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After Ebola, now Plague. The World Health Organizations is warning locals, as well as travelers and tourists planning to visit Madagascar: “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 health care system.”

119 people got sick since August, killing 40, and the epidemic is spreading fast — most recently hitting the congested Madagascar capital city of Antananarivo, according to the World Health Organization.

While plague — as the multiple diseases caused by the Yesinia pestis bacteria are commonly known — conjures up images of some of the darkest periods in medieval history, today the deadly disease is easily treated by antibiotics. The bacterial nature of plague sets it apart from virus-caused diseases such as Ebola, for which there is no known direct cure.

Because the disease is carried and spread by fleas that live on the bodies of rats, modern sanitation and use of insecticides has made the plague a rarity in the modern world.

The problem is that in countries such as Madagascar, an impoverished island of about 22 million in the Indian Ocean, 250 miles off the southeast coast of Africa, where the sanitation can be primitive, the health care system barely functioning and medicine not well distributed, quick diagnosis and treatment of the disease often simply does not happen.

According to the WHO, the first case of plague in the current outbreak occurred in a village about 100 miles from Antananarivo. The capital city of more than two million has now seen two diagnosed cases of plague with one death from the dreaded disease.

A national task force is now being set up, with the WHO’s help, to stop the plague outbreak — a project that is expected to cost $200,000. That is a massive sum in a country where 75 percent of the population subsists below the poverty line of $1.25 per day.

Madagascar has seen up to 600 cases reported each year, though in most of the rest of the world, plague has become extremely rare.

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