Correspondence Address:
Dr. Saurabh RamBihariLal Shrivastava
3^rd Floor, Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Ammapettai Village, Thiruporur - Guduvanchery Main Road, Sembakkam Post, Kancheepuram - 603 108, Tamil Nadu
India

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Dear Editor,

Plague is an infectious zoonotic disease of bacterial origin, with the agent being present in small mammals and their fleas.[1] The disease occurs in two forms, namely bubonic and pneumonic with a case fatality ratio of 45% and 100% (if untreated), respectively.[1] The available global estimates suggest that close to 3250 cases and case fatality ratio of 18% have been reported between 2010 and 2015.[1]

A new outbreak of the disease has been reported in Madagascar since the month of August and till the end of October, in excess of 1800 suspected, probable and confirmed cases and more than 125 deaths have been reported.[2],[3] The current outbreak is anticipated to be severe due to its early onset, rapid spread to new areas (other than the common ones), and there are 5 more months remaining before the disease season comes to an end.[2],[3],[4] Considering the fact that the disease is still associated with panic, preventable with the help of standard preventive measures, and treatable with antibiotics, it is of utmost importance to contain the outbreak and minimize the possibility of the regional transmission of the disease.[2],[3]

Anticipating the risk, the World Health Organization (WHO) has performed an immediate assessment of the chances of disease transmission based on the nation's capacities and susceptibility.[3] It was observed that there was a high, moderate, and low risk for the disease to spread at the national, regional, and global level, respectively.[3] Standard measures, such as identification and end the source of infection, protection of health personnel, ensuring provision of right treatment, strengthening of surveillance activities, isolation of patients of pneumonic form, administration of chemoprophylaxis to the close contacts, promotion of early detection through the collection of right specimen, encouragement of standard disinfection measures, and promotion of safe burial practices, have been advocated.[1],[2],[3]

Further, the efforts have been taken to improve the exit screening at the airport by providing information about the disease to the travelers (viz. symptoms, mode of transmission, preventive measures, and treatment), screening of passengers, and even isolation, if required.[2],[3] In addition, the WHO has distributed almost 1.2 million doses of antibiotics to the health facilities and mobile clinics, and even supported the response activities by providing financial assistance to the nation.[5] Moreover, different international welfare agencies have also joined in containing the outbreak, and steps have also been taken to ensure standardized case management and facilitate community engagement.[3]

Finally, the assessment has been done in the neighboring nations and territories regarding their preparedness (viz. national coordination mechanisms, logistical, epidemiological, and laboratory surveillance capacities) and prevailing gaps, so that appropriate rectification can be done.[1],[3] Furthermore, the status of emergency response teams, mechanisms for risk communication and community engagement, and quality of preparedness at points of entry have also been evaluated.[3] Further, it has been envisaged to mount a coordinated response involving all the concerned stakeholders.[3]

To conclude, to prevent and contain the future outbreak of the disease, there is an immense need to have a better preparedness, plan for the optimal allocation of resources, and strengthened surveillance activities.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References