KIGALI (Reuters) - A plague epidemic in Madagascar has killed 124 people since August in an outbreak that has hit the island’s two main cities the hardest, the authorities said on Wednesday.

Plague is endemic in Madagascar, but the outbreak that has caused 1,192 suspected cases since August is especially worrying because it started earlier in the season than usual and has hit urban rather than rural areas.

In addition, two thirds of the cases are of the pneumonic plague, the deadliest form of the disease.

“The total number of cases (1,192) is already three times higher than the average annual total,” the National Office for Risk and Disaster Management said in a report on Wednesday.

Last week a World Health Organization report said the death toll stood at 94.

The capital Antananarivo and Toamasina, the two largest cities in Madagascar, an island in the Indian Ocean, were the most affected, with 55 percent of cases recorded there.

To date 54 medical staff have been infected, it said.

The report said that of an estimated $9.5 million in aid needed to counter the epidemic, only $3 million has been raised.