While the island nation records cases of the plague every year, this year is notably different and the 2017 outbreak continues to catch the world’s attention as the number of victims rapidly increases.
The most recent statistics show at least 1,800 people are now infected and 127 deaths have been recorded.
Dr Tim Jagatic, a doctor with Medicins Sans Frontieres (Doctors Without Borders), told Express.co.uk the reason behind this year’s shocking outbreak.
He said: “From November until April, there tends to be an outbreak of an average of 400 cases of bubonic plague per year.
“But what happened this year is it looks like there was a case which happened a little bit earlier, in the month of August.
“If a bubonic case goes untreated, it has the ability to transform into the pneumonic form.
“It seems as though somebody who had the bubonic form didn’t get treatment, allowing the plague to transform into the pneumonic form.
“He entered the capital city and then fell sick on a bus that was travelling to Toamasina, and a medical student tried to help him.
“The medical student came into close contact with him and because it was the pneumonic form of the disease, happening earlier than its expected to in a part of the country where it typically doesn’t occur, it went unnoticed for a particular amount of time which allowed the disease to proliferate.”
Dr Jagatic added: “A very important part of epidemiology is trying to find who or what was ‘patient zero’, so that we’ll be able to track exactly how it spread, what dangers it poses, who was in contact with that person.
“Once we find that out, it really helps us to cut the chain of transmission and find out what areas of a country we have to focus our resources on.”
While most cases are recorded in Madagascar occur in remote areas, this outbreak has also hit major urban centres with high populations, including the capital Antananarivo and the port city of Tamatave, allowing it to spread.
Two thirds of the recorded cases in Madagascar are caused by the pneumonic plague, which can be spread through coughs and sneezes and without treatment, can kill within 24 hours.
The outbreak has prompted warnings that it could spread to nine nearby countries, including UK holiday hotspots Mauritius and the Seychelles.
Professor Robin May, an infectious diseases expert at Birmingham University, admitted the growth rate of the outbreak is “concerning”.
Commenting on the WHO figures, Professor May told the Mail: “It sounds like a very big increase in five days. It’s a serious outbreak and needs careful monitoring.
“Depending on what position of the curve you’re at, you’re either going to see a lot more cases or it’ll hit the peak and drop down.”