Randremanana R, et al. - The unusual size of the pneumonic plague epidemic in 2017 in Madagascar offers an opportunity to better understand the epidemiology of pneumonic plagues, particularly in urban settings. There were 2,414 clinically suspected plague cases, including 1,878 (78%) pneumonic plague cases, 395 (16%) bubonic plague cases, one (<1%) septicaemic case, and 140 (6%) cases with unspecified clinical form. In this epidemic, exceptionally large numbers of pneumonic plague case notifications were noted (1,878 in 2017 vs 83 per year on average in 2010-2015). At the end of September 2017, the rapid increase in notified cases, especially of pneumonic form, provoked a large national and international multisectoral response, the creation of a national emergency task force, and a joint response plan to limit the epidemic. Rapid and sustained multipronged efforts were needed given the urban nature of the epidemic, its multiple foci, and the possiblity for international human-to-human spread, and as the potential for a high death toll. In addition, they observed a strong impact of the outbreak on society (eg, school closure) and travel and trade for Madagascar (eg, implementation of airport screening measures and cancelled flights). Improved plague investigation and response efforts can result from the lessons learned here.