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Madagascar's cities struggling to cope with plague outbreak

Coping with a plague outbreak has been a shock for many of Madagascar's city dwellers.

They have waited in long queues for antibiotics at pharmacies and reached through bus windows to buy masks from street vendors.

Schools have been cancelled, and public gatherings are banned.

The plague outbreak has killed 63 people in the Indian Ocean island nation, Madagascar's government has said.

For the first time, the disease long seen in the country's remote areas is largely concentrated in its two largest cities, Antananarivo and Toamasina.

Global health officials have responded quickly.

The World Health Organisation, criticised for its slow response to the 2014 Ebola epidemic in West Africa, has released 1.5 million US dollars and sent plague specialists and epidemiologists.

The Red Cross is sending its first-ever plague treatment centre to Madagascar.

On Wednesday, Madagascar's minister of public health rallied doctors and paramedics in a packed auditorium at the country's main hospital, saying they're not allowed to go on vacation.

"Let's be strong, because it's only us. We're at the front, like the military," Mamy Lalatiana Andriamanarivo said.

The outbreak could continue until the end of infection season in April, experts warn.

Madagascar has about 400 plague cases per year, or more than half of the world's total, according to a 2016 World Health Organisation report.

Usually, they are cases of bubonic plague in the rural highlands.

Bubonic plague is carried by rats and spread to humans through flea bites.

It is fatal about the half the time, if untreated.

Most of the cases in the current outbreak are pneumonic plague, a more virulent form that spreads through coughing, sneezing or spitting and is almost always fatal if untreated.

In some cases, it can kill within 24 hours.

Like the bubonic form, it can be treated with common antibiotics if caught in time.

AP

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