Jamaica has declared an outbreak of the bacterial disease leptospirosis, suspected of causing six deaths, following the devastation from Hurricane Melissa in late October.

The Category 5 hurricane slammed into the Caribbean island on October 28, causing catastrophic flooding and landslides with some 30 inches (76 cm) of rain. The resulting stagnant, contaminated water has created a breeding ground for the disease, officials said.

Health Minister Christopher Tufton announced on Friday that nine cases were confirmed between October 30 and November 20, with 28 additional suspected cases.

Leptospirosis is spread through water or soil contaminated by the urine of infected animals, such as rodents. The infection can enter the human body through cuts in the skin or through the eyes, nose and mouth.

While initial symptoms such as fever, headache and muscle aches can be mistaken for the flu, the disease can progress to a severe and potentially fatal form. It can cause kidney failure, liver damage, meningitis and severe internal bleeding.

“The outbreak follows the passage of the storm which has created conditions that have increased the risk of exposure to contaminated water and soil,” Tufton said at a press conference.

He warned that anyone coming into contact with floodwaters could be at risk, including “farmers, persons engaged in cleanup activities, emergency responders and others navigating flood areas.”

Hurricane Melissa left an estimated $10 billion in damages, according to Jamaican officials, hobbling the nation’s key tourism and agriculture sectors and damaging nearly 200,000 buildings.

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(Reporting by Zahra Burton; Writing by Iñigo Alexander; Editing by Kylie Madry and Bill Berkrot)