At least two dozen people in Madagascar have been killed by the pneumonic plague, also known as the Black Death, an ancient disease that reemerged in the country, infecting more than 114 people in recent weeks.

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Known as the “disease of poverty,” because it has been mostly eradicated throughout the world except in areas with inadequate medical infrastructure, the pneumonic plague is transmitted from person to person through breathing. The disease causes flu-like symptoms: shortness of breath, fever, coughing, and vomiting.

So far, it has been reported in the three cities: Antananarivo (27 cases, 7 deaths); the port of Toamasina in eastern Madagascar (18 cases, 5 deaths); and Faratshio (13 cases, 1 death), according to the The World Health Organization (WHO), which is sending more staff and medical supplies to aid those affected by the outbreak.

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The recent death of a male basketball coach from Seychelles who was participating in a tournament prompted international attention around the outbreak in the country, reported the Seychelles News Agency.

As a result of this and other deaths, the government has been taking precautions banning large public gatherings.

“At airports and bus stations, measures will be taken for passengers to avoid panic and to control the disease,” Madagascar’s prime minister, Olivier Mahafaly Solonandrasana said in a televised address following an emergency meeting with the UN health agency.

A jazz festival, Madajazzcar, is one of many events that have been cancelled until further notice, and a campaign has begun to disinfect schools in the capital city of Antananarivo. Many people have flocked to stores to buy medicine, surgical masks,” and supplies.

“Once everybody hears that this is a major thing, everyone runs out and buys everything at the pharmacy,” Joshua Poole, the Madagascar representative for Catholic Relief Services, an aid group based in Baltimore, Maryland told the Washington Post. “Access to those essential items is a challenge.”

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According to the World Health Organization, the plague is reported nearly every year in Madagascar during the epidemic season (between September and April) in remote areas. However, the current pneumonic plague event has been reported in a non-endemic area and in densely populated cities for the first time.

Other countries that have experienced the plague in recent years include Peru, China, Bolivia, Uganda, Tanzania and Russia, according to the Centers for Disease Control and Prevention (CDC).

Historically, before a cure was found, the disease wiped out millions of people who experienced a slow painful death. The Black Death resulted in an estimated 75 to 200 million deaths across Europe between 1346-53, according to the Express.

Plague can be transmitted to humans by flea bites, contaminated fluid, or tissue of an infected animal, or direct contact with an infected person (pneumonic plague), according to the (CDC).

It can be treated successfully by antibiotics as soon as possible, preferably within 24 hours of the first symptoms.

Dr Charlotte Ndiaye, WHO representative in Madagascar, told the Guardian News  they’re educating communities on appropriate preventive measures.

“Our teams are on the ground in Madagascar providing technical guidance, conducting assessments, supporting disease surveillance, and engaging with communities,” she added. “We are doing everything we can to support the government’s efforts, including coordinating health actors.”

Health authorities are urging everyone in the endemic areas to seek treatment at health centers. WHO has released $250,000 from its emergency fund to get immediate action underway. It plans to appeal for $1.5 million to fully respond to the needs.

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The Plague — Yes, That Plague — Has Killed 22 People in Madagascar

By Carlotta Mohamed