plague workers
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Workers cleaning and disinfecting the tents where patients sleep at the health center.
A state of emergency has gripped Madagascar with schools and public meeting spaces closed, panic buying and hoarding of antibiotics, and 15,000 teachers being re-trained to spot and isolate those with signs of plague.

But the plague, which has so far killed 123 and left hundreds infected, is a super-strain which is even more infectious and deadly than famous the Bubonic Plague of the 14th century.

The Madagascar Plague is actually three plagues.

The first is bubonic - the type which ravaged Europe and the Mediterranean in the thirteen hundreds, leaving up to 60 percent dead.

Comment: Actually, the bubonic plague was universally and unequivocally believed to be the cause of the Black Death in the thirteen hundreds, despite the fact that it is well-established as biologically impossible. For more information, see: New Light on the Black Death: The Viral and Cosmic Connection.

The second is pneumonic - a super strain of the yersinia pestis bacterium which always results in death.

The third, more rare strain, is septecaemic - a life-threatening infection of the blood.

In Madagascar plague is endemic, and flare-ups cause public health emergencies on an almost annual basis but now the nation faces an uncontrolled epidemic which is terrifying the world's health agencies.

Between 1 August and 27 October, 113 people had died and 1,554 cases reported - out of which 985 were pneumonic plague, 230 bubonic plague and 339 unknown.

Madagascar normally only sees about 400 cases each year.

World Health Organisation advice warns: "The pneumonic form is invariably fatal unless treated early. It is especially contagious and can trigger severe epidemics through person-to-person contact via droplets in the air."

Although if caught in time all forms of the Plague will respond to specific targeted antibiotics.

The Plague has also now spread through the capital to coastal cities.

World Health Organization spokesperson Tarik Jašarević said: "We have not seen this before."

The Plague has already turned up in Seychelles and South Africa, Mozambique, Tanzania, Kenya, Ethiopia, Comoros, the Seychelles, Mauritius and Reunion have all been placed on high alert by World Health Organisation (WHO) monitors.

This year's outbreak involves mostly pneumonic plague, a more dangerous form of the disease than the much more common bubonic plague.

Pneumonic plague attacks the lungs and spreads from person to person through droplets from coughing, like a cold, while bubonic plague spreads only from fleas to humans.

About 70 percent of cases so far were classified as pneumonic plague, according to the WHO.

Mr Jašarević said: "It's a worrying situation because it's in an urban setting, and it's transmissible from human to human.

"We need to act quickly to trace the contacts of those infected and put people on a preventive treatment."

About 30 to 60 percent of people who contract bubonic plague die. Untreated pneumonic plague is always deadly, typically within 24 hours of disease onset.

A timely antibiotics dose can, however, save lives, and that's why the WHO delivered an emergency stockpile of nearly 1.2 million doses of antibiotics to the Indian Ocean island nation.