WHO is rapidly scaling up its response to an outbreak of plague in Madagascar that has spread to the capital and port towns infecting more than 100 people in just a few weeks. The Government of Madagascar has confirmed that the death of a Seychellois national was due to pneumonic plague. The basketball coach died in hospital in Antananarivo on Wednesday September 27 while visiting the island nation for a sports event. Health authorities are tracing people with whom he came into contact in recent days and who may have become exposed to the illness. Once identified they will be given antibiotics to prevent infection as a precautionary measure. The incident brings the death count to 21 since the outbreak was identified in late August at least 114 people have been infected. Plague is endemic to Madagascar where around 400 cases of mostly bubonic plague are reported annually. Contrary to past outbreaks this one is affecting large urban areas which increases the risk of transmission WHO October 1 2017 .