The health risk information presented here is summarized from Shoreland Travax®, a decision-support tool used by health care providers to perform a detailed health risk analysis based on specific locations, individual travel styles, and traveler risk behaviors. Travax provides practitioners current, independently researched malaria risk and prevention recommendations in a map-based format that goes beyond the annual WHO and US CDC statements included here. Not included here are current reports from Travax of disease outbreaks or environmental events that may pose elevated risks to travelers’ health and safety. The Providers section of this site offers a directory of health care providers who utilize Shoreland Travax for travel health counseling. Learn more about the detailed reports and maps available from these practitioners (includes links to samples).
Madagascar is a developing nation classified as low income. Located off the southeastern coast of Africa in the Indian Ocean, the climate is extremely diverse with classifications that range from humid equatorial (no dry season) to dry (arid).
See also: Library article for Yellow Fever
Although yellow fever does not occur in Madagascar, an official yellow fever vaccination certificate may be required depending on your itinerary.
- Requirement: A certificate proving yellow fever vaccination is required for travelers aged ≥ 9 months coming from countries with risk of YF transmission. This also applies to airport transit stops (no exit through immigration checkpoint) longer than 12 hours in risk countries.
Depending on your itinerary, your personal risk factors, and the length of your visit, your health care provider may offer you vaccination against COVID-19, hepatitis A, hepatitis B, influenza, measles, mumps, rubella, rabies, typhoid fever, or a one time polio booster if you haven't previously received one for travel. Routine immunizations, such as those that prevent tetanus/diphtheria or "childhood" diseases, should be reviewed and updated as needed.
See also: Library article for Malaria
The following is current information as reported by the World Health Organization (WHO) and the US Centers for Disease Control (CDC):
WHO—International Travel and Health (current online update, Country List)(2020) Malaria risk due predominantly to P. falciparum exists throughout the year in the entire country, with the highest risk in coastal areas.
- Recommended prevention in risk areas: C – Risk of P. falciparum malaria, in combination with reported chloroquine and sulfadoxine–pyrimethamine resistance. Mosquito bite prevention plus atovaquone–proguanil or doxycycline or mefloquine chemoprophylaxis (select according to reported side effects and contraindications) a
aAlternatively, for travel to rural areas with low risk of malaria infection, mosquito bite prevention can be combined with stand–by emergency treatment (SBET).
WHO Country List footnote: When available, the date of the most recent update or confirmation is indicated in parentheses in the country list. If no date is indicated, the most recent update or confirmation was provided before 2013.
CDC—Health Information for International Travel (current online edition)Areas with malaria: All areas, except rare cases in the city of Antananarivo.
- Drug resistance3 : Chloroquine.
- Malaria species: P. falciparum 85%, P. vivax 5%–10%, P. ovale 5%.
- Recommended chemoprophylaxis: All areas except the city of Antananarivo: Atovaquone-proguanil, doxycycline, mefloquine, or tafenoquine.4 Antananarivo: None (practice mosquito avoidance).
3 Refers to P. falciparum malaria unless otherwise noted.
4 Primaquine and tafenoquine can cause hemolytic anemia in people with G6PD deficiency. Patients must be screened for G6PD deficiency before starting primaquine or tafenoquine. See Tafenoquine Approved for Malaria Prophylaxis and Treatment for more information.
See also: Library article for Travelers' Diarrhea
High risk exists throughout the country, including in deluxe accommodations. Community sanitation and food safety measures are generally inadequate. Some itineraries (e.g., remote destinations, austere accommodations) and activities (e.g., ecotourism, eating street or local-market food) further increase risk.
Travelers should observe food and beverage precautions, which reduce the likelihood of illness.
Travelers should carry loperamide for self-treatment of diarrhea and, if risk is moderate to high, an antibiotic to add if diarrhea is severe. Consult a knowledgeable health care provider regarding which antibiotic is appropriate for you and most effective for your destination.
Other Food-Borne Illnesses
Precautions to prevent seafood poisoning may be needed.
Insect- and Arthropod-Borne Diseases
Other Disease and Health Risks
Additional concerns include anthrax disease, Crimean-Congo hemorrhagic fever, helminths, leptospirosis, marine hazards, melioidosis, Nipah virus, plague, schistosomiasis, sexually transmitted infections, tuberculosis.
The material below includes information from the US Department of State (DOS), the UK Foreign, Commonwealth & Development Office (FCO), Global Affairs Canada (GAC), and Australia's Department of Foreign Affairs and Trade (DFAT), as well as from additional open-source material. Standard safety precautions that apply to all international travel can be found in the Library article Safety and Security.
Consular Travel Advice
Due to violent crime targeting Westerners, Canada (GAC) advises avoiding travel to Batterie Beach, Atsimo-Andrefana Region. US (DOS) has a more limited warning. UK (FCO) and Australia (DFAT) have no current warnings.
No intrinsic risk of attack by terrorist groups exists, but unforeseen attacks are possible.
High risk of violent crime (armed robbery, home invasion, home robbery, carjacking, and assault) and high risk of petty crime exist throughout the country, especially in Antananarivo (particularly on the steps leading to the Queen’s Palace; on Avenue de l’Indépendance; in Analakely Market; on the road leading to the Soarano train station, 67 Hectares, Itaosy, Antaninarenina, and Tsaralalana); in coastal cities; in national parks (including Amber Mountain, Ankarana, and Isalo); on Nosy Be and Ile Sainte-Marie islands; in the area surrounding Tolagnaro, Pic Saint Louis, and Batterie Beach.
Kidnappings by criminal groups may occur throughout the country, especially in Antananarivo and surrounding areas. Targets may include foreigners (especially Westerners).
Scams involving false identity (such as criminals posing as tour guides) have been reported.
Protests and demonstrations may infrequently occur, especially in Antananarivo, and have the potential to turn violent without warning. Bystanders are at risk of harm from violence or from the response by authorities. Disruption to transportation, free movement, or the ability to carry out daily activities may occur.
Armed conflict occurs and a dangerous security environment may exist in Anosy Region.
Rent water sports equipment from reputable operators. Scuba dive only with personnel certified by PADI or NAUI and use equipment only from PADI- or NAUI-certified dive operators.
Significant risk of traffic-related injury or death exists. The road traffic death rate is more than 24 per 100,000 population, the highest risk category. Carefully assess the safety of transportation options before any road travel.
Seat belt laws are poorly enforced.
Drunk driving laws are poorly enforced.
Structural standards for vehicles may not meet international standards.
The rainy season is from November through April, coinciding with the cyclone season. Floods, mudslides, and landslides may occur, especially in eastern areas.
Selected Embassies or Consulates in Madagascar
- United States: [+261] 20-23-480-00; mg.usembassy.gov
- Canada: [+261] 20-22-43-270; travel.gc.ca/assistance/embassies-consulates/madagascar
- United Kingdom: [+261] 2022-33053; www.gov.uk/world/organisations/british-embassy-antananarivo
- Australia: Australia does not have an embassy or consulate in Madagascar.
Madagascar's Embassies or Consulates in Selected Countries
- In the U.S.: www.madagascar-embassy.org
- In Canada: www.madagascar-embassy.ca
- In the U.K.: [+44] 020-7052-8277
- In Australia: [+61] 02-9299-2290
HIV testing is not required to obtain a tourist, work, or residence visa.