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 3
Figure 3. Transmission patterns among the initial 29 cases associated with the first urban PP transmission chain in Madagascar, August–November 2017 (emergence 2 in Table 1). Dates are illness onset dates. Solid arrows indicate likely infection sources based on known contact (Table 2); dotted arrows indicate hypothetical infection sources inferred from genetic data, epidemiologic data, or both. Symbols for individual cases indicate male or female sex; red indicates persons who died and blue indicates survivors. Red box indicates the first identified case from the epidemic that triggered the subsequent public health response.
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