The plague in Madagascar has struck major cities, resulting in the World Health Organisation issuing warnings for nine surrounding countries. This comes amid fears the disease could spread via sea trade and flight routes.

These countries and overseas territories are Comoros, Ethiopia, Kenya, Mauritius, Mozambique, Réunion (France), Seychelles, South Africa, and Tanzania.

The outbreak this year is a bigger threat than previous years as it has taken on pneumonic form (it is airborne and can be spread by sneezing and coughing).

Dr Ashok Chopra, a professor of microbiology and immunology at the University of Texas, told The Sun Online that it was possible for the deadly plague to move further into the region given the regular flights going in and out of the country. He sid it spread very rapidly and was fatal without immediate treatment.

Christine South, head of the International Federation of Red Cross and Red Crescent Societies emergency operations, said the organisation had engaged in preparedness support to some of the neighbouring countries.

According to the World Health Organisation, the risk of regional spread was moderate. South added that she believed the plague outbreak may now be stabilising, but medical staff would have a clearer understanding of this over the next few days.

A spokesperson from Travelsafe Clinic told Tourism Update that anyone who had travelled to Madagascar and believed they were experiencing symptoms, should seek treatment immediately. “The plague has a very short incubation period and affected people need to be treated and isolated immediately.”

Symptoms include sudden fevers, head and body aches, vomiting and nausea.

At present, a travel ban has not been enacted.