Africa Middle East Widespread outbreak of bubonic plague hits Madagascar By Dorine Reinstein / October 26, 2017 Share 1 -- The World Health Organization has reported an outbreak of bubonic plague in Madagascar, with 1,200 confirmed cases and 102 deaths reported as of press time.Although bubonic plague occurs nearly every year in Madagascar, an unusual outbreak of plague pneumonia is occurring in widespread areas of Madagascar, including in heavily populated cities of Antananarivo (the capital city and its suburbs) and Toamasina.According to the U.S. Centers for Disease Control and Prevention (CDC), the plague is a bacterial infection that is usually spread through bites by infected fleas. When acquired by flea bite, plague causes symptoms of high fever and swollen and tender lymph nodes (bubonic plague) that usually occur two to six days after the bite. If it is not treated, the infection can spread to the lungs and cause pneumonia.Travelers to Madagascar are advised to avoid highly populated areas and to wear surgical masks while in transit.The U.S. has currently not imposed any travel restrictions to Madagascar with the CDC just warning to practice enhanced precautions.These precautions include using EPA-registered insect repellent that lists protection against fleas on the label and contains at least 25% DEET.Travelers who have had close contact with people with plague pneumonia should immediately notify a health care provider. They may need to take antibiotics to prevent plague.During or after travel to Madagascar, travelers should be alert for symptoms of plague. If symptoms do appear, they should seek medical care and inform the provider about their travel to Madagascar.