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An un­usu­ally wide­spread out­break of the plague is men­ac­ing Mada­gas­car. At least 24 peo­ple have died and more than 130 have been in­fected with plague across the coun­try, ac­cord­ing to the World Health Or­gan­i­sa­tion (WHO).

Plague is en­demic to the coun­try, but “con­trary to past out­breaks, this one is af­fect­ing larger ur­ban ar­eas and ports, which in­creases the risk of per­son-to-per­son trans­mis­sion”, said WHO spokesper­son Tarik Jasare­vic.

Among the re­ported cases, al­most 60 were the more com­mon bubonic plague, in­clud­ing seven deaths. More than 70 – in­clud­ing 17 deaths – are sus­pected to be pneu­monic plague.

Ten cities were re­port­ing pneu­monic cases, in­clud­ing the cap­i­tal, An­tana­narivo, in­creas­ing chances of the disease spread­ing.

Plague is typ­i­cally spread through the bite of in­fected fleas, fre­quently car­ried by rats, caus­ing bubonic plague. Symp­toms in­clude painful, swollen lymph nodes, called bu­bos, as well as fever, chills and cough­ing.

Pneu­monic plague is more vir­u­lent and is an ad­vanced form char­ac­terised by a se­vere lung in­fec­tion. The in­fec­tion can be trans­mit­ted from per­son to per­son via air­borne droplets. The in­cu­ba­tion pe­riod is short, and an in­fected per­son may die within 12 to 24 hours.

An es­ti­mated 400 cases of plague are re­ported in Mada­gas­car ev­ery year.

Out­breaks typ­i­cally oc­cur dur­ing the rainy sea­son as “the rains drive the ro­dents out”, said Daniel Bausch, di­rec­tor of the UK Pub­lic Health Rapid Sup­port Team. Launched in 2016, this team con­sists of clin­i­cians, sci­en­tists and aca­demics de­ployed to tackle out­breaks of disease around the world within 48 hours.

The gov­ern­ment has mo­bilised re­sources to spray schools and other pub­lic places to fight fleas and ro­dents.

Peo­ple have also been lin­ing up at phar­ma­cies in the cap­i­tal – some wear­ing face masks – to get med­i­ca­tion or pro­tec­tion from in­fec­tion.

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