanana
    Abstract:

    Summary Background Madagascar accounts for 75% of global Plague cases reported to WHO, with an annual incidence of 200–700 suspected cases (mainly bubonic Plague). In 2017, a pneumonic Plague epidemic of unusual size occurred. The extent of this epidemic provides a unique opportunity to better understand the epidemiology of pneumonic Plagues, particularly in urban settings. Methods Clinically suspected Plague cases were notified to the Central Laboratory for Plague at Institut Pasteur de Madagascar (Antananarivo, Madagascar), where biological samples were tested. Based on cases recorded between Aug 1, and Nov 26, 2017, we assessed the epidemiological characteristics of this epidemic. Cases were classified as suspected, probable, or confirmed based on the results of three types of diagnostic tests (rapid diagnostic test, molecular methods, and culture) according to 2006 WHO recommendations. Findings 2414 clinically suspected Plague cases were reported, including 1878 (78%) pneumonic Plague cases, 395 (16%) bubonic Plague cases, one ( Interpretation This predominantly urban Plague epidemic was characterised by a large number of notifications in two major urban areas and an unusually high proportion of pneumonic forms, with only 23% having one or more positive laboratory tests. Lessons about clinical and biological diagnosis, case definition, surveillance, and the logistical management of the response identified in this epidemic are crucial to improve the response to future Plague outbreaks. Funding US Agency for International Development, WHO, Institut Pasteur, US Department of Health and Human Services, Laboratoire d'Excellence Integrative Biology of Emerging Infectious Diseases, Models of Infectious Disease Agent Study of the National Institute of General Medical Sciences, AXA Research Fund, and the INCEPTION programme.

  • genetic structure and gene flow of the flea xenopsylla cheopis in madagascar and mayotte
    Parasites & Vectors, 2017
    Co-Authors: Mireille Harimalala, Soanandrasana Rahelinirina, Minoarisoa Rajerison, Sandra Telfer, Helene Delatte, Phillip C Watts, Adelaide Miarinjara, Tojo Ramihangihajason, Sebastien Boyer
    Abstract:

    The flea Xenopsylla cheopis (Siphonaptera: Pulicidae) is a vector of Plague. Despite this insect’s medical importance, especially in Madagascar where Plague is endemic, little is known about the organization of its natural populations. We undertook population genetic analyses (i) to determine the spatial genetic structure of X. cheopis in Madagascar and (ii) to determine the potential risk of Plague introduction in the neighboring island of Mayotte. We genotyped 205 fleas from 12 sites using nine microsatellite markers. Madagascan populations of X. cheopis differed, with the mean number of alleles per locus per population ranging from 1.78 to 4.44 and with moderate to high levels of genetic differentiation between populations. Three distinct genetic clusters were identified, with different geographical distributions but with some apparent gene flow between both islands and within Malagasy regions. The approximate Bayesian computation (ABC) used to test the predominant direction of flea dispersal implied a recent population introduction from Mayotte to Madagascar, which was estimated to have occurred between 1993 and 2012. The impact of this flea introduction in terms of Plague transmission in Madagascar is unclear, but the low level of flea exchange between the two islands seems to keep Mayotte free of Plague for now. This study highlights the occurrence of genetic structure among populations of the flea vector of Plague, X. cheopis, in Madagascar and suggests that a flea population from Mayotte has been introduced to Madagascar recently. As Plague has not been reported in Mayotte, this introduction is unlikely to present a major concern for Plague transmission. Nonetheless, evidence of connectivity among flea populations in the two islands indicates a possibility for dispersal by fleas in the opposite direction and thus a risk of Plague introduction to Mayotte.

Raffaella Bianucci - One of the best experts on this subject based on the ideXlab platform.

  • black death in the rural cemetery of saint laurent de la cabrerisse aude languedoc southern france 14th century immunological evidence
    Journal of Archaeological Science, 2011
    Co-Authors: Sacha Kacki, Minoarisoa Rajerison, Lila Rahalison, Ezio Ferroglio, Raffaella Bianucci
    Abstract:

    Abstract An excavation carried out in 2007 in Saint-Laurent-de-la-Cabrerisse (Aude-Languedoc, southern France), revealed a medieval rural cemetery used during the 8th–14th centuries. One hundred and forty nine graves were identified. Amongst those, three burials radiocarbon dated to the 14th century contained the remains of several individuals. No paleotraumatological evidences of violence due to warfare or to a civil massacre were identified in the exhumed skeletons. Therefore, we hypothesized that the simultaneous inhumations could have occurred during the “Black Death” outbreak or during one of its resurgences. A rapid diagnostic test for the detection of Yersinia pestis F1 antigen was applied to the nine putative Plague victims to authenticate the cause of their death. Seven of the nine individuals tested from the three graves were positive to Y. pestis F1 antigen. We additionally tested fourteen skeletons from single graves archaeologically dated to the 13th–14th centuries. Four of them were positive to Y. pestis F1 antigen, thus showing a higher mortality rate due to Plague than originally expected. The Saint-Laurent-de-la-Cabrerisse Plague victims are the oldest samples from which Y. pestis F1 antigen has been, hitherto, identified. Few rural French cemetery containing Plague victims have previously been identified and amongst them, only one dates to the 14th century. In the present report, we provide suggestive evidence of a second rural cemetery from southern France where victims of Y. pestis infection were buried. Our findings provide new information about the management of the Plagued corpses during the “Black Death” in small rural communities.

  • Plague immunodetection in remains of religious exhumed from burial sites in central France
    Journal of Archaeological Science, 2009
    Co-Authors: Raffaella Bianucci, Michel Signoli, Lila Rahalison, Ezio Ferroglio, Alberto Peluso, Emma Rabino-massa, Jean-yves Langlois, Véronique Gallien
    Abstract:

    The skeletons of four Benedictine nuns and two priests were exhumed from two burial sites in central France. The corpses were dated to the 16th- 18th centuries (archaeological dating). Thick layers of lime were associated with their burials. During the Second Plague Pandemic, lime was associated with Plague burials. We hypothesize that Yersinia pestis infection might have been the cause of death of these religious. A rapid diagnostic test for Plague (RDT), that detects Y. pestis F1 antigen, was applied to all six putative Plague victims. Y. pestis F1 antigen was detected in all six skeletons (100%). The F1 antigen concentrations ranged from 2.5 to 0.625 ng/ml. The eight samples used as negative controls yielded negative results. Soils samples taken from archaeological sites related to both positive and negative samples tested negative for F1 antigen. In earlier reports we provided suggestive evidence that the RDT for Plague might be diagnostic for the detection of Yersinia pestis in ancient human remains. This putative evidence was based on four French and one German reputed Plague sites in which RDT for Plague and PCR sequenced-based analyses were performed. Both tests gave results consistent with our interpretation that RDT is effective in identifying Plague in skeletal remains. Several different European putative Plague burial sites are currently under investigation. We hope to obtain additional material to allow statistical validation of our results obtained thus far. We now confirm that the detection threshold of the RDT for Plague (0.5 ng/ml) is sufficient for a retrospective diagnosis of Plague in ancient skeletal remains. This method supplements the historical record with independent biologic evidence. Thus, our hypothesis that the six religious were infected by Y. pestis during the Plague outbreaks which occurred in the two sites, Poitiers and La Chaize-le-Vicomte, between 1587 and 1632, has independent biologic support.

Voahangy Andrianaivoarimanana - One of the best experts on this subject based on the ideXlab platform.

  • an open label randomized non inferiority trial of the efficacy and safety of ciprofloxacin versus streptomycin ciprofloxacin in the treatment of bubonic Plague imasoy study protocol for a randomized control trial
    Trials, 2020
    Co-Authors: Rindra Vatosoa Randremanana, Voahangy Andrianaivoarimanana, M Raberahona, Randria Mjdd., Minoarisoa Rajerison, A Legrand, T F Rasoanaivo, R Randriamparany, T Mayouyagamana, R. Mangahasimbola
    Abstract:

    BACKGROUND Bubonic Plague is the primary manifestation of infection with Yersinia pestis, accounting for 90% of all Plague cases and with 75% of global cases reported in Madagascar. All drugs in use for treating Plague are registered based on experimental data and anecdotal evidence, and no regimen currently recommended is supported by a randomized clinical trial. The IMASOY trial intends to fill this knowledge gap by comparing two 10-day regimens included in the national guidelines in Madagascar. The primary objective of the trial is to test the hypothesis that ciprofloxacin monotherapy is non-inferior to streptomycin followed by ciprofloxacin for the treatment of bubonic Plague, thus avoiding the need for injectable, potentially toxic, aminoglycosides. METHODS A two-arm parallel-group randomized control trial will be conducted across peripheral health centres in Madagascar in five districts. Males and non-pregnant females of all ages with suspected bubonic or pneumonic Plague will be recruited over the course of three Plague 'seasons'. The primary endpoint of the trial is to assess the proportion of patients with bubonic Plague who have a therapeutic response to treatment (defined as alive, resolution of fever, 25% reduction in the size of measurable buboes, has not received an alternative treatment and no clinical decision to continue antibiotics) as assessed on day 11. DISCUSSION If successful, the trial has the potential to inform the standard of care guidelines not just in Madagascar but in other countries afflicted by Plague. The trial is currently ongoing and expected to complete recruitment in 2022. TRIAL REGISTRATION ClinicalTrials.gov NCT04110340 . Registered on 1 October 2019.

  • epidemiological characteristics of an urban Plague epidemic in madagascar august november 2017 an outbreak report
    Lancet Infectious Diseases, 2019
    Co-Authors: Rindra Vatosoa Randremanana, Voahangy Andrianaivoarimanana, Birgit Nikolay, Beza Ramasindrazana, Juliette Paireau, Quirine Ten A Bosch, Jean Marius Rakotondramanga, Soloandry Rahajandraibe, Soanandrasana Rahelinirina, F Rakotomanana
    Abstract:

    Summary Background Madagascar accounts for 75% of global Plague cases reported to WHO, with an annual incidence of 200–700 suspected cases (mainly bubonic Plague). In 2017, a pneumonic Plague epidemic of unusual size occurred. The extent of this epidemic provides a unique opportunity to better understand the epidemiology of pneumonic Plagues, particularly in urban settings. Methods Clinically suspected Plague cases were notified to the Central Laboratory for Plague at Institut Pasteur de Madagascar (Antananarivo, Madagascar), where biological samples were tested. Based on cases recorded between Aug 1, and Nov 26, 2017, we assessed the epidemiological characteristics of this epidemic. Cases were classified as suspected, probable, or confirmed based on the results of three types of diagnostic tests (rapid diagnostic test, molecular methods, and culture) according to 2006 WHO recommendations. Findings 2414 clinically suspected Plague cases were reported, including 1878 (78%) pneumonic Plague cases, 395 (16%) bubonic Plague cases, one ( Yersinia pestis strains were susceptible to the tested antibiotics. Interpretation This predominantly urban Plague epidemic was characterised by a large number of notifications in two major urban areas and an unusually high proportion of pneumonic forms, with only 23% having one or more positive laboratory tests. Lessons about clinical and biological diagnosis, case definition, surveillance, and the logistical management of the response identified in this epidemic are crucial to improve the response to future Plague outbreaks. Funding US Agency for International Development, WHO, Institut Pasteur, US Department of Health and Human Services, Laboratoire d'Excellence Integrative Biology of Emerging Infectious Diseases, Models of Infectious Disease Agent Study of the National Institute of General Medical Sciences, AXA Research Fund, and the INCEPTION programme.

  • epidemiological characteristics of an urban Plague epidemic in madagascar august november 2017 an outbreak report
    Lancet Infectious Diseases, 2019
    Co-Authors: Rindra Vatosoa Randremanana, Voahangy Andrianaivoarimanana, Birgit Nikolay, Beza Ramasindrazana, Juliette Paireau, Quirine Ten A Bosch, Jean Marius Rakotondramanga, Soloandry Rahajandraibe, Soanandrasana Rahelinirina, F Rakotomanana
    Abstract:

    Summary Background Madagascar accounts for 75% of global Plague cases reported to WHO, with an annual incidence of 200–700 suspected cases (mainly bubonic Plague). In 2017, a pneumonic Plague epidemic of unusual size occurred. The extent of this epidemic provides a unique opportunity to better understand the epidemiology of pneumonic Plagues, particularly in urban settings. Methods Clinically suspected Plague cases were notified to the Central Laboratory for Plague at Institut Pasteur de Madagascar (Antananarivo, Madagascar), where biological samples were tested. Based on cases recorded between Aug 1, and Nov 26, 2017, we assessed the epidemiological characteristics of this epidemic. Cases were classified as suspected, probable, or confirmed based on the results of three types of diagnostic tests (rapid diagnostic test, molecular methods, and culture) according to 2006 WHO recommendations. Findings 2414 clinically suspected Plague cases were reported, including 1878 (78%) pneumonic Plague cases, 395 (16%) bubonic Plague cases, one ( Interpretation This predominantly urban Plague epidemic was characterised by a large number of notifications in two major urban areas and an unusually high proportion of pneumonic forms, with only 23% having one or more positive laboratory tests. Lessons about clinical and biological diagnosis, case definition, surveillance, and the logistical management of the response identified in this epidemic are crucial to improve the response to future Plague outbreaks. Funding US Agency for International Development, WHO, Institut Pasteur, US Department of Health and Human Services, Laboratoire d'Excellence Integrative Biology of Emerging Infectious Diseases, Models of Infectious Disease Agent Study of the National Institute of General Medical Sciences, AXA Research Fund, and the INCEPTION programme.