PLAGUE warnings have been issued for NINE countries surrounding Madagascar amid fears the disease could spread via sea trade and flight routes.

The outbreak is considered a much bigger threat to the region than in previous years because it has taken on its pneumonic form - meaning it is airborne and spread by sneezing and coughing.

8 WHO has issued alerts for nine countries surrounding Madagascar where the outbreak has occurred

And experts say the epidemic could still worsen as the death tolls hits 124 and more than 1,300 are left infected.

The medieval disease famously wiped out ONE THIRD of Europe's population in the 13th and 14th centuries in one of the most devastating pandemics in human history known as the Black Death.

Dr Ashok Chopra, a professor of microbiology and immunology at the University of Texas, told The Sun Online the crisis in Madagascar had yet to peak.

He warned it was possible for the deadly plague to move further into the region given the regular flights going in and out of the country.

8 Red Cross officials work in Antananarivo, Madagascar, where the plague has struck Credit: AFP or licensors

8 A doctor from the local Ministry of Health staffs a heath care checkpoint Credit: AFP or licensors

"If they are travelling shorter distances and they're still in the incubation period, and they have the pneumonic (form) then they could spread it to other places.

"We don't want to have a situation where the disease spreads so fast it sort of gets out of control."

He added: "Most of the cases in the past have been of the bubonic plague but if you look at this particular outbreak, 70 per cent of the cases are pneumonic plague, which is the most deadly form of the disease.

"If the treatment is not given in a very short period of time these people will end up dying."

Dr Ibrahima-Soce Fall says World Health Organisation are working to prevent the spread of plague on Madagascar

8 Some 1,300 people have been infected by the deadly medieval disease Credit: AFP or licensors

8 If they do not receive antibiotics immediately, the disease is extremely deadly Credit: AFP or licensors

Plague symptoms include sudden fevers, head and body aches, vomiting and nausea.

Dr Chopra added that it spreads "very rapidly", as seen by the number of cases in Madagascar doubling within a week.

Speaking from Madagascar, Christine South, head of IFRC's emergency operations, said: "With anything like this there is a possibility that somebody could be infected and get on a plane.

"We have done preparedness support to some of the neighbouring countries."

However, she added that she believed the plague outbreak may now be stabilising but medical staff would have a clearer understanding of this over the next few days.

The nine countries the WHO has warned of being at risk are:

Kenya

Ethiopia

South Africa

Mozambique

Tanzania

Reunion

Mauritius

Seychelles

Comoros

8 Tourists have been warned to stay away from Madagascar after the outbreak of plague left more than 120 dead Credit: Getty - Contributor

8 The Black Death decimated the population of Europe when it swept through the continent in the 1300s Credit: Alamy

8 The Black Death often conjures up chilling images of masked plague doctors, who would stuff fresh herbs and spices in their 'beaks' to deal with the smell

According to the World Health Organisation, the disease - which has struck heavily populated cities - sparked a false alarm in the Seychelles after a traveller reported symptoms of the disease.

WHO stated: "The risk of regional spread is moderate due to the occurrence of frequent travel by air and sea to neighbouring Indian Ocean islands and other southern and east African countries."

"Nine countries and overseas territories have been identified as priority countries in the African region for plague preparedness and readiness by virtue of having trade and travel links to Madagascar.

"These countries and overseas territories include Comoros, Ethiopia, Kenya, Mauritius, Mozambique, La Réunion (France), Seychelles, South Africa, and Tanzania."

The disease remains endemic in rural parts of the African island but the rise in the pneumonic version of the illness has sparked particular concern.

The World Health Organisation said that this year, plague arrived earlier than expected, and the infection is also spreading in urban centres and in areas that until now had not been affected.

Elsewhere this week, a man who caught the bubonic plague from his pet cat and nearly suffered an agonising death has revealed what it was like to lose all fingers and toes to the deadly disease.

Paul Gaylord, who lives in a remote part of Oregon, spoke about the horrific symptoms he suffered as the Black Death threatened his life – and even turned his hands black.

Since the outbreak, Madagascans have been told to stop the traditional practice of Famadihana - which sees locals dig up deceased relatives and dance with them before they are re-buried.

It is feared the ceremony has helped spread an outbreak of pneumonic plague that has left more than 120 dead on the African island.

WHAT IS THE PLAGUE? Plague is an infectious disease caused by bacteria usually found in small mammals and their fleas. It has an extremely high fatality rate and is very infectious, although it can be treated by antibiotics if it's caught early. There are three forms of plague infection: pneumoic plague, septicaemic plague and bubonic plague, the most common form. Bubonic plague was known as the Black Death in medieval Europe, where an outbreak brought entire civilisations to their knees and decimated the world's population. Black Death is spread through the bite of infected fleas, whereas pneumonic plague, the most contagious form, develops after a bubonic infection. Pneumonic infections can then be spread through the air, while septicaemic plague occurs when infection spreads through the bloodstream. The three different types of plague all refer to different ways the disease can be spread. In bubonic infections, plague-causing bacteria can be transmitted between animals and fleas, with infected fleas then passing the disease on to people through bites. Infected people may then develop pneumonic plague once their bubonic infection becomes advanced. Lung-based pneumonic plague can then sometimes be transmitted through the air between sufferers. Following a pneumonic or bubonic infection, people can then develop septicaemic plague, which occurs when the infection spreads through the bloodstream. The World Health Organisation describes plague symptoms as "flu like", with one to seven days between incubation and the symptoms emerging. Sufferers are likely to have painful lymph nodes, chills, fever, headaches, weakness and fatigue. In bubonic sufferers, these inflamed lymph nodes may end up turning into pus-filled open sores. Bubonic plague is fatal in 30-60 per cent of cases, while the pneumonic kind is always fatal, if left untreated.

The Black Death

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