The Black Death outbreak has already infected more than 2,119 people between August 1 to November 10.
And it threatens to spread to neighbouring countries, including Tanzania and Mozambique.
In its latest Situation Report, the World Health Organisation reported eight per cent of people died from the disease (171), and 55 of 114 districts on the island reported at least one case.
And the United Nations agency warned the disease will continue until April 2018 – and risk of infection will remain high over the next six months until the typical end of the plague season, although reports are declining.
The report read: “The number of new cases and hospitalisations of patients due to plague is declining in Madagascar.
“The last confirmed bubonic case was reported on 24 October and the last confirmed pneumonic case was reported on 28 October.
“Since plague is endemic to parts of Madagascar, WHO expects more cases to be reported until the end of the typical plague season in April 2018.
“It is therefore important that control measures continue through to the end of the plague season.”
Madagascar’s rainy season officially started on November 1 and is set to last until the end of April 2018.
The pneumonic plague that is gripping the African island is passed from human to human and can be spread through a cough or a sneeze.
Plague symptoms include sudden fevers, head and body aches, vomiting and nausea.
Without treatment, patients could die within 18 hours.
The latest report comes as an expert warned the disease was impossible to eradicate.
The bacteria that causes plague is now so widespread in wildlife, that humans can’t do anything to get rid of it, said Dr Allen Cheng, Professor of Infectious Diseases Epidemiology at Monash University, Melbourne.
The best way to stop the plague spreading was to focus on flea and rat control in the most at-risk areas, he said.
“It’s not possible to eradicate plague, as it is widespread in wildlife rodents outside the sphere of human influence,” Cheng wrote on The Conversation.
“Outbreaks, generally, are managed reactively by ‘firefighting teams’, deployed to clear houses of fleas, identify and treat cases and give pre-emptive treatment to contacts at risk.
“A more preventative approach, such as the identification of areas at risk using climate models and animal surveys to focus flea and rat control efforts, would be better.
“But, this requires a better understanding of transmission pathways in each region where disease persists.”