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. It is rare today, but Madagascar has the highest incidence in the world. In 2012, the Indian Ocean island reported 256 cases of plague and 60 deaths. Since the most recent plague “season” began last October, the health ministry has reported 42 deaths out of 84 cases, of which 60 are thought to be pneumonic or pulmonary plague, a more virulent strain than the bubonic type.
Last month, just as presidential and parliamentary elections were getting under way, Malagasy officials announced the capital Antananarivo’s coffers were empty and there was no funding for rubbish collection. Refuse has been piling up, encouraging rats and mice. The UN Development Programme and the European Union have donated funds and equipment to help clear the city of garbage.