Health chiefs are desperately trying to contain a deadly outbreak of airborne plague in Africa that has prompted warnings in nine countries.
More than 1,300 cases have now been reported in Madagascar, health chiefs have revealed, as nearby nations have been placed on high alert.
Two thirds of those are suspected to be pneumonic - described as the 'deadliest and most rapid form of plague', World Health Organization figures show.
The deadly disease is caused by the same bacteria that wiped out at least 50 million people in Europe in the 1300s.
However, the lethal form currently spreading is different to the bubonic strain which was behind history's Black Death. Pneumonic can spread through coughing and can kill within 24 hours.
The outbreak is moving quickly, with several British holiday hotspots now deemed at risk of the epidemic spreading, including Seychelles, South Africa and La Reunion.
Mozambique, Tanzania, Kenya, Ethiopia, Comoros and Mauritius are the six other countries to have received the heightened alert.
It has been reported as many as 50 aid workers are believed to have been among the people infected.
The African branch of the WHO states 93 people have lost their lives to the disease so far, lower than the 124 noted in official UN figures.
A WHO official said: 'The risk of the disease spreading is high at national level… because it is present in several towns and this is just the start of the outbreak.'
More than 1,300 cases have now been reported in Madagascar, health chiefs have revealed, as nearby nations have been placed on high alert
More than 1,300 cases of the deadly airborne plague that is spreading across Africa have now been reported, health chiefs have revealed
However, amid widespread fears it could reach Europe and wreak havoc, the WHO has stressed the overall global risk is considered to be 'low'.
How many people have died?
The statement questions the UN figures released last week that warned the plague outbreak has infected less than 1,200.
WHO admitted the outbreaks have centered in cities, including the capital of Madagascar, Antananarivo - heightening the risk of it spreading.
Officials are growing concerned as around two thirds of the cases are suspected to be pneumonic plague, spread through coughing, sneezing or spitting.
It is more deadly then the bubonic variation of the disease which killed a third of Europe's population in the 1300s before being largely wiped out.
Madagascar sees regular outbreaks of the disease, but this one has caused alarm due to how quickly it has spread and a high number of fatalities.
Two thirds of those are suspected to be pneumonic - described as the 'deadliest and most rapid form of plague', World Health Organization figures show
This lethal form, different to bubonic - which killed 50 million in the 1300s, is spread through the air and can kill within just 72 hours of contracting it
Like the bubonic form that often is found in Madagascar's remote highlands, it can be treated with common antibiotics if caught in time.
Health officials are unsure how this year’s outbreak began.
However, bubonic plague which is endemic in rural parts of Madagascar can turn into the pneumonic form if left untreated.
Pneumonic plague, which is more virulent than other forms, can then be passed on through the air.
The bubonic form is spread from fleas that carry the Yersinia pestis bacteria which then bite humans.
It is believed they contract the bacteria from rats fleeing forest fires and striking rural communities.
The first death this year occurred on August 28 when a passenger died in a public taxi en route to a town on the east coast.
Two others who came into contact with the passenger also died.
This outbreak is the first time the disease has affected the Indian Ocean island's two biggest cities, Antananarivo and Toamasina, officials said.
Around 600 cases are reported each year on the island. But this year's outbreak is expected to dwarf previous ones as it has struck so early.
Drafting in help
International agencies have so far sent more than one million doses of antibiotics to Madagascar. Nearly 20,000 respiratory masks have also been donated.
However, the WHO advises against travel or trade restrictions. It has previously asked for $5.5 million (£4.2m) to support the plague response.
Despite its guidance, Air Seychelles, one of Madagascar's biggest airlines, stopped flying temporarily earlier in the month to try and curb the spread.
A Foreign Office spokesman previously said: 'There is currently an outbreak of pneumonic and bubonic plague in Madagascar.
'Outbreaks of plague tend to be seasonal and occur mainly during the rainy season, with around 500 cases reported annually.
Bubonic plague is one of the most devastating diseases in history, having killed around 100million people during the 'Black Death' in the 14th century.
Drawings and paintings from the outbreak, which wiped out about a third of the European population, depict town criers saying 'bring out your dead' while dragging trailers piled with infected corpses.
It is caused by a bacterium known as Yersinia pestis, which uses the flea as a host and is usually transmitted to humans via rats.
The disease causes grotesque symptoms such as gangrene and the appearance of large swellings on the groin, armpits or neck, known as 'buboes'.
It kills up to two thirds of sufferers within just four days if it is not treated, although if antibiotics are administered within 24 hours of infection patients are highly likely to survive.
After the Black Death arrived in 1347 plague became a common phenomenon in Europe, with outbreaks recurring regularly until the 18th century.
Bubonic plague has almost completely vanished from the rich world, with 90 per cent of all cases now found in Africa.
However, there have been a few non-fatal cases in the U.S. in recent years, while in August 2013 a 15-year-old boy died in Kyrgyzstan after eating a groundhog infected with the disease.
Three months later, an outbreak in a Madagascan killed at least 20 people in a week.
A year before 60 people died as a result of the infection, more than in any other country in the world.
Outbreaks in China have been rare in recent years, and most have happened in remote rural areas of the west.
China's state broadcaster said there were 12 diagnosed cases and three deaths in the province of Qinghai in 2009, and one in Sichuan in 2012.
In the United States between five and 15 people die every year as a result, mostly in western states.