Where is the Black Death plague now, where is the case in the US, how many died in Madagascar and could it hit the UK?
A fresh case of suspected plague has hit Madagascar amid fears the disease could spread via sea trade and flight routes
BLACK Death appears to have reached America, prompting fears of a deadly strain spreading across the world after 200 people perished from a plague outbreak in Madagascar last year.
But where exactly is the disease now, why did it start in the African island and could it come to Britain?
Where is the Black Death now?
Authorities believed they had contained the deadly disease after a four-month outbreak in Madagascar last year.
But then on June 18 it emerged a 14-year-old boy in Idaho in the United States was diagnosed with Black Death.
Last year plague warnings were issued for nine countries surrounding Madagascar amid fears the pneumonic disease could spread via merchant or naval seamen or by crew and passengers aboard flight routes.
It is spread from person-to-person through coughing, sneezing, spitting and through contact with other fluids.
Reports on January 23 that a 40-year-old cook in Madagascar was struck down by the bug sparked fears that the illness is back.
The victim, who worked in a local school, was suffering from symptoms consistent with the illness, forcing the school to close its doors for two days for the building to be disinfected.
How did the 2017 outbreak start in Madagascar?
Health officials warned "no one is safe" from a deadly outbreak of Black Death on the holiday island of Madagascar.
The disease became much more contagious through being transmitted from person-to-person through the air – as well as from animals to humans through infected flea bites.
While cases of bubonic plague occur in Madagascar nearly every year, last year's epidemic was "much more dangerous", according to one expert.
The World Health Organisation said that last year the plague arrived earlier than expected.
Relatives of loved ones who died from Black Death have been told to stop the tradition called Famadihana.
The country's health chief Willy Randriamarotia said: "If a person dies of pneumonic plague and is then interred in a tomb that is subsequently opened for a Famadihana, the bacteria can still be transmitted and contaminate whoever handles the body."
The tradition has been banned since the outbreak began, but it is feared ceremonies have taken place regardless.
What is the death toll?
It was believed at least 2009 people were killed by the Black Death by November last year out of a total of 2,267 who were infected, according to latest statistics.
The disease, which contributed to the deaths of more than 50 million people in Europe during the Middle Ages, spread from rural areas into urban areas which are not usually affected.
Experts described the outbreak as the "worst outbreak in 50 years".
No one is thought to have died so far in this suspected outbreak.
Could it spread to the UK?
UK authorities have warned Brits off visiting the African wildlife paradise.
About 8,000 adventurous UK holidaymakers visit each year
Jimmy Whitworth, professor of International Public Health at the London School of Hygiene and Tropical Medicine, said: “It has been a long time since we have seen the plague in an urban environment.
“The risk of it spreading internationally is low. But the risk of this continuing to spread within Madagascar is still quite high.”
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What do the experts say?
Dr Ashok Chopra, a professor of microbiology and immunology at the University of Texas, told The Sun Online the crisis in Madagascar had yet to peak.
He said: "If they are travelling shorter distances and they're still in the incubation period, and they have the pneumonic (form) then they could spread it to other places.
"We don't want to have a situation where the disease spreads so fast it sort of gets out of control.
"Most of the cases in the past have been of the bubonic plague but if you look at this particular outbreak, 70 per cent of the cases are pneumonic plague, which is the most deadly form of the disease.
";If the treatment is not given in a very short period of time these people will end up dying."
Speaking from Madagascar, Christine South, head of IFRC's emergency operations, said: "With anything like this there is a possibility that somebody could be infected and get on a plane.
"We have done preparedness support to some of the neighbouring countries."
WHAT IS THE PLAGUE?
Plague is an infectious disease caused by bacteria usually found in small mammals and their fleas.
It has an extremely high fatality rate and is very infectious, although it can be treated by antibiotics if it's caught early.
There are three forms of plague infection: pneumoic plague, septicaemic plague and bubonic plague, the most common form.
Bubonic plague was known as the Black Death in medieval Europe, where an outbreak brought entire civilisations to their knees and decimated the world's population.
Black Death is spread through the bite of infected fleas, whereas pneumonic plague, the most contagious form, develops after a bubonic infection.
Pneumonic infections can then be spread through the air, while septicaemic plague occurs when infection spreads through the bloodstream.
The three different types of plague all refer to different ways the disease can be spread.
In bubonic infections, plague-causing bacteria can be transmitted between animals and fleas, with infected fleas then passing the disease on to people through bites.
Infected people may then develop pneumonic plague once their bubonic infection becomes advanced.
Lung-based pneumonic plague can then sometimes be transmitted through the air between sufferers.
Following a pneumonic or bubonic infection, people can then develop septicaemic plague, which occurs when the infection spreads through the bloodstream.
The describes plague symptoms as "flu like", with one to seven days between incubation and the symptoms emerging.
Sufferers are likely to have painful lymph nodes, chills, fever, headaches, weakness and fatigue.
In bubonic sufferers, these inflamed lymph nodes may end up turning into pus-filled open sores.
Bubonic plague is fatal in 30-60 per cent of cases, while the pneumonic kind is always fatal, if left untreated.
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