An outbreak of bubonic plague on the African island nation of Madagascar has killed 40 people since the initial outbreak began in August. The virulence has left many health officials anxious: With only 119 infections reported, the death count is disproportionately high.

The first case of the disease appeared in a village two hours from the capital of Antananarivo, but has since moved into the densely populated city, where local authorities worry of a spike in infections.

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Three infection sub-types of Yersinia pestis, the bacterium that causes plague, are known; the bubonic form attacks the lymphatic system and causes characteristic swellings, called buboes, of the lymph nodes. Septicemic plague occurs when the bacteria infects the blood and like the bubonic type, is spread through the bite of infected fleas. The most serious variant, pneumonic plague, occurs when Y. pestis attacks the lungs after being inhaled and can kill within 24 hours. 

Two percent of the cases reported in this latest outbreak were confirmed to be pneumonic. 

One of Africa's poorer nations, Madagascar's basic health infrastructure is ill-suited to manage a large-scale outbreak. In a statement, the World Health Organization (WHO) said a national task force has been set up to assist, with the Red Cross and Malagasy authorities to control and treat the disease.

WHO officials have not yet issued travel warnings for the country.

Already ravaging Asia when introduced to Europe in 1347, the plague is responsible for one of the most famous pandemics in history, with over 100 million dead. While the bacterium also spread to the Middle East and northern Africa, southern Africa, safely walled behind the Sahara Desert, was largely spared. Ironically, this has left today's populations in the region particularly vulnerable to Y. pestis.

Periodic outbreaks of plague continue to appear; Peru reported cases in 2010, and China quarantined the city of Yumen when a man died of plague earlier this year.

Tagsmadagascar, bubonic plague, Africa, black death