A confirmed outbreak of pneumonic plague has been reported in Madagascar including in the port city of Toamasina.  Caution should be exercised by vessels calling in Madagascar.  Current information is available from the U.S. embassy at (https://mg.usembassy.gov/security-message-u-s-citizens-plague-outbreak-madagascar-including-antananarivo-toamasina/) and the Centers for Disease Control at (https://wwwnc.cdc.gov/travel/notices/alert/plague-madagascar).  Any questions regarding this alert should be directed to the CDC at (https://wwwn.cdc.gov/dcs/contactus/form).  Please pay attention to these sources for updates.  This alert will automatically expire on October 31, 2017.