Madagascar is at risk of a major outbreak of bubonic plague unless it can clean up its rat-infested jails, health experts have warned.
The Indian Ocean island became the most severely affected country in the world last year, with 256 cases and 60 fatalities from the disease known as the "black death" when it swept through Europe in the 14th century.
The International Committee of the Red Cross (ICRC) and the Malagasy prison authorities have launched a campaign against rodents in Antanimora prison in the capital, Antananarivo, where 3,000 inmates are behind bars.
Christoph Vogt, head of the ICRC delegation in Madagascar, said: "The chronic overcrowding and the unhygienic conditions in prisons can bring on new cases of the disease. That's dangerous not only for the inmates but also for the population in general."
An average of 500 cases have been recorded on the island every year since 2009. October is the peak month as hot humid weather attracts fleas, which transmit the disease from rats and other animals to humans.
"Rat control is essential for preventing the plague, because rodents spread the bacillus to fleas that can then infect humans," Vogt added. "So the relatives of a detainee can pick up the disease on a visit to the prison. And a released detainee returning to his community without having been treated can also spread the disease."
Malagasy prison authorities are working to eliminate rats and prevent the spread of the plague in Antanimora prison with the technical support of the ICRC and the Pasteur Institute of Madagascar. Detainees and prison staff are taking part in the disinfection work and insecticide spraying while the ICRC distributes hygiene products and rodent traps.