The other eight countries are the Comoros, Ethiopia, Kenya, Mauritius, Mozambique, France's La Réunion, the Seychelles and Tanzania.
Two thirds of the cases are the pneumonic form of the disease, which can spread from person to person.
While plague is now a regular occurrence in Madagascar, experts are growing anxious over this year's epidemic, which has killed 124 people since August alone.
"Most of the cases in the past have been of the bubonic plague but if you look at this particular outbreak, 70 percent of the cases are pneumonic plague, which is the most deadly form of the disease".
"Historically, the plague was responsible for widespread pandemics with high mortality".
Unfortunately, the nation of 24 million has another point of infamy these days-the island nation is the site of the black death, the very same plague that decimated Europe many centuries ago.
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The WHO has reportedly delivered 1.2 million doses of antibiotics to the country.
Plague can be treated with antibiotics‚ and recovery is common if treatment starts early.
How is it transmitted?
Plague is an infectious disease caused by the bacteria Yersinia pestis, a zoonotic bacteria, usually found in small mammals and their fleas.
The virus can be transmitted between animals and humans by the bite of infected fleas or the inhalation of infected respiratory droplets. Domestic cats can also carry the plague and scratches and bites from the infected felines pose a risk factor.
Its symptoms are flu-like - fever, chills, body aches, nausea, vomiting, and swelling of the lymph nodes in the groin, neck or armpits. Bubonic plague can advance and spread to the lungs, which is the more severe type of plague called pneumonic plague.
The third strain septicemic, when the infection spreads through the bloodstream.
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