The World Health Organisation (WHO) has confirmed 449 cases of an outbreak of plague in Madagascar, with 48 deaths (case fatality rate 11%). 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 9 deaths).  A single area on the northern coast is affected. 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. Read more...