An unusually large plague outbreak in Madagascar has taken 94 lives, the World Health Organisation said on Friday.

The number of suspected cases has reached 1,153, Dr. Ibrahima Soce Fall, Africa emergencies chief for the U.N. health agency, told reporters in Geneva.

More cases are expected, "but we think we can affect the curve very quickly thanks to the deployment of human resources and all types of intervention," he said. International agencies have sent more than one million doses of antibiotics and deployed medical teams.

Plague is endemic in Madagascar, but this year’s outbreak is unusual because for the first time the disease has affected the Indian Ocean island’s two biggest cities, Antananarivo and Toamasina.

More than 70 percent of the cases are pneumonic plague, a more virulent form that spreads through coughing, sneezing or spitting and is almost always fatal if untreated.