Plague in Madagascar – A Tragic Opportunity for Improving Public Health

by Paul S. Mead
The New England Journal of Medicine, December 20, 2017

3 pp. 716 kB

For much of the world, the public health importance of plague has waned substantially over the past century. Antibiotic treatment and prophylaxis have reduced morbidity and mortality, and improved living standards have reduced human contact with rodents and the fleas that transmit the disease. Barring a catastrophic global event, the likelihood of a plague pandemic comparable to the Black Death is extremely low. Nevertheless, the disease continues to cycle quietly in discrete, enzootic foci in rural areas of Asia, Africa, and the Americas. Inevitable eruptions, like the current outbreak in Madagascar, pose a pernicious challenge to the world’s medical and public health community. They also, however, provide important opportunities to improve medical care for infected persons and to enhance detection and response capabilities.

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