ANTANANARIVO, Madagascar (WCMH/AP) – More than 120 people have died from the plague in the island country of Madagascar according to the World Health Organization.

Since August, health officials have recorded 1,801 confirmed, probable and suspected cases of the disease. Officials with the Ministry of Health of Madagascar say 127 people have died.

Plague is endemic in Madagascar, meaning it is regularly found in the country, but what makes this year’s outbreak unusual is that the disease has reached the country’s two largest cities and other non-endemic areas.

The WHO says 62% of the reported cases have been classified as pneumonic plague and 15% have been classified as bubonic plague. One of the remaining cases is septicemic plague and the rest have yet to be classified. Pneumonic plague is usually fatal if not treated and can spread through coughing, sneezing or spitting.

While there has been a decline in the rate of new cases reported, officials expect the total number of cases reported to continue to rise until plague season ends in April 2018.

The WHO says that the risk of international spread appears to be very low, based on the data available.

___The Associated Press contributed to this report.