Madagascar

Medical Summary

General Information

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).

Vaccinations

Routine vaccinations are essential due to a persistent rise of vaccine-preventable diseases (especially markedly high rates of diphtheria, pertussis, and measles) globally. Prior to travel, travelers should be up-to-date with the age-appropriate routine vaccinations recommended by their home country, which may include: COVID-19; H. influenzae type B (Hib); hepatitis A; hepatitis B; herpes zoster; human papillomavirus; influenza; measles, mumps, rubella; meningococcal; pneumococcal; polio; rotavirus; tetanus, diphtheria, pertussis (Tdap preferred; consider an early pertussis booster for high-risk travelers); varicella.

Yellow Fever

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.

Other Vaccines

Depending on your itinerary, your personal risk factors, and the length of your visit, your health care provider may offer you vaccination against chikungunya, dengue, rabies, or typhoid fever.

Malaria

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. Mosquito-bite prevention plus atovaquone-proguanil or doxycycline or mefloquine chemoprophylaxis (select according to drug-resistance pattern, reported side-effects and contraindications).^{a, b
  a}Alternatively, for travel to rural areas with low risk of malaria infection, mosquito bite prevention can be combined with stand–by emergency treatment (SBET).
  ^bIn certain areas with multidrug-resistant malaria, mefloquine chemoprophylaxis is no longer recommended. At present, these areas include Cambodia, south-eastern Myanmar and Thailand.

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 accurate date is indicated, the most recent update or confirmation was provided prior to 2013.

CDC—Health Information for International Travel (current online edition)

Transmission areas

• All; except in Antananarivo (the capital) where malaria transmission is rare

Drug resistance²

• Chloroquine

Species

• P. falciparum (primarily)
• P. ovale and P. vivax (less commonly)

Recommended chemoprophylaxis

• All areas (except the city of Antananarivo): Atovaquone-proguanil, doxycycline, mefloquine, tafenoquine³
• Antananarivo: No chemoprophylaxis recommended (insect bite precautions and mosquito avoidance only)^{4
  2} Refers to P. falciparum malaria, unless otherwise noted.
  ³ Tafenoquine can cause potentially life-threatening hemolysis in people with glucose-6-phosphate-dehydrogenase (G6PD) deficiency. Rule out G6PD deficiency with a quantitative laboratory test before prescribing tafenoquine to patients.
  ⁴ Mosquito avoidance includes applying topical mosquito repellant, sleeping under an insecticide-treated mosquito net, and wearing protective clothing (e.g., long pants and socks, long-sleeve shirt). For additional details on insect bite precautions, see Sec. 4, Ch. 6, Mosquitoes, Ticks & Other Arthropods.

Other Concerns

Travelers' Diarrhea

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 brucellosis, seafood poisoning may be needed.

Insect- and Arthropod-Borne Diseases

Murine typhus, tick-bite fever, West Nile virus may pose a risk. Personal protective measures are important.

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.

Safety and Security

See also: Library article for Safety and Security

Key Safety Risks

• Risk of violent protests
• Risk of security forces responding to protests with excessive force
• Violent crime
• Kidnapping, which may target foreign nationals
• Random acts of armed violence
• Piracy

Emergency Contacts

The national emergency number is 117.