Plague has killed 57 people out of 213 known cases in Madagascar, and more deaths are expected after recent flooding forced tens of thousands of people from their homes and displaced rats, the World Health Organization (WHO) said Tuesday. The U.N. agency's first update since late November, when there were 119 plague cases including 40 deaths, was based on new figures from the Health Ministry. The plague outbreak started in August on the Indian Ocean island, one of the world's poorest countries, where the disease is endemic. The bacterial disease is mainly spread from one rodent to another by fleas. Humans bitten by an infected flea usually develop a bubonic form of plague, which swells the lymph node and can be treated with antibiotics. However, if the bacteria reach the lungs, the patient develops pneumonia, which is transmissible from person to person through coughing. Pneumonic plague is one of the most deadly infectious diseases and can kill people within 24 hours. "Plague established a foothold in the capital city, affecting densely populated slums. This is alarming, as around 8 percent of cases progress to the lethal pneumonic form," said WHO Director-General Margaret Chan. The WHO director said flooding from a tropical storm and a cyclone last week displaced tens of thousands of people and untold numbers of rats, "raising the risk of more rodent-borne epidemics." Adding to the danger, the fleas that transmit the disease from rats to humans have developed resistance to the primary insecticide, she told the WHO executive board.
