A bubonic plague epidemic could break out in Madagascar if the country doesn't get a grip on the disease's spread, according to public health experts.

Last year the island nation off Africa's east coast recorded 256 cases and 60 deaths from the plague. An annual October surge is caused by hot, humid weather attracting fleas which spread the disease from rats to humans.

The deadly bacteria Yersinia pestis primarily affects wild rodents, spread by fleas. It wiped out at least a third of Europe's population in the Middle Ages, but is now very rare. But according to the BBC, the International Committee of the Red Cross and the Pasteur Institute said Madagascar's dirty, overcrowded prisons are a suitable breeding ground for the disease.

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Christophe Rogier, of the Pasteur Institute, which fights pandemics in poorer countries, said: "If the plague gets into prisons there could be a sort of atomic explosion of plague within the town. The prison walls will never prevent the plague from getting out and invading the rest of the town."

Africa accounts for more than nine out of ten bubonic plague cases worldwide. The World Health Organisation says the last major bubonic plague outbreak was in Peru in 2010. Then, 12 people were infected.