. Could Mutate To Become Untreatable
The plague death toll shows no sign of slowing as official figures reveal 165 have now lost their lives in Madagascar’s ‘worst outbreak in 50 years’.
Data shows a 15 per cent jump in fatalities over three days, with scientists concerned it has reached ‘crisis’ point and 10 countries now placed on high alert.
At least 2,034 people have been struck down by a more lethal form of the ‘medieval disease’ so far in the country off the coast of Africa, according to WHO statistics.
Some experts fear the disease could mutate and become untreatable during this year’s outbreak – which is expected to blight Madagascar until April.
Others worry the plague will go beyond mainland Africa and eventually reach the US, Europe and Britain, leaving millions more vulnerable due to how quick it can spread.
Experts warn the outbreak of plague in Madagascar this year is being fueled by a strain more lethal than the one which usually strikes the country.
Two thirds of cases have been caused by the airborne pneumonic plague, which can be spread through coughing, sneezing or spitting and kill within 24 hours.
It is strikingly different to the bubonic form, responsible for the ‘Black Death’ in the 14th century, which strikes the country each year and infects around 600 people.
Malawi was added to the growing list of nations placed urged to brace for a potential outbreak over the weekend, becoming the tenth.
South Africa, Seychelles, La Reunion, Tanzania, Mauritius, Comoros, Mozambique, Kenya and Ethiopia have already been told to prepare.
Paul Hunter, professor of health protection at the world-renowned University of East Anglia, was the first expert to predict the plague could travel across the sea.
He previously told MailOnline: ‘The big anxiety is it could spread to mainland Africa, it’s not probable, but certainly possible, that might then be difficult to control.
‘If we don’t carry on doing stuff here, at one point something will happen and it will get out of our control and cause huge devastation all around the world.’
Adding to the fears, he told the Daily Star: ‘There is always a risk with travel that the disease will spread globally.
‘We don’t want a situation where the disease spreads so fast it gets out of control. We are talking about it spreading in days rather than weeks.’
However, he was adamant that it would be easy for an economically developed country to contain the treatable disease in its current form.
Professor Hunter’s concerns echoed that of dozens of leading scientists, many of whom have predicted the ‘truly unprecedented’ outbreak will continue to spiral.
Professor Jimmy Whitworth, an international health scientist at the London School of Hygiene & Tropical Medicine, described it as the worst outbreak in 50 years.
And Professor Johnjoe McFadden, a molecular geneticist at Surrey University, said that the plague is ‘scary’ and is predominantly a ‘disease of the poor’.
Speaking exclusively to MailOnline, he also said: ‘It’s a crisis at the moment and we don’t know how bad it’s going to get.’
Professor McFadden added: ‘It’s a terrible disease. It’s broadly caused more deaths of humans than anything else, it’s a very deadly pathogen.
‘It is a disease of poverty where humans are being forced to live very close to rats and usually means poor sewage and poor living conditions.
‘That’s the root cause of why it’s still a problem in the world. If we got rid of rats living close enough to mankind then we wouldn’t have the disease.’
HOW DID THIS YEAR’S OUTBREAK BEGIN?
Health officials are unsure how this year’s outbreak began.
However, some believe it could be caused by the bubonic plague, which is endemic in the remote highlands of Madagascar.
If left untreated, it can lead to the pneumonic form, which is responsible for two thirds of the cases recorded so far in this year’s outbreak.
Rats carry the Yersinia pestis bacteria that causes the plague, which is then passed onto their fleas.
Forest fires drive rats towards rural communities, which means residents are at risk of being bitten and infected. Local media reports suggest there has been an increase in the number of blazes in the woodlands.
Without antibiotics, the bubonic strain can spread to the lungs – where it becomes the more virulent pneumonic form.
Pneumonic, which can kill within 24 hours, can then be passed on through coughing, sneezing or spitting.
However, it can also be treated with antibiotics if caught in time.
Madagascar sees regular outbreaks of plague, which tend to start in September, with around 600 cases being reported each year on the island.
However, this year’s outbreak has seen it reach the Indian Ocean island’s two biggest cities, Antananarivo and Toamasina.
Experts warn the disease spreads quicker in heavily populated areas.
Professor McFadden warned in countries such as Madagascar ‘people often need to walk more than a day to receive proper medical treatment’.
Commenting on previous figures, Professor Robin May, an infectious diseases expert at Birmingham University, told MailOnline the outbreak was ‘concerning definitely’.
Amid concerns the plague had reached crisis point, the World Bank decided to release an extra $5 million (£3.8m) to control the rocketing amount of cases.
The money will allow for the deployment of personnel to battle the outbreak in the affected regions, the disinfection of buildings and fuel for ambulances.
The latest World Health Organization figures come days after aid workers on the ground revealed that police are having to seize the corpses of plague victims.
Charlotte Ndiaye, of the WHO, described the situation as being ‘terrible’, with many traditional families unwilling to part with their loved ones.
Hundreds of families are confused about what they should do with the dead bodies, Ms Ndiaye told South African’s Mail & Guardian newspaper.
If officials suspect someone to have died from pneumonic plague, an officer armed with chemicals will be disposed to kill any bacteria on the corpse.
They are then placed in a sealed body bag and placed in a common grave – but the practice goes against the traditions of the Malagasy culture.
In the culture, there is an annual celebration to honour the dead – and aid workers previously warned this would fuel an increase in cases.
All Saints Day, otherwise known as the ‘Day of the Dead’, is a public holiday which takes place on November 1 each year. Crowds often gather at local cemeteries.
‘In that type of situation, it may be easy to forget about respiratory etiquettes,’ Panu Saaristo, the International Federation of Red Cross’ team leader for health in Madagascar, previously told MailOnline.
Concerned health officials have also warned an ancient ritual, called Famadihana, where relatives dig up the corpses of their loved ones, may be fueling the spread.
To limit the danger of Famadihana, rules enforced at the beginning of the outbreak dictate plague victims cannot be buried in a tomb that can be reopened.
WHY DID THE ‘GODZILA’ EL NINO TRIGGER THE WORST PLAGUE IN 50 YEARS?
Experts also believe last year’s natural phenomenon El Niño – dubbed ‘Godzilla’, triggered an increase in rat populations in rural areas, sparking the beginning of the epidemic which has so far infected at least 1,300 people.
Forest fires have also driven the rats and their plague-carrying fleas towards areas inhabited by humans, local reports state as a reason behind the surge in cases recorded this year.
But Professor Matthew Bayliss, from Liverpool University’s Institute of Infection and Global Health, suggested floods and heavy rains – triggered by Cyclone Enawo, may also be to blame.
Speaking exclusively to MailOnline, he warned the particularly aggressive El Niño of 2016 may be behind the aggressive start of this year’s outbreak, which has seen it hit two heavily populated cities for the first time, including the capital Antananarivo.
‘2016 was the strongest El Niño on record, and was nicknamed by some ‘Godzilla’,’ he said. Some have suggested the growing burden of climate change was to blame.
‘It is a change to the movements of water in the Pacific Ocean which then has an effect on climate in many parts of the world, including east and southern Africa.
‘Our own research suggests that El Niño played a role of the Zika outbreak, but it is also possible that the conditions have facilitated this large scale plague outbreak.’
Professor Bayliss, alongside colleagues including climatologist Dr Cyril Caminade, were behind a 2014 study that found outbreaks of plague in Madagascar are linked to the naturally occurring climate event in the tropical Pacific Ocean.
Published in the Proceedings of the National Academy of Sciences, they found large outbreaks tend to coincide with the fluctuation of air pressure and sea surface temperature, partly driven by El Niño. It was based on 48 years worth of data.
They were also behind another study, released in the same journal in December last year, which found El Niño fuelled the Zika outbreak in South America. It went on to strike more than 70 countries and caused a surge in the number of babies born with abnormally small heads.
What is El Niño?
El Niño, along with its little sister La Niña, are part of a recurring shift in climate that occurs as warm water shifts from one side of the Pacific to the other.
It is caused by a shift in the distribution of warm water in the Pacific Ocean around the equator.
Usually the wind blows strongly from east to west, due to the rotation of the Earth, causing water to pile up in the western part of the Pacific.
This pulls up colder water from the deep ocean in the eastern Pacific.
However, in an El Niño, the winds pushing the water get weaker and cause the warmer water to shift back towards the east. This causes the eastern Pacific to get warmer.
But as the ocean temperature is linked to the wind currents, this causes the winds to grow weaker still and so the ocean grows warmer, meaning the El Niño grows.
This change in air and ocean currents around the equator can have a major impact on the weather patterns around the globe by creating pressure anomalies in the atmosphere.
Instead, their remains must be held in an anonymous mausoleum. But the local media has reported several cases of bodies being exhumed covertly.
Despite the serious risks publicised by the authorities, few in Madagascar question the turning ceremonies and dismiss the advice.
Willy Randriamarotia, the Madagascan health ministry’s chief of staff, said: ‘If a person dies of pneumonic plague and is then interred in a tomb that is subsequently opened for a Famadihana, the bacteria can still be transmitted and contaminate whoever handles the body.’
Experts have long observed that plague season coincides with the period when Famadihana ceremonies are held from July to October.
Last week MailOnline revealed the ‘Godzilla’ El Niño of 2016 has also been blamed for the severity of this year’s outbreak by causing freak weather conditions.
Plague season hits Madagascar each year, and experts warn there is still six months to run – despite already seeing more than triple the amount of cases than expected.
Usually the country sees cases of bubonic plague, which is transmitted by rat flea bites and was responsible for the 100 million fatalities from the ‘Black Death’ in the 14th century.