KOCHI-“Rat fever” has killed at least 12 people with another 54 suspected fatal cases in the southern Indian state of Kerala since August, after the worst floods in almost a century, authorities said Tuesday.

A total of 372 people have been infected with the disease, known properly as leptospirosis and transmitted in water, soil or food containing urine from rodents and other animals.

The bacteria can enter the body through cuts or abrasions on the skin, or through the mouth, nose and eyes, according to the World Health Organization. Person-to-person transmission is rare.

Early symptoms of leptospirosis such as high fever, muscle ache, vomiting, red eyes and chills are similar to those of other diseases, making it difficult for health workers to diagnose.

Other disease outbreaks including dengue fever following last month’s floods - which killed almost 500 people and forced more than a million from their homes - have left 28 dead.

More than 50,000 people have acute diarrhoea, authorities said. Cases of malaria and chicken pox have also been reported. “We had anticipated leptospirosis due to contaminated water and are taking all measures to distribute preventive drugs in camps,” Kerala health director Sarita R L told AFP.

The floodwaters have now largely receded and fewer than 10,000 people remain in temporary camps, down from 1.4 million at the height of the crisis.

The monsoon, which lasts from June to September, causes widespread death and destruction across South Asia each year.

The death toll in India this year currently stands at around 1,400 across 10 states, and heavy rainfall is forecast across several areas in the coming days.

In the north-eastern state of Nagaland, 11 people have died and 50,000 others are stranded across some 530 villages, with roads including the national highway into the state cut.

Nagaland’s chief minister Neiphiu Rio took to Twitter to appeal for donations, posting photos of widespread damage and saying that 10 relief camps had been opened.

In the northern states of Uttar Pradesh and Uttarakhand around 270 people have perished.

Earlier this year Kerala was also the epicentre of an outbreak of the Nipah virus, spread mainly by bats, which claimed 13 lives.