From VOA Learning English, this is the Health Report.

　　For much of 2014, health officials around the world have been guarding against Ebola virus.

　　There is another disease that can cause as much attention and fear – the plague.

　　Last week, the World Health Organization reported on cases of plague in the island nation of Madagascar. WHO officials warned the disease could spread throughout the country.

　　Madagascar's health ministry reported in November that the plague has killed nearly 50 people. And it said over 130 people are thought to be infected.

　　Just the word plague alone calls up images of the Black Death hundreds of years ago. The Black Plague killed more than 25 million people in Medieval Europe.

　　Madagascar is far from that number.

　　But the World Health Organization reports that the plague could infect many people. So, the WHO is working with health officials in Madagascar to contain the outbreak.

　　The plague is not new to Madagascar. It seems to reappear in the country every year.

　　However, the WHO's Christian Lindmeier says the U.N. health agency is very concerned about this outbreak. He says the number of cases of plague appears to be higher than in recent years.

　　"Cases have been reported in 16 districts of seven regions. In Antananarivo, the capital and largest city in Madagascar, also two recorded cases have been identified, including one death."

　　Mr. Lindmeier says the disease could spread quickly because of the city's high population and the weakness of the health care system. Another problem is that the insects spreading the disease are becoming resistant to the chemical product designed to kill them.

　　The first case of the plague was identified on August 31. The patient died three days later. However, the health officials in Madagascar did not report the outbreak to the WHO until November 4.

　　Christian Lindmeier says measures for the control and prevention of plague are being put into effect in the affected areas. He says personal protective equipment, insecticides and antibiotics are being made available in those areas.

　　He says a WHO expert has gone to Madagascar to work with the health officials there. They plan to fully investigate the situation to see what more needs to be done to bring the disease under control.

　　"Plague can be a very severe disease in people with a case fatality ratio of 30 to 60 percent if left untreated. Plague is caused by the bacteria Yersinia pestis, a zoonotic bacteria usually found in small animals and their fleas. People infected with plague usually develop flu-like symptoms after an incubation period of three to seven days."

　　Humans bitten by an infected flea usually develop a bubonic form of plague. It causes the swelling, or enlargement, of lymph nodes. If the bacteria reach the lungs, the patient develops pneumonia. The disease can spread from person to person through infected droplets spread by coughing.

　　Bubonic plague can be successfully treated with antibiotic drugs if caught early. But the WHO says pneumonic plague is one of the most deadly infectious diseases. It can kill patients within 24 hours after infection. To date, WHO says only two percent of reported cases are of the pneumonic form.

　　I'm Anna Matteo.

　　Lisa Schlein reported this story from Geneva, Switzerland. Anna Matteo wrote it for VOA Learning English. George Grow was the editor.