It's a disease most people associate with the Black Death, which wiped out a quarter of the world's population more than 600 years ago.

But the plague is still a problem and now it's gripped the holiday island of Madagascar, where at least 94 have died as a result of the killer disease already.

The Department of Foreign Affairs and Trade has warned Australian travellers to exercise caution in Madagascar due to the plague epidemic, where health authorities are scrambling to stem an outbreak amid fears it could spread further.

A number of other governments have similarly updated their travel advice to the holiday island, including authorities in the UK, Portugal and the United Arab Emirates, among others.

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The World Health Organisation (WHO) said it was racing to stop the spread of the plague in Madagascar, off Africa's southeast coast, where more than 1150 cases have been confirmed since August.

Red Cross volunteers talk to villagers about the plague as public gatherings are banned due to the outbreak. Photo / AP
Red Cross volunteers talk to villagers about the plague as public gatherings are banned due to the outbreak. Photo / AP

The disease is endemic in Madagascar but this year's outbreak is unusually large and even more worrying because it started earlier in the season than usual and it's hitting towns rather than rural areas, Reuters reported.

Madagascar's two biggest cities, Antananarivo and Toamasina, have been struck by the deadly disease and health officials say it's spreading at an "alarming rate".

"Normally, people who catch the plague live in poor areas, but people in every place in society are catching the disease," Madagascar's director of health promotion Dr Manitra Rakotoarivony said.

More than 70 per cent of the cases are pneumonic plague, a more virulent form of the plague that spreads through coughing, sneezing or spitting and is almost always fatal if untreated, AP reported.

In some cases, it can kill within 24 hours.

Like the bubonic form that often is found in Madagascar's remote highlands, and was at the centre of the Black Death epidemic that spread through Europe in the Middle Ages, the pneumonic plague can be treated with common antibiotics if caught in time.

A school staff member sprays a classroom against the plague in Antananarivo as schools remain shut due to the outbreak. Photo / AP
A school staff member sprays a classroom against the plague in Antananarivo as schools remain shut due to the outbreak. Photo / AP

International agencies have sent more than one million doses of antibiotics and deployed medical teams to the island nation. The Red Cross is sending its first-ever plague treatment centre to Madagascar.

Who said the risk of global spread of the outbreak is low and it advises against travel or trade restrictions.

Madagascar is popular with travellers for its picturesque landscapes and unique wildlife, including lemurs and chameleons, and has a large expat community of Americans and Brits in particular.

Australia's Department of Foreign Affairs and Trade said pneumonic plague is spread from person to person by respiratory droplets in the air.

"Affected persons experience flu-like symptoms," the department said. "Practice good hygiene and speak to your health provider before travelling."

DFAT already urges Australians to exercise caution in Madagascar due to risks associated with political instability on the island, as well as the risk of armed robbery and violence.