South Africa has taken several measures to prevent the importation of an outbreak of a plague into the country following the confirmation of 449 cases in Madagascar.
According to the Department of Health, the plague is a zoonotic disease caused by a bacterium Yersinia pestis.
The World Health Organisation (WHO) has confirmed 449 cases of an outbreak of a plague in Madagascar, with 48 deaths.
The outbreak is primarily located in the middle third of the island, around the Antananarivo (239 cases and 21 deaths) and Toamasina Province on the east coast (147 cases and nine deaths). A single area on the northern coast is affected.
According to the department, where a plague is an endemic, it is usually found in rodents and is spread by fleas from rodent to rodent, or to other mammals.
"Humans may acquire the plague from persons with pneumonic plague through droplet transmission or from direct contact with infected rodents or through the bite of an infected flea. The incubation period ranges from two to eight days," the department said.
Symptoms of pneumonic plague include coughing, fever and chest pain.
"South African travellers to Madagascar are advised to avoid highly populated areas, and to wear surgical masks while in transit. Liberal application of DEET-containing insect repellent is advised to prevent flea bites. Prophylactic antibiotics are not advised," the department said.
All travellers returning from Madagascar must monitor their health for 15 days and seek medical care immediately at their nearest health facility if they develop fever, chills, head and body aches, painful and inflamed lymph nodes, or shortness of breath with coughing and/or blood-tainted sputum.
Travellers have been advised to inform their doctor about their recent travel and their symptoms.
"There is also a risk of contracting malaria through bites from infected mosquitoes while in Madagascar, making insect bite prevention doubly important. All returning travellers with fever must be tested for malaria," the department said.
Measures to prevent the importation of the plague include:
Alerting all airline companies to remain vigilant for suspected ill passengers;
Port health officials have enhanced their screening measures to detect ill passengers arriving in the country;
All provincial outbreak response teams have been alerted to enhance preparedness and implement response measures in the event that a case is detected in the country;
Standard operating procedures for the management of a suspected case of plague have been circulated to stakeholders; and
The National Institute for Communicable Diseases has the laboratory capacity to diagnose the plague and is actively supporting preparedness measures in the country.
The department said the majority of cases are presenting as pneumonic plague unlike the usual bubonic form.
"The WHO has classified the outbreak as Grade 2 with the level of risk for local spread being high. Risk to the region is moderate because of frequent air and sea travel, but the global risk is perceived to be low," the department said.
The WHO situational report may be found here.