JOHANNESBURG (AP) — Madagascar's Red Cross is stepping up efforts to stem a plague outbreak that has killed 30 people and spread into urban areas.

Red Cross officials said Friday that the situation is particularly worrying because pneumonic plague, which is spread from person to person, has occurred for the first time in non-endemic areas and crowded cities. It says cases of bubonic plague, transmitted from animals to people through flea bites, occur almost annually in Madagascar.

Aid workers say there have been 194 cases of plague, mostly pneumonic. The Malagasy Red Cross mobilized 700 volunteers to work on community education, tracing people who have been in contact with plague victims and other health initiatives.

The outbreak began after the death of a 31-year-old man in Madagascar's central highlands in late August.