Travel Health Advisories for UN Personnel

Plague in Madagascar (Updated on 18 Oct 2017)

Madagascar has recently confirmed a plague outbreak which has been ongoing since August 2017.  The latest WHO situation report (including the geographical distribution of cases of plague found in Fig. 1) is available at  It should be noted that plague is endemic in Madagascar, especially in the central highlands. 

What is plague?

Plague is an animal disease that can spread to humans – caused by Yersinia pestis bacteria.  It is transmitted to humans through the bite of infected fleas that live among rodents such as squirrels, chipmunks, woodrats, prairie dogs, rabbits, and mice. 

How do people become infected with plague?

People most commonly acquire plague when they are bitten by a flea that is infected with the plague bacteria. People can also become infected from direct contact with infected tissues or fluids while handling an animal that is sick with or that has died from plague. Finally, people can become infected from inhaling respiratory droplets after close contact with cats and humans with pneumonic plague.

What are the different forms of plague?

There are three forms of plague:

·        Bubonic plague: Patients develop sudden onset of fever, headache, chills, and weakness and one or more swollen, tender and painful lymph nodes (called buboes). This form is usually the result of an infected flea bite. The bacteria multiply in the lymph node closest to where the bacteria entered the human body. If the patient is not treated with appropriate antibiotics, the bacteria can spread to other parts of the body.

·        Septicemic plague: Patients develop fever, chills, extreme weakness, abdominal pain, shock, and possibly bleeding into the skin and other organs. Skin and other tissues may turn black and die, especially on fingers, toes, and the nose. Septicemic plague can occur as the first symptoms of plague, or may develop from untreated bubonic plague. This form results from bites of infected fleas or from handling an infected animal.

·        Pneumonic plague: Patients develop fever, headache, weakness, and a rapidly developing pneumonia with shortness of breath, chest pain, cough, and sometimes bloody or watery mucous. Pneumonic plague may develop from inhaling infectious droplets or from untreated bubonic or septicemic plague that spreads to the lungs. The pneumonia may cause respiratory failure and shock. Pneumonic plague is the most serious form of the disease and is the only form of plague that can be spread from person to person (by infectious droplets).

There is currently no commercially available vaccine or preventive medication against plague. However, antibiotic treatment is effective against the plague bacteria, so early diagnosis and early treatment can save lives.

Could one person get plague from another person?

Yes, when a person has plague pneumonia they may cough droplets containing the plague bacteria into air. If these bacteria-containing droplets are breathed in by another person they can cause pneumonic plague. Human-to-human transmission is rare and typically requires direct and close contact with the person with pneumonic plague.

What is the risk for UN personnel?

The risk of infection with Yersinia pestis for international travellers to Madagascar is generally low. However, UN personnel travelling to rural areas of plague-endemic regions may be at risk, particularly if camping or hunting or if contact with rodents takes place.

Advice for UN Personnel Residing in/Travelling to Madagascar

WHO advises against any restriction on travel or trade on Madagascar based on the available information.

UN personnel residing in or travelling to Madagascar are recommended to:

·        Be aware about the current plague outbreak in the country and understand that plague is endemic in Madagascar.

·        Seek advice from their personal physician on prevention, post exposure chemoprophylaxis, and where to seek medical treatment should they develop plague related symptoms.

·        Protect against flea bites using repellent products for personal protection against mosquitoes, which may equally be protective against fleas and other blood-sucking insects.  WHO recommends formulations (lotions or sprays) based on the following active ingredients - DEET, IR3535, Icaridin (KBR3023) or Picaridin.

·        Actively reduce rodent habitat in your home workplace and recreational areas.  All possible rodent food supplies should be removed and homes and buildings made rodent-proof.

·        Unless recommended by your physician, UN personnel should avoid self-administration with antibiotics as prophylaxis.  Antibiotic prophylactic treatment is only recommended for UN personnel who have been in close contact with plague cases, or with other high risk exposures (such as bites from infected fleas or direct contact with body fluids or tissues of infected animals). 

·        In case of contact and potential exposure to pneumonic plague patients or other high risk exposures, UN personnel should immediately notify health care personnel or authority and seek medical advice regarding chemoprophylaxis.

·        Be aware that malaria is endemic in Madagascar and consider taking antimalarial prophylaxis when travelling to Madagascar (WHO recommends atovaquone-proguanil or doxycycline or mefloquine chemoprophylaxis.)

Upon return from travel, or while residing in Madagascar, UN personnel should be on alert for sudden onset of fever, chills, painful and inflamed lymph nodes, or shortness of breath with coughing and/or blood-tainted sputum.  If such symptoms appear, they should seek immediate medical care and inform their physician about their travel history to Madagascar.

In addition, UN personnel who are residing in or travelling into previously non-endemic regions from where cases of pneumonic plague have been recently reported, should avoid crowded areas, avoid contact with dead animals, infected tissues or materials, and avoid close contact with patients with pneumonic plague in such areas.

For more information, please see the following websites: 

or contact


This page will be updated as new information is received.


General Travel Health Resources

Travel-Related Resources from the World Health Organization (WHO)
World Health Organization: Disease Outbreak News (DONs)

This website describes all recent disease outbreaks and provides WHO recommendations for prevention and control for each outbreak listed.

World Health Organization: International Travel and Health

This website is the WHO's international travel and helath page and contains the latest updates for travellers.

World Health Organization: Vaccination Requirements and Recommendations for Yellow fever and Malaria (16 February 2017)

This website/document provides all UN personnel with the latest WHO recommendations and country requirements to travellers regarding the need for yellow fever vaccination and malaria prevention.

Please note that country requirements for vaccinations are subject to change at any time. It is important for travellers to ensure that they know the requirements of the country to which they are travelling by checking with the relevant consulate or embassy.


Travel Information from Selected Governments
USA: Centers for Disease Control and Prevention: Travel Health Notices
Canada: Public Health Agency of Canada: Travel Health Notices
UK: Travel Health Pro
Australia: Smart Traveller