Plague deaths rise to nearly 200 as outbreak grows in Madagascar

A serious outbreak of the plague is threatening residents and tourists in Madagascar 

The World Health Organization (WHO) reports more than 2,000 confirmed or suspected cases and that the death toll has reached 195 as of this week.  

The WHO expects that number to rise through April 2018, but does say that the threat of the disease’s spread seems to be decreasing.

While the plague, once known as the Black Death, is not the deadly threat it was centuries or even decades ago,  some experts have worry the disease could become resistant to antibiotics. 

Despite the slowdown in known infections, the threat level for Madagascar remains high.

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Plague outbreak ravages Madagascar
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Plague outbreak ravages Madagascar
A council worker sprays disinfectant during the clean-up of the market of Anosibe in the Anosibe district, one of the most unsalubrious district of Antananarivo on October 10, 2017. The World Health Organization has warned that a deadly outbreak of the plague, which began in late August, has claimed more than 20 lives in Madagascar and is swiftly spreading in cities across the country. Rats are porters of fleas which spread the bubonic plague and are attracted by garbages and unsalubrity. Pneumonic plague, which is passed through person-to-person transmission, has also been recorded. / AFP PHOTO / RIJASOLO (Photo credit should read RIJASOLO/AFP/Getty Images)
People walk past a full dumpster as Council workers begin the clean-up of the market of Anosibe in the Anosibe district, one of the most unsalubrious districts of Antananarivo on October 10, 2017. The World Health Organization has warned that a deadly outbreak of the plague, which began in late August, has claimed more than 20 lives in Madagascar and is swiftly spreading in cities across the country. Rats are porters of fleas which spread the bubonic plague and are attracted by garbages and unsalubrity. Pneumonic plague, which is passed through person-to-person transmission, has also been recorded. / AFP PHOTO / RIJASOLO (Photo credit should read RIJASOLO/AFP/Getty Images)
People clear garbage during the clean-up of the market of Anosibe in the Anosibe district, one of the most unsalubrious districts of Antananarivo on October 10, 2017. The World Health Organization has warned that a deadly outbreak of the plague, which began in late August, has claimed more than 20 lives in Madagascar and is swiftly spreading in cities across the country. Rats are porters of fleas which spread the bubonic plague and are attracted by garbages and unsalubrity. Pneumonic plague, which is passed through person-to-person transmission, has also been recorded. / AFP PHOTO / RIJASOLO (Photo credit should read RIJASOLO/AFP/Getty Images)
A boy covers his mouth as a council worker sprays disinfectant during the clean-up of the market of Anosibe in the Anosibe district, one of the most unsalubrious districts of Antananarivo on October 10, 2017. The World Health Organization has warned that a deadly outbreak of the plague, which began in late August, has claimed more than 20 lives in Madagascar and is swiftly spreading in cities across the country. Rats are porters of fleas which spread the bubonic plague and are attracted by garbages and unsalubrity. Pneumonic plague, which is passed through person-to-person transmission, has also been recorded. / AFP PHOTO / RIJASOLO (Photo credit should read RIJASOLO/AFP/Getty Images)
Doctors and nurses from The Ministry of Health and officers of the Malagasy Red Cross staff a healthcare checkpoint at the 'taxi-brousse' station of Ampasapito district in Antananarivo on October 5, 2017, with the mission of informing passengers leaving Antananarivo, and to potentially detect cases suspected of plague. Madagascan authorities have ordered two universities to close temporarily as efforts intensify to halt a plague outbreak that has killed 33 people and caused widespread panic. The Indian Ocean island nation suffers annual plague outbreaks, but this year the disease has affected urban areas, triggering concern from the World Health Organization (WHO). / AFP PHOTO / RIJASOLO (Photo credit should read RIJASOLO/AFP/Getty Images)
Doctors and nurses from The Ministry of Health and officers of the Malagasy Red Cross staff a healthcare checkpoint at the 'taxi-brousse' station of Ampasapito district in Antananarivo on October 5, 2017, with the mission of informing passengers leaving Antananarivo, and to potentially detect cases suspected of plague. Madagascan authorities have ordered two universities to close temporarily as efforts intensify to halt a plague outbreak that has killed 33 people and caused widespread panic. The Indian Ocean island nation suffers annual plague outbreaks, but this year the disease has affected urban areas, triggering concern from the World Health Organization (WHO). / AFP PHOTO / RIJASOLO (Photo credit should read RIJASOLO/AFP/Getty Images)
Doctors and nurses from The Ministry of Health and officers of the Malagasy Red Cross staff a healthcare checkpoint at the 'taxi-brousse' station of Ampasapito district in Antananarivo on October 5, 2017, with the mission of informing passengers leaving Antananarivo, and to potentially detect cases suspected of plague. Madagascan authorities have ordered two universities to close temporarily as efforts intensify to halt a plague outbreak that has killed 33 people and caused widespread panic. The Indian Ocean island nation suffers annual plague outbreaks, but this year the disease has affected urban areas, triggering concern from the World Health Organization (WHO). / AFP PHOTO / RIJASOLO (Photo credit should read RIJASOLO/AFP/Getty Images)
Doctors and nurses from The Ministry of Health and officers of the Malagasy Red Cross staff a healthcare checkpoint at the 'taxi-brousse' station of Ampasapito district in Antananarivo on October 5, 2017, with the mission of informing passengers leaving Antananarivo, and to potentially detect cases suspected of plague. Madagascan authorities have ordered two universities to close temporarily as efforts intensify to halt a plague outbreak that has killed 33 people and caused widespread panic. The Indian Ocean island nation suffers annual plague outbreaks, but this year the disease has affected urban areas, triggering concern from the World Health Organization (WHO). / AFP PHOTO / RIJASOLO (Photo credit should read RIJASOLO/AFP/Getty Images)
Doctors and nurses from The Ministry of Health and officers of the Malagasy Red Cross staff a healthcare checkpoint at the 'taxi-brousse' station of Ampasapito district in Antananarivo on October 5, 2017, with the mission of informing passengers leaving Antananarivo, and to potentially detect cases suspected of plague. Madagascan authorities have ordered two universities to close temporarily as efforts intensify to halt a plague outbreak that has killed 33 people and caused widespread panic. The Indian Ocean island nation suffers annual plague outbreaks, but this year the disease has affected urban areas, triggering concern from the World Health Organization (WHO). / AFP PHOTO / RIJASOLO (Photo credit should read RIJASOLO/AFP/Getty Images)
Doctors and nurses from The Ministry of Health and officers of the Malagasy Red Cross staff a healthcare checkpoint at the 'taxi-brousse' station of Ampasapito district in Antananarivo on October 5, 2017, with the mission of informing passengers leaving Antananarivo, and to potentially detect cases suspected of plague. Madagascan authorities have ordered two universities to close temporarily as efforts intensify to halt a plague outbreak that has killed 33 people and caused widespread panic. The Indian Ocean island nation suffers annual plague outbreaks, but this year the disease has affected urban areas, triggering concern from the World Health Organization (WHO). / AFP PHOTO / RIJASOLO (Photo credit should read RIJASOLO/AFP/Getty Images)
A pedestrian passes a Ministry of Health and Malagasy Red Cross healthcare checkpoint at the 'taxi-brousse' station of Ampasapito district in Antananarivo on October 5, 2017, with the mission of informing passengers leaving Antananarivo, and to potentially detect cases suspected of plague. Madagascan authorities have ordered two universities to close temporarily as efforts intensify to halt a plague outbreak that has killed 33 people and caused widespread panic. The Indian Ocean island nation suffers annual plague outbreaks, but this year the disease has affected urban areas, triggering concern from the World Health Organization (WHO). / AFP PHOTO / RIJASOLO (Photo credit should read RIJASOLO/AFP/Getty Images)
Doctors and nurses from The Ministry of Health and officers of the Malagasy Red Cross staff a healthcare checkpoint at the 'taxi-brousse' station of Ampasapito district in Antananarivo on October 5, 2017, with the mission of informing passengers leaving Antananarivo, and to potentially detect cases suspected of plague. Madagascan authorities have ordered two universities to close temporarily as efforts intensify to halt a plague outbreak that has killed 33 people and caused widespread panic. The Indian Ocean island nation suffers annual plague outbreaks, but this year the disease has affected urban areas, triggering concern from the World Health Organization (WHO). / AFP PHOTO / RIJASOLO (Photo credit should read RIJASOLO/AFP/Getty Images)
A young woman (L) gestures as she is examined by a doctors at a healthcare checkpoint at the 'taxi-brousse' station of Ampasapito district in Antananarivo on October 5, 2017, with the mission of informing passengers leaving Antananarivo, and to potentially detect cases suspected of plague. Madagascan authorities have ordered two universities to close temporarily as efforts intensify to halt a plague outbreak that has killed 33 people and caused widespread panic. The Indian Ocean island nation suffers annual plague outbreaks, but this year the disease has affected urban areas, triggering concern from the World Health Organization (WHO). / AFP PHOTO / RIJASOLO (Photo credit should read RIJASOLO/AFP/Getty Images)
Doctors and nurses from The Ministry of Health and officers of the Malagasy Red Cross staff a healthcare checkpoint at the 'taxi-brousse' station of Ampasapito district in Antananarivo on October 5, 2017, with the mission of informing passengers leaving Antananarivo, and to potentially detect cases suspected of plague. Madagascan authorities have ordered two universities to close temporarily as efforts intensify to halt a plague outbreak that has killed 33 people and caused widespread panic. The Indian Ocean island nation suffers annual plague outbreaks, but this year the disease has affected urban areas, triggering concern from the World Health Organization (WHO). / AFP PHOTO / RIJASOLO (Photo credit should read RIJASOLO/AFP/Getty Images)
Doctors and nurses from The Ministry of Health and officers of the Malagasy Red Cross staff a healthcare checkpoint at the 'taxi-brousse' station of Ampasapito district in Antananarivo on October 5, 2017, with the mission of informing passengers leaving Antananarivo, and to potentially detect cases suspected of plague. Madagascan authorities have ordered two universities to close temporarily as efforts intensify to halt a plague outbreak that has killed 33 people and caused widespread panic. The Indian Ocean island nation suffers annual plague outbreaks, but this year the disease has affected urban areas, triggering concern from the World Health Organization (WHO). / AFP PHOTO / RIJASOLO (Photo credit should read RIJASOLO/AFP/Getty Images)
ANTANANARIVO, MADAGASCAR - OCTOBER 03 : Workers from Department of Emergency and Response to Epidemics and Disasters (SURECA) within the Ministry of Health of Madagascar implement a desinsectisation in a public school in Antananarivo, Madagascar as plague spreads rapidly in cities across the country on October 3, 2017. Twenty people have died so far from plague in Madagascar while more than 100 other suspected cases have been registered across the country. (Photo by Henitsoa Rafalia/Anadolu Agency/Getty Images)
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In a plague outbreak update published on November 15, the WHO said it would be “scaling up of preparedness and operational readiness activities in neighboring Indian Ocean islands and other southern and east African countries.” 

Among them are the Seychelles, Kenya, South Africa, and Tanzania. 

“The overall global risk is considered to be low. WHO is re-evaluating the risk assessment based on the evolution of the outbreak and information from response activities,” the organization also notes.

Travelers to Madagascar are advised to avoid contact with dead animals, protect themselves against flea bites, and stay out of the proximity of patients suffering from pneumonic plague. 

People who present with symptoms including shortness of breath with coughing and/or blood-tainted sputum, swollen lymph nodes, chills, and fever should seek immediate medical attention.

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