An outbreak of pneumonic plague – commonly known as the Black Death – has killed at least 45 people and could become an epidemic in the United States, experts have warned. More than 231 cases of the contagious disease have been recorded in Madagascar this year, and the number of deaths is higher than in previous years due to the country’s “deteriorating” medical services.

And experts in the United States have warned “continued underinvestment” in health services there could see the disease spread rapidly into an epidemic. In August, a public health warning was issued in northern Arizona after fleas had tested positive for pneumonic plague. The bubonic strain of the disease is passed on by flea bites, whereas the more infectious pneumonic type is spread through coughing. READ MORE