An outbreak of the plague has killed 40 people out of 119 cases in Madagascar since late August, the World Health Organization says. 

The World Health Organization fears the disease will spread rapidly in the capital.

The bacterial disease is mainly spread from one rodent to another by fleas.

Humans bitten by an infected flea can develop a bubonic form of the plague.

If the bacteria reaches the lungs, the patient can develop pneumonia and can die within 24 hours.

Down the street from one of the city's hospitals, one resident says she worries about preparedness. 

"The basic hospital here can't even take care of cases of serious illnesses, because they don't have the facilities."

So far the WHO has not recommended any trade or travel restrictions based on the outbreak.