While plague is now a regular occurrence in Madagascar, experts are growing anxious over this year's epidemic, which has killed 124 people since August alone.
"Normally, the people who catch the plague. live in poor areas, but in this case we find the well-to-do, the directors, the professors, people in every place in society, catching the disease", Dr Manitra Rakotoarivony, Madagascar's director of health promotion, told The Guardian.
While the majority of the cases are the most lethal form - pneumonic, which has a fatality rate of 100% and can kill within just 24 hours - there are two other strains, bubonic and septicemic.
Historically, plague was responsible for widespread pandemics with high mortality rates. People can contract plague if they are in bitten by infected fleas‚ and develop the bubonic form of plague. It was known as the "Black Death" during the fourteenth century, causing more than 50 million deaths in Europe.
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Today, plague is easily treated with antibiotics and by taking standard precautions to prevent becoming infected.
The WHO has reportedly delivered 1.2 million doses of antibiotics to the country.
The black death broke out in Madagascar last month, reportedly affecting urban areas which, according to the World Health Organization, increases its chances of transmission and spread. The virus can be transmitted between animals and humans by the bite of infected fleas or the inhalation of infected respiratory droplets.
People infected with plague usually develop symptoms after an incubation period of seven days when acute febrile illness (a rapid onset of fever and symptoms such as headache, chills or muscle and joint pains) sets in. Bubonic plague can advance and spread to the lungs, which is the more severe type of plague called pneumonic plague.
In bubonic sufferers, these inflamed lymph nodes may end up turning into pus-filled open sores.