An outbreak of the plague has killed 24 people in Madagascar.
At least 114 people have been infected with plague and the disease is affecting large urban areas unlike past outbreaks, increasing the risk of transmission, according to the World Health Organisation (WHO).
The outbreak in recent weeks has led to the country's government banning large public gatherings in the capital in a bid to curb the spread of the disease.
Local media reported that in the capital, Antananarivo, five people have died of the plague, including a basketball coach from the Seychelles who was participating in a tournament.
The coach, 49-year-old Alix Allisop, died in a hospital on Wednesday after experiencing breathing problems, according to media in the Seychelles.
The Government has told children to stay home from school in the coming days as it undertakes a campaign to disinfect classrooms in the capital.
Plague has also been reported in other cities on the African island.
WHO, which is sending more staff and supplies, including antibiotics, to Madagascar, said about 400 case of plague, mostly bubonic, are reported every year in the country.
The last reported outbreak in Madagascar occurred in a remote area in December 2016 and was mostly bubonic plague, the United Nations health agency said.
"Bubonic plague is spread by infected rats via flea bite, pneumonic by person-to-person transmission.
"The current outbreak includes both forms of plague," the agency said.
It described plague as a "disease of poverty" that can kill quickly if untreated but can be cured if antibiotics are administered early.
Many people have bought surgical masks and other medical supplies in large quantities, raising concerns about a shortage of medicine.
"Once everybody hears that this is a major thing, everyone runs out and buys everything at the pharmacy," said Joshua Poole, the Madagascar representative for Catholic Relief Services, an aid group based in Baltimore, Maryland.
"Access to those essential items is a challenge."