Madagascar faces an epidemic of bubonic plague, the deadly scourge that wiped out half of Europe during the Middle Ages, experts have shockingly warned.
Charities have said prisoners in the island's notoriously dirty jails are most at risk but an outbreak could easily spread to the population at large.
The Red Cross and Pasteur Institute today warned that if the plague gets into prisons there could be a "atomic explosion of plague" within the town, the BBC reported.
"The prison walls will never prevent the plague from getting out and invading the rest of the town," said the institute's Christophe Rogier.
"A prison is not a sealed place," he told the BBC.
Madagascar had 256 plague cases and 60 deaths last year, the world's highest recorded number, BBC News reported.
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A study published in September in the American Journal of Tropical Medicine and Hygiene, showed how plague outbreaks still flare up around the world.
According to the study, which tallied the reported cases of plague around the world between 2000 and 2009, more than 20,000 people became infected during that time.
People contracted the disease via rodents, bad camel meat and sick herding dogs, the report said. Cases in Libya and Algeria re-emerged after decades of absence.
Over that period, the biggest burden was in Africa: in Congo 10,581 people contracted plague, followed by Madagascar with 7,182 cases and Zambia with 1,309 cases.
"These events, although showing progress, suggest that plague will persist in rodent reservoirs mostly in African countries burdened by poverty and civil unrest, causing death when patients fail to receive prompt antimicrobial treatment," the authors wrote in their paper.
In the United States during that time period, 56 people contracted the plague and seven died, the report showed. The cases occurred mainly because plague has become endemic in squirrels and wild rodents in the American West.