Although no cases of plague have been diagnosed in France since 1945, the disease remains present in several countries (Madagascar, the Democratic Republic of the Congo, Peru, and, more rarely, the southwestern United States, China, etc.).

As this is a potentially contagious disease that is very serious in humans and often fatal, early detection of any human case imported into the country is therefore essential. Furthermore, the proximity of Réunion and Mayotte to Madagascar makes this disease a significant concern in the French departments of the Indian Ocean.

This is why the public health implications are significant.

Epidemiological Surveillance of Plague

As part of plague surveillance, Santé publique France:

• Conducts epidemiological surveillance of suspected cases, particularly in the Indian Ocean departments.

• Provides scientific expertise to the Regional Health Agencies (ARS) for epidemiological investigations.

• Conducts a risk assessment in the event of an unusual health incident related to plague (for example, during the major plague epidemic that occurred in Madagascar during the winter of 2017/2018) and proposes prevention recommendations.

Mandatory reporting

Mandatory reporting involves collecting as comprehensive information as possible regarding all cases of certain diseases known as “notifiable diseases” from biologists and physicians.

It involves two successive procedures: reporting and notification.

Physicians and laboratory professionals who suspect or diagnose a notifiable disease must report it immediately and by any appropriate means (phone, fax, email) to the physician at the Regional Health Agency (ARS) in their area of practice.

• The report allows the ARS physician to implement individual and collective preventive measures around the cases and, if necessary, to initiate investigations to identify the source of the infection and take action to reduce it.

• Notification occurs after reporting and most often after confirmation of the diagnosis. Reporting physicians or laboratory scientists notify the ARS physician at their place of practice using a form specific to each disease. Notification enables the analysis and monitoring of the progression of these diseases within the population in order to better target local and national prevention efforts.

Definition of cases to be reported and notified

As part of its mission to monitor plague, Santé publique France collaborates with the National Reference Center for Yersiniosis, whose mission is:

1. Expertise in the microbiology and pathology of infectious agents, the development, optimization, validation, and dissemination of laboratory tests; and the identification and confirmation of the pathogen

2. Providing scientific or technical advice in response to any request from the Minister of Health, Santé publique France, and healthcare professionals

3. Contributing to epidemiological surveillance:

   • by coordinating a network of laboratories that can be entrusted with conducting tests and subsequently reporting the results,

   • by performing the analyses necessary for the surveillance of the pathogen;

4. Immediate notification to Santé publique France, the Ministry of Health, and, where applicable, the regional health agency of any finding that may pose a risk or threat to the health of the population.

Surveillance partners:

• Regional Health Agencies

List and locations: http://www.ars.sante.fr

• The National Reference Center (CNR)

Director: Dr. Anne-Sophie LE GUERN
Tel.: 01 45 68 83 27
Email: anne-sophie.le-guern@pasteur.fr
Address: Institut Pasteur, Yersinia
Research Unit 25-28, rue du Docteur Roux - 75724 Paris Cedex 15
Secretariat: or 01 45 68 83 29 - Fax: 01 45 68 89 54 - Email: cnr.yersinia@pasteur.fr CNR Plague and Other
Yersiniosis Website: https://www.pasteur.fr/fr/sante-publique/cnr/les-cnr/peste-autres-yersinioses

To learn more about the missions of the National Reference Centers, click here.

• The Directorate General of Health (Ministry of Health): www.sante.gouv.fr

Regional surveillance around Madagascar

Plague occurs in an endemic-epidemic pattern in Madagascar in the central highlands of the island above 800 meters in elevation, with a marked seasonal pattern between October and March. In 2017–2018, a large-scale epidemic occurred, with transmission also in the Lowlands and an unusually high percentage of pneumonic plague cases.

Learn more

• Epidemiological characteristics of an urban plague epidemic in Madagascar, August–November, 2017: an outbreak report

• Summary information document on plague for healthcare professionals titled: “THE LATEST ON PLAGUE”