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Malawi was added to the growing list of nations placed urged to brace for a potential outbreak last weekend, becoming the tenth.
South Africa, Seychelles, La Reunion, Tanzania, Mauritius, Comoros, Mozambique, Kenya and Ethiopia have already been told to prepare.
Others worry it will eventually hit the US, Europe and Britain, leaving millions more vulnerable due to how quick it can spread through populations.
And with the plague season expected to run until April, scientists believe there will be another spike of cases in the coming months.
Scores of doctors and nurses have already been struck down with the disease, and there are growing fears hospitals will be unable to cope if it continues its rampage.
But local officials are adamant the outbreak is slowing down as the number of new cases is on the decline.
If left untreated, it can lead to the pneumonic form, which is responsible for two thirds of the cases recorded so far in this year's outbreak.
Rats carry the Yersinia pestis bacteria that causes the plague, which is then passed onto their fleas.
Madagascar sees regular outbreaks of plague, which tend to start in September, with around 600 cases being reported each year on the island.
Without antibiotics, the bubonic strain can spread to the lungs - where it becomes the more virulent pneumonic form.
Pneumonic, which can kill within 24 hours, can then be passed on through coughing, sneezing or spitting.
It is easily treated with antibiotics in the current climate - however, experts are still concerned it will cause eternal havoc because it is constantly mutating.
Kyle Harper, a professor of classics and letters at the University of Oklahoma, said biological evolution is 'cunning and dangerous'.