An outbreak of plague in November 2013, occurred in the African island nation of Madagascar.[14] As of 16 December, at least 89 people were infected, with 39 deaths[15] with at least two cases involving pneumonic plague. However, as many as 90% of cases were later reported to have involved pneumonic plague.[16] The WHO and Institut Pasteur were both involved in administering antibiotic compounds and attempting to stop the spread of the disease.