Health officials suspect it's no coincidence that the outbreak - which has infected more than 1,100 people and killed 124 since August - coincides with the time of year when families customarily exhume the remains of dead relatives, wrap them in a sheet, and dance with them through the streets in a sacred ritual, AFP reports.
The organisation says that the overall risk of the plague is very high in Madagascar and that, depending on the type of plague, there is a 30 to 100% chance of death within 72 hours if it is left untreated.
The good news is that the plague can be treated with antibiotics if caught soon enough.
Historically, plague was responsible for widespread pandemics with high mortality rates.
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According to a report by Quartz Africa, most of the deaths in Madagascar have been caused by the pneumonic version of the plague, which is more contagious, and is transmitted from animals to humans by bacteria.
South Africa is one of the countries which have already put measures in place to prevent an outbreak, according to the report.
"Sometimes bubonic plague progresses to pneumonic plague‚ when the bacteria reaches the lungs‚" reads the World Health Organization website's recently updated entry on plague. While the bubonic plague is spread through infected fleas from common mammals, pulmonary plague is transmitted from human to human. Domestic cats can also carry the plague and scratches and bites from the infected felines pose a risk factor.
Pneumonic infections can then be spread through the air, while septicaemic plague occurs when infection spreads through the bloodstream.
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Its symptoms are flu-like - fever, chills, body aches, nausea, vomiting, and swelling of the lymph nodes in the groin, neck or armpits. The lymph node then becomes inflamed, tense and painful, and is called a 'bubo.' At advanced stages of the infection the inflamed lymph nodes can turn into suppurating open sores.
Plague is a constant threat in Madagascar, where several hundred cases are usually reported each year.
Screening measures at ports of entry have been enhanced to detect ill passengers‚ and provincial outbreak response teams have been alerted in case there are any reported incidents.
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