At least 143 people have died and more than 2,000 others have been infected by the plague in  Madagascar, following an outbreak in early August this year. In late October, warnings were issued for nine countries surrounding Madagascar, as officials were concerned about the spread of the disease. Now, Malawi has been added to the list, the country bracing itself for a potential outbreak.

The World Health Organisation (WHO) says that the risk of regional spread stems from frequent air and sea travel between neighboring Indian Ocean islands and other southern and east African countries.

Previously, nine countries and overseas territories were identified for plague preparedness and readiness in the region, including Comoros, Ethiopia, Kenya, Mauritius, Mozambique, La Réunion (France), Seychelles, South Africa, and Tanzania.

Saturday, Malawi’s health secretary has confirmed that the country now among those preparing for any reported cases of the disease, amid mounting concerns of Africa’s “porous borders.”

Dr. Dan Namarika said, “We have infection prevention materials ready and groups and teams ready to be activated if there is a trigger.”

Cases of plague infections have risen by eight per cent in only one week in Madagascar, and scientists are trying to prevent the disease from spreading to mainland Africa. The majority of the cases being reported this year are the pneumonic form, making the current outbreak a more substantial threat than it has been in previous years. The pneumonic form is airborne, and can therefore be spread by sneezing or coughing.

While the current strain can be cured with antibiotics, WHO has pledged $5-million to go towards paying for extra medical personnel, the disinfection of buildings and fuel for ambulances, in order to combat the spread of the disease. They predict it may take six months to stem the current outbreak, described by health expert Professor Jimmy Whitworth as the “worst in 50 years or more.”

The plague, also known as the “Black Death,” killed nearly 30% of Europe’s population in the 13th and 14th centuries.