The World Health Organization (WHO) has warned that there is a risk of a plague spreading through Africa, with more than 1,300 infected so far.

The disease is currently confined to Madagascar, where it originated in August this year. It is concentrated in the cities of Antananarivo and Toamasina.

In an effort to stop the spread, more than 1.2 million doses of antibiotics have been delivered to the country. However, there are concerns about preventing the spread of the outbreak.

‘’The risk of the disease spreading is high at national level,” said the WHO, “because it is present in several towns and this is just the start of the outbreak.”

South African health authorities are now on high alert for the possibility of imported cases. None have yet been confirmed in South Africa.

But with at least 93 people having died from the plague so far, authorities are being careful to ensure there is no spread. Passengers from Madagascar are being checked on arrival for a fever or a cough, according to the National Institute of Communicable Diseases (NICD).

The WHO noted that the number of cases has been declining since October 12, with the most recent on October 20. However, they couldn’t rule out the possibility of further spikes between now and April 2018.

The plague is pneumonic, which means it passes from person to person via droplets of mucus and water released when coughing – known as an airborne plague. Although plague is an annual occurrence in Madagascar, the fact that this year it is pneumonic has raised concerns.

“If a suspected case arrives in South Africa‚ the country has a network of communicable disease workers, who would trace the patient’s contacts and offer preventive antibiotics if required,” said the NICD.

At the moment, there are no travel and trade restrictions from the WHO, who noted that the risk of international spread was very low.

People who have been exposed are advised to immediately seek medical attention, with symptoms including a cough, fever, or painful swollen glands. Travelers to Madagascar should apply insect repellent containing DEET, as the disease can be spread by fleas, and avoid crowded areas.

The disease may have been spread in part by a ritual in Madagascar called “famadihana”, where corpses are dug up and danced around tombs.