ANTANANARIVO, Madagascar (AP) — An international aid group says a deadly outbreak of plague in Madagascar has not yet reached its peak.

Action Against Hunger said Monday that 102 plague deaths have been reported since the outbreak began in August and that most of the nearly 1,300 reported cases of plague are of the pneumonic kind, a more virulent form that spreads through coughing, sneezing or spitting and is almost always fatal if untreated. It says the highest number of cases have been detected in Madagascar's capital, Antananarivo.

Olivier Le Guillou, the aid group's director in Madagascar, says, "we have not yet reached the peak."

Plague is endemic in Madagascar. This year's outbreak is unusual because for the first time the disease has affected the Indian Ocean island's two biggest cities, Antananarivo and Toamasina.