Fleas spread the bubonic plague from wild rodents in the forest to rats in the villages and then on to humans in the highlands of Madagascar.
The highland streaked tenrec is one of the forest animals that act as a reservoir for the plague on the diverse island off the coast of Africa.
The pathogen that spreads the plague is believed to have been responsible for the Black Death, which killed tens of millions in the Medieval period.
Matthew Baylis, professor of veterinary epidemiology at Liverpool University’s Institute of Infection and Global Health, said that the plague is endemic in Madagascar.
Prof Baylis said that the plague circulates among wild animals, such as the highland streaked tenrec, in the forest. Fleas then spread the plague to rats in villages.
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He said: “It’s endemic in Madagascar and it’s been there for well over 100 years. Every now and then, it spreads to the human population in the form of bubonic plague.
“But pneumonic plague can turn into pneumonic plague, in particular if people are not treated quickly. These people with pneumonic plague can spread it more quickly to other people.”
It is not known why the plague outbreak has been so bad this year, but Prof Baylis suggested that it could be connected to the El Nino in 2016.
He said: “We have suspicions – and it is no more than a suspicion – that it could be related to the El Nino we had a year ago.”
He said that is it possible that changes in rainfall affected fleas and rats, stimulating the bubonic plague which has led into the pneumonic plague.
The World Health Organization (WHO) has said the Madagascar’s Ministry of Health reported 1,231 cases and 124 deaths – mostly of pneumonic plague – between August 1 and October 25.
“The proportion of pneumonic plague – the form which can be transmitted from person to person – is much higher than in the past,” a WHO spokesperson told The Independent.
There is also a suggestion that a Madagascan ritual known as famadihana, which involves the turning of the bones of the dead, could be linked to the spread of the plague.
Willy Randriamarotia, Madagascar’s health ministry chief of staff, said: “If a person dies of pneumonic plague and is then interred in a tomb that is subsequently opened for the ritual, the bacteria can still be transmitted and contaminate whoever handles the body.”
Médecins Sans Frontières (MSF) said: “Three types in the current outbreak in Madagascar: the bubonic, pneumonic and septicemic plague.
“What makes this outbreak exceptional is the wide occurrence of the most lethal form of plague, the pneumonic plague that is also the only form that spreads from human to human.”