The Madagascanhealth service is struggling to cope with the plague as 81 healthcare workers are also battling the infection themselves.(Black Death and incurable Marburg Virus now spreading across Africa’s Cities) 

Although the disease is largely endemic to Madagascar, experts have noted this outbreak as being the worst in 50 years.

Dr Derek Gatherer from Lancaster University told Mail Online the nation's health authority is "bursting at its seam" and there is likely to be a surge in polio cases.

He said getting the "polio vaccine programme running to plan will be something of a challenge".

Black Death cases have been reported since August. It can be treated effectively with antibiotics - but only if caught early enough.

Officials fear the number of cases will continue to rise as Madagascan plague sufferers are wary of seeking hospital treatment.

Jean Benoit Manhes, the deputy representative of Unicef, said some people have fled hospitals because "they're afraid of needles" and they're "not used to hospital treatment".

Nine surrounding African countries have been placed on high alert amid fears the disease could spread and mutate.

South Africa, Seychelles, La Reunion, Tanzania, Mauritius, Comoros, Mozambique, Kenya and Ethiopia have already been told to prepare.

Professor Allen Cheng, an infectious disease expert at Monash University insists the plague cannot be eradicated.

Writing for The Conversation he said the infection is "widespread in wildlife rodents, outside the sphere of human influence".

The plague season normally runs from September through to April. But with an earlier outbreak this year, and still no sign of vaccination, the disease may evolve.