Public Health Emergency of International Concern second PHEIC was issued in May 2014 with the resurgence of polio after its near-eradication, deemed "an extraordinary event." On Friday, August 8, 2014, the World Health Organization declared its third Public Health Emergency of International Concern in response to the outbreak of Ebola in Western Africa. On Monday, February 1, 2016, the World Health Organization declared its fourth PHEIC in response to clusters of microcephaly and Guillain–Barré syndrome in the Americas, which at the time were suspected to be associated with the ongoing outbreak of Zika virus. Later research and evidence bore out these concerns; in April, the WHO
21st century Madagascar plague outbreaks in the capital Antananarivo there were two confirmed cases, including one death. On 4 November 2014, the Ministry of Health of Madagascar reported the outbreak to the World Health Organization. A more recent outbreak of plague in Madagascar began in August 2017 and expanded rapidly, with about two-thirds of cases transmitted person-to-person as pneumonic plague, the most dangerous form of the disease. The death toll of 124 by 20 October exceeded that of previous outbreaks. More than half of cases have been recorded in the capital of Antananarivo and the main port of Toamasina, the largest cities in Madagascar. Nine