More than 231 cases of the contagious disease have been recorded in Madagascar this year, and the number of deaths is higher than in previous years due to the country’s “deteriorating” medical services.
And experts in the United States have warned “continued underinvestment” in health services there could see the disease spread rapidly in to an epidemic.
In August, a public health warning was issued in northern Arizona after fleas had tested positive for pneumonic plague.
The bubonic strain of the disease is passed on by flea bites, whereas the more infectious pneumonic type is spread through coughing.
The long list of grim symptoms include gangrene, high fever and chills. The two types of plague contributed to the deaths of more than 50 million people in Europe during the Middle Ages.
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US doctor Peter Small, a clinician trained in infectious diseases who has been working in Madagascar for several years, told Newsweek: “We have plague cases every year out west.
“The only reason we have cases and not epidemics is because we invest in a public health system.
“However, if we continue to underinvest in public health, those cases could become epidemics here in the US.”
After the reports of infected fleas in August, health officials told residents in the Navajo and Coconino counties to “take precautions to reduce their risk of exposure to the serious disease”.
Dr Stephen Morse, a professor who focuses on infectious disease at New York’s prestigious Columbia University, said plague outbreaks such as Madagascar’s illustrate what what can happen when public health measures are compromised.
He told Newsweek: “I think anytime we have an outbreak of serious magnitude, it can still obviously have the opportunity for further spread, so the important thing is to have public health measures as quickly as possible.”
The World Health Organisation says more people have died from plague in Madagascar in recent years even though the total number of infections has not risen.
Experts said in 2015 this is due to the “symptomatic of the deteriorating fabric of the health system as a result of recent social and political crises in the country.”