Since early February 2011 deaths from both pneumonic and bubonic plague have been occurring in Northern Madagascar. As of February 23rd a total of 45 cases had been detected in the country with 23 deaths. It is thought that plague initially spread as locals mistook symptoms of plague for influenza. It was only after 3 people in one family died in the district of Ambilobe that doctors were alerted. In a report dated March 15th, additional deaths were reported from the Antananarivo region. While plague typically occurs yearly in Madagascar’s Central Highlands, the current outbreak is occurring in a region where the disease is not endemic. In areas affected, homes are being sanitized, and preventative treatment is being given to those who have had contact with plague victims.