On the bustling streets of the Madagascar capital of Antananarivo, a disease lurks in the shadows.br br Only some of its residents are still in the dark.br br (SOUNDBITE) (Malagasy) ANTANANARIVO RESIDENT, MISSI AINA, SAYING:br br "I don't know about this disease. What is the plague?"br br Since August an outbreak of the plague in the country has already killed 40 people out of 119 confirmed cases.br br And the World Health Organization fears the disease will spread rapidly in the capital.br br The bacterial disease is mainly spread from one rodent to another by fleas.br br Humans bitten by an infected flea can develop a bubonic form of the plague.br br If the bacteria reaches the lungs, the patient can develop pneumonia and can die within 24 hours.br br Down the street from one of the city's hospitals, one resident says she worries about preparedness.