Authorities in Madagascar say they are trying to contain an outbreak of plague similar to the Black Death that swept Medieval Europe.
The disease has already killed 40 people in the country and is spreading to the capital Antananarivo, where two people have been infected.
Plague is spread by fleas and mostly affects rats, but humans can also contract the disease if they are bitten by a disease-carrying flea.
The World Health Organisation says health workers have mounted a pest control campaign through slum areas of the city in an effort to stop the disease spreading.
“There is now a risk of a rapid spread of the disease due to the city’s high population density and the weakness of the healthcare system,” a WHO statement on November 21 said.
“The situation is further complicated by the high level of resistance to deltamethrin (an insecticide used to control fleas) that has been observed in the country.”
The health ministry’s secretary general, Philemon Tafangy, said “two hundred households have been disinfected” this month.
He said those who had contact with the infected had been given antibiotics in a bid to prevent the disease from spreading.
The WHO last week said the plague was first identified in August. The bubonic form prompts swelling of the lymph node, but can be treated with antibiotics.
The pneumonic version, which affects the lungs, can be spread from person to person through coughing and can kill within 24 hours.
Families of plague victims given ‘dirty looks’
In Ankasina, a slum outside Antananarivo, the family of the young woman who died from the plague said they were stigmatised by the community.
According to Bernadette Rasoarimanana, the mother of the deceased woman, community members have been giving them “dirty looks” since the death of her daughter.
Residents of the poor and overcrowded slum speak of squalid conditions, infested with rats, increasing the risk of infection.
“Our neighbourhood is really dirty and has been neglected by the state for a long time,” she said.
Plague often breaks out in the vast island nation.
According to the International Committee of the Red Cross, the country has recorded on average 500 cases of plague every year since 2009.
The Black Death, otherwise known as the bubonic plague, is estimated to have killed some 25 million people across Europe in the Middle Ages.