WIKIMEDIA, ROCKY MOUNTAIN LABORATORIES, NIAID, NIHIn the past week, public health officials in Madagascar have reported 230 new cases of plague and 17 deaths from the bacterial disease, bringing the outbreak’s total in the past two months to 387 infections and 45 deaths, according to the World Health Organization’s (WHO) update yesterday (October 9). The BBC reports that WHO has delivered more than 1 million doses of antibiotics to combat the outbreak.

Plague is endemic to Madagascar, but the spike in infections in the past two months has surpassed typical annual totals and led to an outbreak designation. “Local authorities and international partners are concerned that the outbreak may further spread as it is already present in several cities, and the plague epidemic season has already started and usually runs from September to April,” says the European Centre for Disease Prevention and Control, in an assessment published yesterday.

The bacterial infection is spread by fleas, although humans can catch it from one another by coming into contacted with infected bodily fluids. Of concern presently is the high percentage of “pneumonic plague” cases—72 percent of the Malagasy outbreak—in which patients’ lungs get infected, because coughing can spread the disease.

According to the BBC, cities in Madagascar have ramped up prevention by setting up rat traps, spraying insecticides, closing schools, and cancelling public events.