Epidémies de peste urbaine à Majunga, côte ouest de Madagascar : résumé

In August 1991, an epidemic of urban plague broke out in Majunga, a port on the western coast of Madagascar. As the first resurgence of the disease in this area in 70 years, the episode was a dramatic reminder of the ubiquity of the disease and layed low the falsely reassuring idea that plague was confined to well known centers of high altitude. After the epidemic had claimed 12 victims, 21 patients suffering from bubonic plague and 7 cases of pneumonic plague, it was brought under control by treating exposed subjects and introducing antivectorial measures. Transmission to man continued in the shape of sporadic cases of bubonic plague until April 1992 and a total number of 41 probable or confirmed bacteriological cases (not counting those deceased) were recorded out of 2020 suspected cases. The history of the disease related almost all these cases to the highly populated and unsanitary neighbourhood of Marolaka, situated on the edge of the Betsiboka estuary, and which has kept semi-rural characteristics. Its murine population had practically disappeared, decimated by an epizootic in early July. Out of the two captured sets of two #Rattus rattus (41 fleas per animal) and two #R. norvegicus each, three were carriers of the bacillus. Numerous shrew-mice (#Suncus murinus) occupied the zone and three tested positive to the direct bacteriological test. For the insectivore, the mean #Xenopsylla cheopis index 4 (n=16), rising to 26 in positive animals. The discovery of a plague infested rat carrying #X. cheopis and the persistence of #P. irritans after insecticide treatments, led us to doubt the efficiency of the antivectorial fight that had been undertaken. Risk of endemization was referred to. After a period of quiet of 3 years, isolated cases were detected in March and May 1995, followed by a new epidemic between July 1995 and March 1996. 617 clinical suspects of bubonic plague were notified... (D'après résumé d'auteur