2017-10-05 from cbc.ca

Elisah Raharimalala and her daughter wear face masks as they make their way around the capital of Madagascar, Antananarivo, a city of more than a million people. They're wearing the mouth and nose coverings to protect themselves not from air pollution or the common cold but from the plague, a disease that in the West is more commonly associated with the Middle Ages.

"We are worried because we live in the less-pleasant part of the town," said Raharimalala. "Our place is clean, but in the communities around us, there are dead rats."

In 14th-century Europe, the plague was known as the Black Death and by some estimates caused an estimated 50 million deaths during that period.

In Canada, there has not been a human case of the plague since 1939 (although a case was detected in a Saskatchewan prairie dog this summer). Worldwide, there are between 1,000 and 2,000 reported cases a year, largely confined to rural areas, according to the Centers for Disease Control and Prevention.

But now, a deadly outbreak of plague is spreading across Madagascar, a country that already had the highest number of cases of the disease in the world.

And it's spreading fast — faster than it has in the past in Madagascar, according to the World Health Organization (WHO).

"People just don't think of plague in 2017 as a cause of illness. We think of this in medieval times killing a huge proportion of the world but lo and behold, it's alive and well," said Dr.Isaac Bogoch, an infectious disease and tropical medicine specialist at the Toronto General Hospital.

"This is not something like Ebola or Zika where we are worried about this spreading all over the world. Plague is already in many, many parts of the world, but cases are usually very sporadic, and there are limited amount of cases per year. Madagascar just seems to be a hotbed and has been for some time."

WHO spokesperson Tarik Jasarevic explained that Madagascar sees more cases of plague than other poor countries because of several factors that combine to create just the right conditions for the spread of the disease: plague is already present on the island; rats live in close proximity to humans; and people live in poverty with unsanitary living conditions.

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