The Madagascar Health Ministry (computer translated) reported over the weekend new plague counts for the country and it show the number of cases have risen to 343, including 42 deaths as of Oct. 7.

In the capital and largest city of Antananarivo with a population of some 1.6 million people, 142 cases and more than a dozen deaths have been reported to date.

Bipolar staining of a plague smear prepared from lymph aspirated from an adenopathic lymph node, or bubo, of a plague patient./CDC
Bipolar staining of a plague smear prepared from lymph aspirated from an adenopathic lymph node, or bubo, of a plague patient./CDC

The outbreak, which is at least half pneumonic plague, has prompted the closing of schools and prompted bans of jail visits to slow the epidemic.

The World Health Organization (WHO) announced last week a delivery of 1.2 million doses of antibiotics to assist the country.

The plague is endemic in the country, with epidemic seasonal peaks ranging from September to March. According to the general secretary of the Madagascar Ministry of Health, between 300 and 600 suspected cases are reported each year, with about 30 cases of pulmonary plague and 10 to 70 deaths.

WHO data reveals that for the six years from Jan. 1, 2010 to Dec. 31 2015,  3248 cases of plague in humans were reported, resulting in 584 deaths. Of this total, Madagascar is the most seriously affected country in the world with 74 percent of all cases globally with 2,404 and eight out 10 human plague deaths (476).

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Plague is an infectious disease caused by the bacterium, Yersinia pestis. It is found inanimals throughout the world, most commonly rats but other rodents like ground squirrels, prairie dogs, chipmunks, rabbits and voles. Fleas typically serve as the vector of plague. Human cases have been linked to the domestic cats and dogs that brought infected fleas into the house.

People can also get infected through direct contact with an infected animal, through inhalation and in the case of pneumonic plague, person to person.

Related: Congo, Madagascar top countries reporting most plague 2000-2009, US reports 57 cases

Yersinia pestis is treatable with antibiotics if started early enough.

There are three forms of human plague; bubonic, septicemic and pneumonic.

Bubonic plague: This is the most common form. In this form, the bacteria enter the body through the bite of an infected flea or rodent. Here the bacteria infect the lymphatic system. After a few days to week, the person will experience fever, chills, weakness, and swollen lymph glands. These are called buboes.

Untreated bubonic plague is fatal about half the time.

Septicemic plague: This form is also contracted from a flea or rodent bite. Sometimes it appears subsequent to untreated bubonic or pneumonic plague. It involves bloodstream dissemination to all areas of the body. Buboes do not occur. Symptoms are endotoxic shock and disseminated intravascular coagulation. Untreated septicemic plague is nearly always fatal.

Pneumonic plague: Probably the most serious form of plague and it’s when the bacteria infect the lungs and cause pneumonia. It is contracted when the bacteria is inhaled (primary) or develops when bubonic or septicemic plague spreads to the lungs.

Pneumonic plague is contagious and can be transmitted person to person. It is highly communicable under appropriate climate conditions, overcrowding and cool temperatures. Untreated pneumonic plague is frequently fatal.