Health officials have been scrambled to a school in southwestern Germany where dozens of children have been infected with lung-choking tuberculosis.

A total of 109 students, teachers and other school employees at the Michael Ende non-denominational school have found themselves in the grip of the disease, following an outbreak in the town of Bad Schönborn.

Authorities revealed that four people, including two students, have active cases of tuberculosis, meaning they could be contagious. The four have been removed from the school and are receiving medical treatment.

“We cannot rule out the possibility that there will be new cases of active illness,” Ulrich Wagner from the Karlsruhe health department said to the Badische Neueste Nachrichten newspaper.

The outbreak comes after two children in two separate schools in Bad Schönborn were found in early July to have active tuberculosis. The disease has since continued to spread in the Michael Ende school. The eighth grade class has been particularly badly affected, with 56 students –88 percent of the entire class– contracting the illness.

Local broadcaster SWR is reporting that health officials are now examining the school building to determine how the bacteria was able to infect so many people.

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