Doubling Back on Madagascar

A robust global response helped quell Madagascar’s plague outbreak. Now it’s time to double back and learn from it, says Paul S. Mead.

The WHO has clocked 2417 total cases from August 1-November 26. That is alarming, but “our worry should be tempered” knowing that “only 33 culture-confirmed cases have been identified to date,” he writes.

The effort to avoid missing cases can lead to misleading numbers amid an outbreak, Mead writes.

“The true magnitude of the outbreak may take time to determine,” Mead writes—in the meantime, we should evaluate which elements of the response worked, and which didn’t.

The New England Journal of Medicine (Comment)

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