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The geographic distribution of plague patients was visualized by using a simplified map of Mahajanga.
A general change in the distribution of plague cases during the study period was also observed.
The geographic distribution of plague laboratory-confirmed cases according to districts is shown in Figure 4.
Thus, fluctuating weather conditions have been suggested to affect the dynamics of plague within its reservoirs and, through this, the number of human infections, while some little-known factors seem likely to limit the distribution of plague between large epidemics [ 15, 16, 19].
The demographic shift in burden of illness from persons of Asian heritage to those of American Indian heritage over time reflects change in the geographic distribution of plague from overcrowded urban neighborhoods dominated by immigrant populations along the Pacific Coast to the rural areas in the Southwest, including tribal lands.
The "Host Niche Hypothesis" (HNH) postulates that plague distributions are mediated by host distributions, such that the distribution of plague depends on an amalgam of host ranges, and the presence of a particular host species could extend the distributional potential of the pathogen [ 11].
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Similarly, a recent study that modeled the future distribution of plague-carrying ground squirrels in California using 1 km2 BioClim variables suggested a subtle geographic shift to higher latitudes and altitudes with a limited reduction at lower latitudes [43].
This concept can be exemplified by the spatial distributions of plague cases and areas with high projected plague risk in Arizona, New Mexico, Utah, and Colorado and incidence of endemic Lyme disease in California (8, 9 ).
Socioeconomic indicators associated with temporal changes in the distribution of human plague cases in New Mexico were investigated for 1976 2007.
Elevation, temperature of land surface and normalized difference vegetation index play a large part in determining the distribution of the enzootic plague.
We used field surveillance data in an ecological niche modeling (ENM) framework to depict spatial distribution of natural foci of plague in Qinghai-Tibetan Plateau.
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