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The World Health Organization is reporting an outbreak of plague in Madagascar, and warns the disease could spread quickly in country's capital, Antananarivo.

The United Nations agency said Friday that 119 cases of plague have been confirmed in the African island nation, with 40 deaths.

It said only two cases and one death have been recorded in Antananarivo, but said "there is a risk of a rapid spread of the disease due to the city's high population density and the weakness of the healthcare system."

The first case was identified August 31 in the village of Soamahatamana.

Plague, a bacterial disease, is mainly spread from one rodent to another by fleas. Efforts to control it have been complicated by a “high level of resistance” to the insecticide deltamethrin that has been observed in the country, the WHO reported.

When an infected flea bites a human, a bubonic form of plague can develop, with characteristic swollen lymph nodes. Untreated, it can lead to pneumonia, an infection readily spread by coughing and one that can be deadly. But, if caught early, the disease can be successfully treated with antibiotics. Only 2 percent of the reported cases in Madagascar are of the pneumonic form.

The WHO said government and health partners including the Red Cross are implementing measures to contain the outbreak. Personal protective equipment, insecticides and antibiotics have been made available in the affected areas, it said.

The agency did not recommend any trade or travel restrictions.