A village in Madagascar has been hit by a deadly outbreak of the bubonic plague, medical experts on the island have confirmed.
Tests were carried out after at least 20 people in the village, near the north-western town of Mandritsara, were reported to have died last week.
The International Committee of the Red Cross warned in October that Madagascar was at risk of a plague epidemic.
The disease is transmitted to humans via fleas, usually from rats.
Bubonic plague, known as the Black Death when it killed an estimated 25 million people in Europe during the Middle Ages, is now rare.
Last year, Madagascar had 60 deaths from the plague, the world's highest recorded number.
The Pasteur Institute of Madagascar confirmed on Tuesday that tests taken from bodies in the village last week showed that they had died of the bubonic plague.
The BBC's Tim Healy in the capital, Antananarivo, says health officials have now gone to the remote area to investigate.
There has been a programme to exterminate rats, fleas and cockroaches in Madagascar's prisons to avoid outbreaks of the plague, which is spread because of unhygienic conditions, he says.
The Pasteur Institute said there were concerns that the disease could spread to towns and cities where living standards have declined since a coup in 2009 and the ensuing political crisis.
On 20 December a second round is being held of presidential elections aimed at ending the political deadlock.