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The huge island nation off the coast of south east Africa has been hit with a fatal outbreak of the disease, which has so far claimed at least 124 lives and infected 1,333 people. The plague has already spread from the Ankazobe District, where the outbreak originated, into the capital of Antananarivo and the port city of Toamasina. In the the majority of recorded cases, the victim has been infected with pneumonic plague, the deadliest strain of the disease which has a 100 per cent fatality rate if not treated. It is the same form of plague that killed an estimated 200 million people across Europe and Eurasia in the 14th century, in one of the deadliest pandemics in human history that became known as the Black Death.

Unlike the more common bubonic plague, which is usually contracted via flea bites, the pnuemonic plague is airborne and can be transferred via coughing and sneezing. Initially, the World Health Organisation (WHO) had said their was a relatively low risk of the outbreak spreading beyond Madagascar, as the incubation period for pneumonic plague is incredibly short and most people infected with it would be too ill to travel. But as the outbreak continues to spread, health officials are worried the plague could reach overseas as infected travellers pass the bacteria on during plane or boat trips.

GETTY The plague has spread across Madagascar and there are fears it could reach overseas

Nine nearby countries - South Africa, Mauritius, Seychelles, Tanzania, La Réunion, Mozambique, Kenya, Ethiopia and Comoros - have all been put on notice and launched emergency plans in case of spread. Unicef, the Red Cross, the Center for Disease Control and Prevention (CDC) and the European Centre for Disease Prevention and Control (ECDC) have all mobilised teams to prepare for such a scenario. They aim to increase public awareness to increase surveillance, particularly at borders, draw up contingency plans and sourcing medication.

Plague outbreak, latest photos from Madagascar Wed, November 1, 2017 There is currently an outbreak of both pneumonic and bubonic plague in Madagascar Play slideshow AFP/Getty Images 1 of 18 Workers cleaning and disinfecting the tents where patients sleep at the health center Plague Triage and Treatment Center, in Toamasina

In its latest update, the WHO said: “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. “WHO is prepositioning equipment and supplies, including personal protective equipment, antibiotics and other equipment required to safely identify plague cases, in Comoros, Mauritius, Mozambique, Seychelles, and Tanzania. The organisation added: “Due to the increased risk of further spread and the severe nature of the disease, the overall risk at the national level is considered very high.

EXPRESS The countries at risk of infection