In November 2014, Madagascar was hit by a major outbreak of bubonic plague. Its epicenter was in Amparafaravola, a midsize town with a hospital staff that was caught off guard. Public outreach was slow and disorganized, dispensaries were understocked with antibiotics, and people did not believe the new fever was the actual plague … until several deaths occurred.
The evolution of the disease into the more lethal pneumonic variety risked a cataclysmic rise in mortalities. Health-care providers feared it would spread like wildfire into the capital, Antananarivo, where it has long existed at low-grade levels, especially within prisoner and homeless populations.
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