Thursday, November 2, 2017

Shipping Lines Need to Alert Crews to Dangers of Plague if Visiting Madagascar

Outbreak Much More Widespread Than Normal
Shipping News Feature
MADAGASCAR – The recent outbreak of plague has led to calls from international authorities for shipping lines with vessels that visit the country to pay especial care to the health of their crews and to be on high alert for any signs of infection in any of their sailors as there is great concern that the outbreak may spread off the island and onto the African continent.

Although bubonic plague occurs nearly every year in Madagascar, the current outbreak is unusual in that plague pneumonia is occurring in widespread areas of Madagascar, including in heavily populated cities of Antananarivo (the capital city and its suburbs) and Toamasina. The World Health Organization (WHO) and the Madagascar Ministry of Health are leading a public health response to the outbreak, assisted by personnel from partner organisations around the world, including the CDC.

Plague is a bacterial infection that is usually spread through bites by infected fleas. When acquired by flea bite, plague causes symptoms of high fever and swollen and tender lymph nodes (bubonic plague) that usually occur 2–6 days after the bite. If it is not treated, the infection can spread to the lungs and cause pneumonia.

Plague pneumonia (or ‘pneumonic plague’) is the only form that can be directly transmitted from one person to another. In rare but serious cases, a person with severe plague pneumonia can spread the infection directly to others by coughing up droplets that contain the plague bacteria. These bacteria-containing droplets can cause pneumonic plague in another person if breathed in. On board an enclosed ship, especially with shared crew quarters, this form is extremely contagious and a great hazard.

Symptoms of plague pneumonia typically appear 2–4 days after inhaling plague bacteria and usually include sudden onset of high fever and cough and other general symptoms such as headache, chills, and weakness.

Plague can be treated with antibiotics. However, without prompt treatment, plague can cause serious illness or death. No vaccine is available to prevent plague but travellers can take steps to prevent plague, and plague can be prevented with antibiotics. Travelers to Madagascar should:

  • Use EPA-registered insect repellent that lists protection against fleas on the label and contains at least 25% DEET.
  • Avoid close contact with sick or dead animals.
  • Avoid close contact with seriously ill people, especially people who are coughing up blood.

Travelers who have had close contact with people with plague pneumonia should immediately notify a health care provider. They may need to take antibiotics to prevent plague.

During or after travel to Madagascar, crew should be alert for symptoms of plague. If symptoms do appear, they should seek medical care and inform the provider about their travel to Madagascar.