There are growing fears a plague epidemic in Madagascar that has killed 124 people since August could spread via flights and sea trades.
The outbreak has sparked warnings for nine countries to be prepared of the possible spread of the plague after 1,192 suspected cases in the past two months in Madagascar.
The epidemic is considered to be especially worrying because it started earlier in the season than usual and has hit urban as well as rural areas.
Doctors and nurses from The Ministry of Health and officers of the Malagasy Red Cross staff set up a checkpoint as the plague continues to threaten local residents. Source: Getty
In addition, two thirds of the cases are of the pneumonic plague, the deadliest form of the disease.
Dr Ashok Chopra, a professor of microbiology and immunology at the University of Texas, said there was concern of a greater outbreak given the high number of flights going in and out of the country.
"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,” Dr Chopra told The Sun.
“Most of the cases in the past have been of the bubonic plague but if you look at this particular outbreak, 70 percent 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."
The capital Antananarivo and Toamasina, the two largest cities in Madagascar, an island in the Indian Ocean, were the most affected, with 55 percent of cases recorded there.
A worker decontaminates a local classroom. Source: Getty
"The total number of cases (1,192) is already three times higher than the average annual total," the National Office for Risk and Disaster Management said in a report on Wednesday.
It reported that at least 54 medical staff have also been infected.
The report said that of an estimated $9.5 million in aid needed to counter the epidemic and only $3 million has been raised so far.
The plague wiped out nearly one third of Europe’s population in the 13th and 14th centuries, a pandemic dubbed the Black Death.