Madagascar has been struck by a fast-spreading outbreak of plague, creating panic and prompting the World Health Organization to send 1.2 million doses of antibiotics to the island nation.

Since August, the country has reported over 200 infections and 33 deaths.

The outbreak is beginning to resemble the early stages of the West African Ebola crisis in 2014: a lethal disease normally confined to sparsely populated rural areas has reached crowded cities and is spreading in a highly transmissible form.

Schools, universities and other public buildings have closed so they can be sprayed to kill fleas, which may carry the infection. The government has forbidden large public gatherings, including sporting events and concerts.

Fears that the outbreak could spread to other countries are rising.

Late last month, plague struck a basketball tournament for teams from Indian Ocean countries, killing a coach from the Seychelles and infecting another from South Africa. The players are being monitored, Malagasy health authorities told the W.H.O.