[9] The report stated the outbreak beginning in September 2014 peaked from November through end-December and had slowed down as of February 2015.

[9] The report explained that Madagascar's plague "season" typically runs through April and stopped short of officially declaring the outbreak over.

[10] More than half of cases have been recorded in the capital of Antananarivo and the main port of Toamasina, the largest cities in Madagascar.

[14] In January 2018 the experts declared the outbreak over as no new cases had been reported since November 2017, although the World health organization stated that there was a "moderate" chance of re-occurrence.

[15] The outbreak began in August 2017 with the death from pneumonic plague of a 31-year-old man who had been traveling in a crowded minibus toward the capital city of Antananarivo in the central highlands.

[16] The outbreak expanded rapidly, transmitted person-to-person in the pneumonic form of the disease, which accounted for more than 60 percent of cases.

Urban areas that are major transportation hubs for shipping and recreation are at high risk for transmitting plague to nearby countries.

The outbreak was initially recognized on 11 September by local authorities and confirmed by the Institut Pasteur de Madagascar.

The bubonic form, transmitted by the bites of fleas from rodents, is more usual in the annual outbreaks in Madagascar.

The government announced they had "temporarily suspended gatherings to the general public in places where the traceability of the participants is difficult if not impossible (stadiums, sports palaces, gymnasiums …)".

[21] By 8 November, deaths had risen to 165 with infections totalling over 2000, however the rate of spread had slowed, raising hope that the outbreak was starting to come under control.

Concerns continued to be raised that plague might still spread to neighboring countries, or mutate to a form that could be more difficult to treat.

This type of plague is treatable with antibiotics, but if not treated effectively, the infection can spread to different parts of the body.

[25] When an endemic disease, such as Ebola or plague, is introduced to a new geographic area that is densely populated with international shipping routes, it increases transmission rates and leads to severe outbreaks and potential pandemics.

Insufficient waste management, lack of clean water, and poor infrastructure are all issues that are breeding grounds for rats and fleas and therefore perpetuate plague transmission in urban areas.

[26] Historically, rats who acted as hosts to the flea vector subsequently died once they were infected with plague.

Urban areas that are a major transportation hub for shipping and recreation are at high risk for transmitting plague to nearby countries.

[29] In addition to agricultural factors that increase prevalence of plague, burial practices in Madagascar also spread disease.

This custom is based on a belief that the dead do not join the rest of their ancestors until their body reaches full decomposition with appropriate ceremonies.

Rats and fleas thrive in rural and urban areas of Madagascar due to the impoverishment of the country.

In addition to the new committee, Madagascar reallocated funds in order to help with isolation, treatment, and supplies.

[27] These solutions to the outbreak helped, as cases of plague declined and hospitalized patients decreased in volume.

[12] A South African basketball player who contracted plague while attending a tournament in Madagascar was successfully treated and returned home.

[35] The World Health Organization warned that there was a high risk the disease could spread to nine other countries in Africa and the Indian Ocean (Ethiopia, Kenya, Tanzania, Mozambique, South Africa, Seychelles, Comoros, Réunion and Mauritius) because of frequent trade and travel with Madagascar.