Nine countries including British holiday hotspots have been issued with plague warnings after an especially deadly outbreak in Madagascar.

Health officials in the Seychelles, South Africa and La Reunion - among others - have been told to be vigilant amid fears plane passengers could spread the disease.

So far 124 people have died and more than 1,000 have been infected in Madagascar, making it one of the island's worst outbreaks in years.

The World Health Organisation has issued heath warnings to nine countries including the Seychelles, South Africa and La Reunion after a plague outbreak in Madagascar

There are fears the pneumonic variant of the disease, which is spread through the air, could be transferred to these countries via plane passengers

Pnemonic plague is the airborne variant of the bubonic plague, which was spread through the bites of infected fleas and killed a third of Europe's population in the 1300s

The warning comes after a scare in the Seychelles earlier this month when a plane passenger complained of symptoms.

The 34-year-old man was a regular visitor to Madagascar who returned to the country on October 6 before developing symptoms three days later.

He was immediately referred to hospital where he was isolated and treated, the WHO said. It was later found he did not have the disease.

Of particular concern is the fact that two thirds of cases are the pneumonic variant of the disease, which is spread through the air and can kill within 72 hours of contracting it.

It is more deadly then the bubonic variation of the disease which killed a third of Europe's population in the 1300s.

Madagascar sees regular outbreaks of the disease, but this one has caused alarm due to how quickly it has spread and a high number of fatalities.

A spokesman for the World Health Organisation said: '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.

While Madagascar experiences seasonal plague outbreaks, this year three times the normal number of people have caught the disease and 124 have died

British tourists have already been put on alert to avoid possibly infected areas in Madagascar

'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.'

WHO has delivered 1.2 million doses of antibiotics to fight the disease while the Red Cross has been training hundreds of volunteers on the island to publicise preventative measures.

The disease is typically curable if antibiotics are administered quickly.

A Foreign Office spokesman said: 'There is currently an outbreak of pneumonic and bubonic plague in Madagascar.

'Outbreaks of plague tend to be seasonal and occur mainly during the rainy season, with around 500 cases reported annually.

'Whilst outbreaks are not uncommon in rural areas, the latest outbreak has seen an increase in reported cases in urban areas, including Antananarivo.'

Madagascar, off the coast of Africa, is a popular destination for British and European travellers.