An outbreak of bubonic plague in  Madagascar is quickly becoming an epidemic, giving a grim look into how this dreaded disease, once known as the Black Death, killed off one-third of the entire world population.

Madagascar, a poor country in the Indian Ocean, suffers annual outbreaks of the plague with an estimated 400 cases every year. This current outbreak threatens to be much worse than the usual annual outbreak. In the past two months, at least 74 people died from the disease and over 800 more have been infected.

Usually, the plague is limited to rural areas that become infected when rats flee summer brush fires in the summer or floods in the winter. The plague develops in rats and is carried by fleas in their fur. But the majority of the cases reported this year have been in urban centers. In an urban environment, there is a greater risk of transmission and health officials fear that this outbreak may become a full-blown epidemic.

Another point of concern is that 70 percent of the victims recorded this year have been infected with the highly contagious pneumonic form of the disease, transferred through coughing. The pneumonic version of the plague can be fatal within 72 hours and is more dangerous than the bubonic form transferred by rats. Both forms can be treated with antibiotics, making early detection a priority. If untreated, the disease has 100 percent mortality rate. Of Madagascar’s 114 districts, 35 have reported cases of plague, including at least 10 cities.

This current epidemic is believed to have begun in late August when a 31-year-old man traveled from his home in Toamasina, a town on Madagascar’s east coast, to the central highlands town of Ankazobe, in a region where plague is endemic. He apparently contracted the disease in the rural region, developing symptoms on the journey home. He died undiagnosed soon after arriving. 31 people who came into contact with him became ill, four of whom died.

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The government has responded with significant safety measures. Travellers at major transport hubs are subject to medical inspections, infected areas have been fumigated to kill fleas, public gatherings are banned, and schools and universities have been shut to combat the outbreak.

The World Health Organization (WHO) has delivered nearly 1.2 million doses of antibiotics and released $1.5 million in emergency funds. The Red Cross has released more than $1 million to deploy a treatment center and mobilized more than 1,000 volunteers to monitor people who have been in contact with infected patients.

A WHO official said: “The risk of the disease spreading is high at the national level because it is present in several towns and this is just the start of the outbreak.”

Experts said the risk of a global pandemic remains low, as most patients exhibit symptoms quickly and become too sick to travel. People infected with plague usually develop flu-like symptoms after an incubation period of three to seven days, according to WHO and typical symptoms include the sudden onset of fever, chills, head and body-aches and weakness, vomiting, and nausea.

Nonetheless, a 34-year-old man visited Madagascar two weeks ago and returned to the neighboring country of Seychelles three days later. He quickly developed symptoms of pneumonic plague and was treated at a local health center. Ten people who had contact with him developed symptoms and are being treated for the disease.

The Black Death was one of the most devastating pandemics in human history, resulting in the deaths of an estimated 75 to 200 million people in Eurasia and peaking in Europe in the 14th century. The Black Death is estimated to have killed 30–60 percent of Europe’s total population.

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Source: Israel in the News