r has been experiencing a large
outbreak of plague. As of [Fri 10 Nov 2017], a total of 2119
confirmed, probable and suspected cases of plague, including 171
deaths (case fatality rate: 8 percent), have been reported by the
Ministry of Health of Madagascar to WHO.

From 1 Aug through 10 Nov 2017, 1618 (76 percent) cases and 72 deaths
have been clinically classified as pneumonic plague, including 365 (23
percent) confirmed, 573 (35 percent) probable and 680 (42 percent)
suspected cases. In addition to the pneumonic cases, 324 (15 percent)
cases of bubonic plague, one case of septicemic plague, and 176
unspecified cases (8 percent), have been reported to WHO (Figure 1
[for Figures, see original URL - Mod.LL]). Up to 82 healthcare workers
have had illness compatible with plague, none of whom have died.

From 1 Aug through 10 Nov, 16 (out of 22) regions of Madagascar have
reported cases. Analamanga Region has been the most affected,
reporting 72 percent of the overall cases (Figures 2 and 3).

As of [Fri 10 Nov 2017], 218 out of 243 (90 percent) contacts under
follow-up were reached and provided with prophylactic antimicrobials.
Since the beginning of the outbreak, a total of 7122 contacts were
identified, 6729 (95 percent) of whom have completed their 7-day
follow up and a course of prophylactic antimicrobials. Only 9 contacts
developed symptoms and became suspected cases.

Laboratory confirmation of plague is being conducted by the Institut
Pasteur of Madagascar, National WHO Collaborating Center for plague in
Madagascar. Up to 25 isolates of _Yersinia pestis_ have been cultured
and all are sensitive to antimicrobials recommended by the National
Program for the Control of Plague.

The number of new cases and hospitalizations of patients due to plague
is declining in Madagascar. The last confirmed bubonic case was
reported on [Tue 24 Oct 2017] and the last confirmed pneumonic case
was reported on [Sat 28 Oct 2017].

Since plague is endemic to parts of Madagascar, WHO expects more cases
to be reported until the end of the typical plague season in April
2018. It is therefore important that control measures continue through
to the end of the plague season.
Is anybody out there?