Twenty villagers on the island nation of Madagascar have died from an outbreak of bubonic plague.
On Tuesday, the Pasteur Institute of Madagascar revealed test results from the deceased found in the northwestern town of Mandritsara last week and confirmed that they had died of bubonic plague, the Guardian reports.
The disease is usually transmitted to humans from black rats carrying fleas infected with the plague bacteria, the outlet notes.
Last year, the African island reported 256 cases and 60 deaths from the “Black Death.” According to the Centers For Disease Control, Madagascar and sub-Saharan Africa have accounted for 95 percent of reported plague cases in recent years. Other cases have been reported in India, Indonesia and parts of Africa.
One of the first symptoms of the deadly disease is the swelling of the lymph nodes. In some cases, the bacteria may spread to the lungs, causing the patient to develop pneumonia, which can lead to death in 24 hours, according to the World Health Organization. If the disease is treated early enough with antibiotics, the chances of fatality drastically decline.
In October, the International Committee of the Red Cross (ICRC) warned that inmates in Madagascar are typically most at risk for catching the disease, due to the prevalence of rats and unsanitary conditions in the country's prisons, the BBC reported.
“If the plague gets into prisons there could be a sort of atomic explosion of plague within the town. The prison walls will never prevent the plague from getting out and invading the rest of the town," Christophe Rogier of the Pasteur Institute told the BBC in October.
However, the ICRC is working to eradicate all rats from the island’s prisons to curb the impending threat to local towns, the Guardian noted.