Public Health England has published guidance on the epidemiology, symptoms, diagnosis and management of plague, including a risk assessment for UK nationals visiting Madagascar – the most affected region worldwide.

3,248 cases of plague were reported worldwide between 2000 and 2015, PHE says. Most cases in humans occur in Africa, with the most affected country considered to be Madagascar, where a ‘seasonal upsurge’ usually occurs between September and April.

In 2017, this upsurge began earlier than usual and has affected regions that are usually plague free, including Antananarivo, the capital city, PHE says.

Regarding the risk to UK travellers, PHE says: “The probability of a case occurring in a person returning to the UK is very low, however, certain features of this outbreak increase the risk of infection to low-moderate for international travellers and those working in Madagascar.”

These factors include the high proportion of cases that are pneumonic, a highly infectious form of the disease, and that fact that cases are being seen across Madagascar without any evident epidemiological link.

PHE advises travellers to Madagascar to “seek advice four to six weeks before travelling.

“They should be aware of the risks and the potential outcome for infection, and the measures they can take to reduce these risks. There is no vaccine to protect against plague.”

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