Multiple Introductions of Yersinia pestis during Urban Pneumonic Plague Epidemic, Madagascar, 2017
Voahangy Andrianaivoarimanana
1, Cyril Savin
1, Dawn N. Birdsell
1, Amy J. Vogler, Anne-Sophie Le Guern, Soloandry Rahajandraibe, Sylvie Brémont, Soanandrasana Rahelinirina, Jason W. Sahl, Beza Ramasindrazana, Rado Jean Luc Rakotonanahary, Fanjasoa Rakotomanana, Rindra Randremanana, Viviane Maheriniaina, Vaoary Razafimbia, Aurelia Kwasiborski, Charlotte Balière, Maherisoa Ratsitorahina, Laurence Baril, Paul Keim, Valérie Caro, Voahangy Rasolofo, André Spiegel, Javier Pizarro-Cerda
2, David M. Wagner
2, and Minoarisoa Rajerison
2
Author affiliations: Institut Pasteur de Madagascar, Antananarivo, Madagascar (V. Andrianaivoarimanana, S. Rahelinirina, B. Ramasindrazana, R.J.L. Rakotonanahary, F. Rakotomanana, R. Randremanana, M. Ratsitorahina, L. Baril, V. Rasolofo, A. Spiegel, M. Rajerison); Institut Pasteur, Paris, France (C. Savin, A.-S. Le Guern, S. Brémont, A. Kwasiborski, C. Balière, V. Caro, J. Pizarro-Cerda); Northern Arizona University, Flagstaff, Arizona, USA (D.N. Birdsell, A.J. Vogler, J.W. Sahl, P. Keim, D.M. Wagner); Madagascar Ministry of Public Health, Antananarivo (S. Rahajandraibe, V. Maheriniaina, V. Razafimbia)
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Figure 1
Figure 1. Plague emergence in Madagascar, August–November 2017. A) Locations of emergences. Gray shading indicates plague-endemic regions in the central and northern highlands; yellow shading indicates 12 districts from which human plague emerged from environmental reservoirs 20 times during August–November 2017. Districts are listed in chronological order of emergences. Multiple numbers in the list correspond to different independent emergences from the same district (Table 1); only the first number is indicated on the map. Black box indicates the area shown in panel B. B) Movements (red arrows) of some of the cases (Table 2) associated with the first urban pneumonic plague transmission chain (emergence 2 in Table 1). Blue polygons indicate districts of origin/destination for travel; blue circles indicate the cities of Moramanga and Toamasina.
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