Plague information


Plague is a bacterial infection caused by Yersinia pestis. It is a disease of wild animals, mainly rodents. Plague is usually spread from animal to animal or from animal to human by fleas; occasionally, human-to-human transmission leads rapidly to outbreaks.


Humans acquire plague from:

  • bites by fleas infected with plague bacteria;
  • direct contact with infected rodents or other animals, usually in the course of hunting, trapping, skinning or meat cutting;
  • inhaling airborne droplets containing the plague bacterium from humans infected with pneumonic plague (person to person spread).


  • Bubonic plague – infection of the lymph nodes following bite of an infected rat flea;
  • Septicaemic plague – infection of the blood that may be a complication of untreated bubonic plague or the first presentation of plague;
  • Pneumonic plague – infection of the lungs that may follow septicaemic plague, or that develops after inhaling infectious droplets. Pneumonic plague is highly infectious and can be fatal if not treated early (within 18-24 hours of onset).


It usually takes from 2 to up to 10 days after exposure for a person to develop typical signs and symptoms.

  • Sudden onset, rapid progression;
  • Fever, chills, headache, weakness;
  • Painful, swollen lymph nodes (buboes) in the groin, armpit or neck;
  • Shortness of breath, cough, chest pain and bloody sputum (pneumonia);
  • Sometimes abdominal pain, nausea, vomiting and diarrhoea;
  • Late stage, septicaemia – bleeding, multi-organ failure;
  • Plague is successfully treated with antibiotics, if diagnosed and treated promptly.


The risk for average holiday and business travellers is low. Certain activities may expose some to higher risk (e.g. healthcare workers, visiting friends and relatives).

Travellers to Madagascar are advised to:

  • Avoid crowded urban areas, and camping/hiking in affected rural areas;
  • Avoid close contact with ill persons;
  • Avoid contact with rodents and dead animals;
  • Use DEET-containing insect repellent to prevent flea bites;
  • Obtain medical attention for sudden onset of feverish illness.


Returning travellers should be on the alert for the early signs and symptoms of plague, especially fever, cough and shortness of breath. If concerned, they should seek medical care immediately and inform the healthcare worker about their Madagascar travel.

For further information: please visit the NICD website at

Updated: 01 March 2018

Read 2024 times Last modified on Thursday, 01 March 2018 17:03

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Important Notice

You are advised to visit your general practice surgery or a travel medicine clinic at least 6 weeks before you travel. However, it is never too late to seek advice.

If you have a medical condition, you are advised to discuss the suitability of the trip before you book.


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