Experts have detected the bubonic plague in a Madagascar village where at least 20 people were confirmed to have died last week. Though the disease is rare today, the Red Cross warned of a Madagascar outbreak in October, and 60 people in the country died from the disease last year, the BBC notes—more than anywhere else on Earth. Doubly concerning: The Guardian notes that this outbreak is one of the planet's worst in recent memory, and took place outside the island's customary plague season: July to October.
The village in question is also at a lower elevation than those typically affected in Madagascar, raising the possibility that the disease's reach is growing; Madagascar typically sees up to 400 cases a year, as much as a third of the global total. Rats are generally the source of the bubonic plague; it spreads to humans through fleas, but does not spread human-to-human. That makes the country's rat-infested prisons particularly susceptible. With experts warning that the disease could spread, officials are investigating the village, near the town of Mandritsara in the country's northwest. (As for the United States, it isn't entirely free of the plague.)