The Red Cross and Pasteur Institute say inmates² in the island's dirty, crowded jails are particularly at risk.

 

The number of cases rises each October as hot humid weather attracts fleas³, which transmit the disease from rats and other animals to humans.

 

Madagascar had 256 plague cases and 60 deaths last year, the world's highest recorded number.

 

Bubonic plague, known as the Black Death when it killed an estimated 25 million people in Europe during the Middle Ages, is now rare.

 

The International Committee of the Red Cross (ICRC) in Geneva and the Pasteur Institute have worked with local health groups in Madagascar since February 2012 on a campaign to improve prison hygiene⁴.

 

"If the plague gets into prisons there could be a sort of atomic explosion of plague within the town. The prison walls will never prevent the plague from getting out and invading the rest of the town," said the institute's Christophe Rogier.

 

The ICRC said the 3,000 inmates of Antanimora, the main prison in the heart of the capital Antananarivo, live with a huge rat population which spreads infected fleas through food supplies, bedding and clothing.

 

The ICRC's Evaristo Oliviera said this could affect not only inmates and staff, but others they come into contact with.

 

"A prison is not a sealed place, first of all the staff themselves who work in the prison are at risk, and they go home at the end of the day, already perhaps being a vector of the disease," he told the BBC.

 

"Also the rats themselves, they can go in and out of the jail and also propagate the disease. 

 

"And the prisoners do have visitors who can be also infected, and the prisoners eventually go out as well so we have many many ins and outs for the disease to spread."

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