Madagascar prepares for potential epidemic of bubonic plague

Madagascar faces a potential outbreak of the bubonic plague, an illness that eliminated nearly half the population of Europe in the 14th century, if it does not clean up its rat-infested prisons, health experts have warned.

"If the plague gets into prisons, there could be a sort of atomic explosion of plague within the town. The prison walls will never prevent the plague from getting out and invading the rest of the town," the Pasteur Institute's Christophe Rogier told the BBC.

The International Committee of the Red Cross (ICRC) and the Pasteur Institute of Madagascar, a nonprofit research organization, have been leading efforts to improve prison hygiene since February 2012.

The ICRC and prison authorities announced Thursday that they had launched a campaign to prevent an epidemic of the disease in Antanimora Prison, where 3,000 inmates are held.

Inmates in the island's jails are especially at risk, according to the ICRC, due to overcrowding, unhygienic conditions and a chronic rat infestation.

"Rat control is essential for preventing the plague, because rodents spread the bacillus to fleas that can then infect humans. So the relatives of a detainee can pick up the disease on a visit to the prison. And a released detainee returning to his community without having been treated can also spread the disease," Christoph Vogt, head of the ICRC delegation in Madagascar, said.

Africa accounts for more than 90 percent of cases worldwide, according to the World Health Organization.

Madagascar experiences an outbreak every year, with an average of 500 cases annually. The disease peaks in October due to hot and humid conditions that attract fleas. The fleas transmit the disease to rats and other animals, which then spread the disease to humans.

The disease is easily treatable with antibiotics if caught early, according to the U.S. Centers for Disease Control and Prevention, but poverty and a lack of facilities prevent many from seeking medical help. 

Disinfection measures and insecticide spraying will be carried out by detainees and prison staff. Hygiene products and rodent traps will be dispersed by ICRC staff.

Last year, Madagascar recorded 256 cases and 60 deaths from the plague, according to WHO figures.