22nd November 2017 – The WHO update of 20th November has declared that the epidemic phase of the plague outbreak in Madagascar is ending but is not over. WHO will usually declare an outbreak to be over after two maximum incubation periods has passed (2×7=14 days).

However, given the endemic status of plague in Madagascar and given that the usual season ends in April, they may not do that just yet. Therefore, all measures in place in Seychelles continue. These include the temporary suspension of Air Seychelles flights to Madagascar, active isolation, measures at the ports of entry, and surveillance at all levels.

In view of the greatly decreased risk of human to human transmission, disease circulation exit screening in Madagascar, entry screening in Seychelles, easy treatment of cases, no antibiotic resistance detected and confirmatory tests being done locally, completed preparedness and response plan including a communication plan, make the chance of a plague case entering Seychelles and spreading very low at this stage.

Since the onset of the outbreak in Madagascar in August 2017, 2267 cases have been reported with 195 deaths. 76% of the total number of cases were pneumonic. During the outbreak 82 healthcare workers got infected but none died.

Only two foreigners contracted the plague while in Madagascar; the late Mr Alix Alisop (Seychellois) and a South African coach who was one of his contacts when he was ill. The latter recovered.

The number of cases in Madagascar has steadily declined since mid-October. The last confirmed bubonic plague case was reported on 7th November 2017, and the last confirmed pneumonic plague case was reported on 14th November 2017.

Since plague is endemic to parts of Madagascar, WHO expects more cases to be reported until the typical plague season ends in April 2018. It is therefore important that control measures continue through to the end of the plague season. With all the measures in place it is expected that any new cases would be managed more promptly.