Plague, Yersinia pestis, Scourge of God, or the Black Death – the plague has many names. It is known if at all, from the history books. Plague is a disease with a long history. Especially in the Middle Ages numerous plague epidemicscarried large parts of the European population off, so that the infectious disease was referred to as “Black Death”. More recently, the plague is largely eradicated in most parts of the globe due to improved hygienic conditions and better medical care. But in Africa, Russia, Asia and as well in the U.S. in the past centuries there have been outbreaks of the disease. 2013 – Madagascar is once again before an epidemic of plague. Non-profit organizations such as the Pasteur Institute and the Red Cross say that the very poor population of the island, which comprises the largest part, is most at risk. Due to lack of hygiene and education a disaster is inevitable. Madagascar has recorded 256 cases of plague and 60 resulting deaths last year – the world’s highest recorded number in the last century. The disease encounters favorable conditions by the poverty and the low level of hygiene in most parts of Madagascar. An annual average of 500 cases have been recorded since 2009. The rainy season from October to August is the peak of the infection. The wet weather makes the flea population explode, which transmit the bubonic plague of rats and other animals, to humans. If the disease is not treated, as the last stage it can develop to pneumonic plague. This is highly infectious, it is transmitted by aerosol droplet infection from person to person. Only an early detection prevents death. Although the disease can be cured with antibiotics, the inhabitants of rural areas are often ashamed to seek treatmentor do not have the access to basic health care. As an initial measure they consult traditional healers, trying to heal them with burl wood, saliva and spells. Experts say that Africa – especially Madagascar has more than 90% of plague cases worldwide.