The plague has broken out in Madagascar and killed 40 people and infected 79 people so far, said the World Health Organization.

The disease is spreading rapidly — 16 districts of seven regions have been infected, and recently the Madagascar capital of Antananarivo encountered two cases, including one death. The disease is expected to spread rapidly in the capital due to the dense population and weak healthcare system.

A small but significant 2 percent of plague cases have been pneumonic, which can be spread by simply coughing, and death can come as soon as 24 hours after infection. The rest of the cases are the milder bubonic form, which can be treated by antibiotics if diagnosed in time.

Contributing to the spread of the plague has been an increase in the number of fleas in the area. The fleas have developed a resistance to a key insecticide called deltamethrin.

A national force has pulled resources to counter the plague, which includes resources from WHO, the Pasteur Institute of Madagascar, the Commune urbaine d’Antananarivo, and the Red Cross. The African Development Bank has given $200,000 to the project.

The Ministry of Health of Madagascar, according to WHO, said the first person diagnosed with this plague, or the patient zero, was a man from the Soamahatamana village in the district of Tsiroanomandidy. He was diagnosed on Aug. 31 and died days later. The WHO was notified of an outbreak on Nov. 4.

WHO released their statistics on 21 Nov. saying they were true as of Nov. 16.

For now, WHO does not believe travel or trade restriction to Madagascar is necessary.