By Corey Charlton

The deadly plague outbreak has struck Madagascar's major cities sparking fears it has yet to 'peak' and could spread into the surrounding region

PLAGUE warnings have been issued for NINE countries surrounding Madagascar amid fears the disease could spread via sea trade and flight routes.

The outbreak is considered a much bigger threat to the region than in previous years because it has taken on its pneumonic form - meaning it is airborne and spread by sneezing and coughing.

And experts say the epidemic could still worsen as the death tolls hits 124 and more than 1,300 are left infected.

The medieval disease famously wiped out ONE THIRD of Europe's population in the 13th and 14th centuries in one of the most devastating pandemics in human history known as the Black Death.

Dr Ashok Chopra, a professor of microbiology and immunology at the University of Texas said the crisis in Madagascar had yet to peak.

He warned it was possible for the deadly plague to move further into the region given the regular 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.

"We don't want to have a situation where the disease spreads so fast it sort of gets out of control."

He added: "Most of the cases in the past have been of the bubonic plague but if you look at this particular outbreak, 70 per cent 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."

Plague symptoms include sudden fevers, head and body aches, vomiting and nausea.

Dr Chopra added that it spreads "very rapidly", as seen by the number of cases in Madagascar doubling within a week.

Speaking from Madagascar, Christine South, head of IFRC's emergency operations, said: "With anything like this there is a possibility that somebody could be infected and get on a plane.

"We have done preparedness support to some of the neighbouring countries."

However, she 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.

The nine countries the WHO has warned of being at risk are:

1. Kenya

2. Ethiopia

3. South Africa

4. Mozambique

5. Tanzania

6. Reunion

7. Mauritius

8. Seychelles

9. Comoros

According to the World Health Organisation, the disease - which has struck heavily populated cities - sparked a false alarm in the Seychelles after a traveller reported symptoms of the disease.

WHO stated: "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."

"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."

The disease remains endemic in rural parts of the African island but the rise in the pneumonic version of the illness has sparked particular concern.

The World Health Organisation said that this year, plague arrived earlier than expected, and the infection is also spreading in urban centres and in areas that until now had not been affected.

Elsewhere this week, a man who caught the bubonic plague from his pet cat and nearly suffered an agonising death has revealed what it was like to lose all fingers and toes to the deadly disease.

Paul Gaylord, who lives in a remote part of Oregon, spoke about the horrific symptoms he suffered as the Black Death threatened his life – and even turned his hands black.