Red Cross volunteers talk to villagers about the plague outbreak in Antananarivo, Madagascar. Picture: Alexander Joe/AP

Cape Town - The Institute for Communicable Diseases on Thursday alerted South African citizens travelling to Madagascar to avoid highly populated areas containing the plague outbreak in the country.

The World Health Organisation (WHO) released a report on October 20, which indicated that 1297 cases and 102 deaths - with a case fatality rate of seven percent -has been reported to health authorities in Madagascar.

"The majority of cases (65 percent) are presenting as pneumonic plague, rather than the usual bubonic form," the institute said.

Madagascar - under the leadership of the public health minister and with the support of the WHO - established a multi-sectoral national response coordination committee to coordinate response on the outbreak.

Read: SA on alert after 48 plague deaths in Madagascar

"Enhanced contact tracing, improved surveillance and diagnostic capacity, restriction of public gatherings, infection prevention and control and community mobilisation are all underway," the institute said.

WHO has identified nine countries that are at high risk for the plague that could be imported through trade and travel between the countries.

The countries at risk are South Africa, Mozambique, Tanzania, Ethiopia, Mauritius, Comoros, Seychelles, Kenya, and France's La Réunion

The institute said that South African authorities have been placed on alert.

"Since notification of the outbreak, the South African national department of health with support from the NICD, and the WHO country office have been working together to ensure public safety. "

Airline companies have been asked to be sharp-eyed for suspected ill passengers and the Civil Aviation Authority has received training in the event of  suspected cases.

"Port health officials have enhanced their screening measures to detect and respond to ill passengers arriving in the country. All provincial outbreak response teams have been alerted to enhance preparedness and implement response measures in the event that a case is detected in the country," the institute said.

Management standard operating procedures was circulated to stakeholders and the National Institute for Communicable Diseases is in a state of readiness for measures in the country.

"South African travellers to Madagascar are advised to avoid highly populated areas and to wear surgical masks while in transit. Liberal application of DEET-containing insect repellent is advised to prevent flea bites. Prophylactic antibiotics are not advised."

Travelers from Madagascar was asked to monitor their health for 15 days and to seek urgent medical attention.

Signs of infection are fever, chills, head and body aches, painful and inflamed lymph nodes, or shortness of breath with coughing and/or blood-tainted sputum.

Anyone with these symptoms are advised to tell their doctor exactly what their symptoms are and about their recent travel.

"Persons with fever should also be tested for malaria," the institute said.