An outbreak of the plague on Madagascar has infected more than 2,000 people, claiming 195 lives, as the World Health Organisation (WHO) warns that it expects the number of cases to keep rising until April next year.

The disease has been raging on the African island since the beginning of August, killing one in 10 infected. Though the WHO is confident the epidemic is drawing to a close, its latest figures shows that in the week beginning November 6, 216 instances of plague were reported.

Between August 1 and November 17, there have been 2,267 confirmed, probable and suspected cases of plague, the WHO said, with 195 deaths.

“WHO expects more cases to be reported until the end of the typical plague season in April 2018,” the global body said. “It is therefore important that control measures continue through to the end of the plague season.”

Though the WHO said it believes the risk of international spread to be “very low”, it said that nine countries and overseas territories have been “identified as priority countries for plague preparedness and readiness”.

The capital, Antananarivo, has been affected by the outbreak Credit: Getty

These countries - including South Africa and Kenya (all listed below) - are “implementing readiness activities, including increased public awareness of plague, enhancing surveillance for the disease (particularly at points of entry), and prepositioning of equipment and supplies”.

Comoros Ethiopia Kenya Mauritius Mozambique La Réunion Seychelles South Africa Tanzania

“The risk of international spread is mitigated by the short incubation period of pneumonic plague, implementation of exit screening measures and advice to travellers to Madagascar,” it said, before urging against travel and trade restrictions on the island.

What is the plague?

It may surprise some to learn that outbreaks of the plague are not limited to the medieval Black Death, but some 600 cases of the disease continue to be reported each year.

This year, there have been outbreaks in Madagascar, the Democratic Republic of Congo and Peru, though there is presence of the plague bacteria, natural foci, in the US, India and Russia.

Risk of the plague, according to the WHO, as of 2016 Credit: WHO

Between 2010 and 2015, there were 3,248 cases worldwide, resulting in 584 deaths.

The disease is carried by small mammals and their fleas, through which it is transmitted to other animals and humans.

“Plague is a very severe disease in people,” says the WHO, “with a case-fatality ratio of 30 per cent to 100 per cent if left untreated.

“The pneumonic form is invariably fatal unless treated early. It is especially contagious and can trigger severe epidemics through person-to-person contact via droplets in the air.

The plague was spread by black rats and their fleas Credit: Corbis

“Historically, plague was responsible for widespread pandemics with high mortality. It was known as the 'Black Death' during the fourteenth century, causing more than 50 million deaths in Europe. Nowadays, plague is easily treated with antibiotics and the use of standard precautions to prevent acquiring infection.”

What are the symptoms?

There are two types of plague - bubonic and pneumonic - both presenting themselves after an incubation period of up to a week, with a sudden onset of fever, chills, head and body aches, and weakness, vomiting and nausea.

Bubonic, the most common form and caused by the bite of an infected flea, affects the lymph nodes and causes swelling sores filled with pus.

Pneumonic, or lung-based plague, is the most virulent form and can kill if not treated within 24 hours of the onset of symptoms.

What should I do if travelling to the affected regions?

The Foreign Office is not advising against travel to Madagascar, but directs visitors to the WHO page on the outbreak.

The WHO says: “Travellers should protect themselves against flea bites, avoid contact with dead animals, infected tissues or materials, and avoid close contact with patients with pneumonic plague.

“In case of sudden symptoms of fever, chills, painful and inflamed lymph nodes, or shortness of breath with coughing and/or blood-tainted sputum, travellers should immediately contact a medical service.

The WHO says it expects plague cases to be reported until next year Credit: Getty

“Upon return from travel to Madagascar, travellers should be on alert for the above symptoms. If symptoms appear, travellers should seek medical care and inform their physician about their travel history to Madagascar.”

Dr Richard Dawood said travel in the region remains safe. “The WHO has identified countries at possible risk of receiving imported cases from Madagascar, and therefore where increased surveillance is needed as part of the necessary public health response. This has been reported in the news media as possibly indicating a significant risk to travel more generally, and has understandably given rise to some anxiety.

“However, no travel restrictions have been imposed and no imported cases have yet occurred. Plague is a disease of close contact under crowded/unhygienic conditions, and is easily treated with commonly available antibiotics. Foreign travellers undertaking the usual tourist activities in these countries are not considered to be at risk.”

When was the last major outbreak?

The third plague pandemic - after the Black Death and an earlier outbreak in the Roman Empire, said to have killed as many as 50 million people - came from China in 1855. From there it spread throughout Asia. The WHO still considered the pandemic active as recently as 1959.

In 1994, an outbreak in India caused an estimated 700 infections and 52 deaths.

When was the last case of the plague in the UK?

The Black Death in England, beginning in Weymouth in June 1348 before reaching London by the summer of 1349, killed as much as 60 per cent of the population.

The plague returned in 1361-62, claiming the lives of one fifth of the populace, and again a number of times on a smaller scale, before one of the final outbreaks, the Great Plague of London in 1665-66, which killed 100,000 people in the capital.

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As corpses piled up in the streets of London, great mass graves were dug across the city and surrounding countryside.

Research by Historic UK in 2014 charted plague pits from Westminster to Soho and Green Park to Shepherd’s Bush. In the year previous, engineers working on the Crossrail Project unearthed 14 bodies in Charterhouse Square in Farringdon, revealing a previously unknown Black Death plague pit.

Some say the Great Fire of London marked the end of the plague in the city.

Where is the Plague Village?

Eyam in Derbyshire has become known as the Plague Village after its residents, during an outbreak in 1665, chose to isolate themselves rather than let the infection spread.

Eyam, Derbyshire Credit: William Robertson

Over the course of 14 months, the plague ran its course, killing as many as 260 out of 350 villagers.

Today, the village’s history is recalled in the Eyam Museum.