by Salil JajodiaA plague of pneumonic plague has spread rapidly throughout Madagascar in recent weeks, with more than 680 recorded cases.  Government authorities were late to realize that the disease was not bubonic plague, but the more virulent pneumonic for, causing the rate of spread to increase in recent days;  this is especially concerning in a country with undeveloped health infrastructure.According to officials from the Red Cross, this is the first time pneumonic plague is present in the urban environment.  This form of plague causes a severe lung infection, and is generally carried by infected fleas (which tend to reside in unsanitary environments).  Given that the disease is transmissible through air, the outbreak has alarmed the people of Madagascar.The outbreak first started with the case of a 31-year-old man in the central highlands who traveled through the capital on his journey home, indirectly infecting more than 30 people.  The spread of the disease to other countries is also important to consider, and in recent days a man in Seychelles was diagnosed with plague upon his return from Madagascar.Locals in Madagascar tend to try and guard themselves from the disease themselves due to the ill-equipped clinics and hospitals.  The mayor of Toamasina claimed that Madagascar had been defeated, and asks for more international support.  Currently the WHO has been taking action, and is setting up its first plague treatment centre while spending $1.5 million in the effort to stop the spread.  Many international groups are now responding, including Medecins Sans Frontieres and US Centers for Disease Control and Prevention among others.This situation is especial worrying considering the Ebola outbreak that shook West Africa from 2013-2016. With the close-quarter and unhygienic conditions present in rapidly urbanizing populations in developing countries, the risk of uncontrollable diseases causing disaster keeps increasing every year.  Plague has been described as a disease of poverty; it’s curable by antibiotics but kills quickly in the absence of treatment.In terms of the future, experts generally agree that the risk of national spread is significantly high due to domestic conditions.  However, the risk of international spread is estimated to be quite low considering that infected patients tend not to travel.  The most critical thing for Madagascar to do in the coming weeks is effectively allocate the international and domestic resources to ensure that people who are infected are identified and quarantined to stem further flow, while ensuring quick treatment for those with common symptoms.Sources:http://www.latimes.com/world/africa/la-fg-madagascar-plague-20171013-htmlstory.htmlhttp://www.cbc.ca/news/health/plague-madagascar-1.4353330http://edition.cnn.com/2017/10/16/health/madagascar-pneumonic-bubonic-plague-outbreak-continues/index.html