The World Health Organisation says an outbreak of plague has now killed 40 people in Madagascar.

There have been 119 confirmed cases of the disease in the country since August. 2% of the cases are the pneumonic form of the disease

There are fears it could spread rapidly in Madagascar's capital Antananarivo due to the city's high population density and what the WHO calls "the weakness of the healthcare system". 

Cases have been identified in 16 districts in seven regions of the country, including two cases in the capital.

The WHO is not recommending any travel or trade restrictions to Madagascar.

The first case was identified on 31st August, and the patient died on September 3rd,

Plague is carried between rodents by fleas, with humans contracting the bubonic form of the disease if bitten by an infected flea. The more deadly pneumonic form occurs if the infection reaches a patient's lungs. It is then transmissible to others through coughing.

In a statement, the WHO says "if diagnosed early, bubonic plague can be successfully treated with antibiotics. Pneumonic plague, on the other hand, is one of the most deadly infectious diseases; patients can die 24 hours after infection. The mortality rate depends on how soon treatment is started, but is always very high."