Travel vaccinations for Madagascar: recommendations, yellow fever rules and malaria

Madagascar requires no vaccinations if you travel directly from Germany. The German Federal Foreign Office (Auswärtiges Amt) recommends hepatitis A and polio for all travellers. Even more important than any single vaccine is malaria protection: according to the Foreign Office and the DTG, the risk is high all year throughout the country and moderate in the capital Antananarivo. Further vaccinations depend on how you travel and for how long.

Entry rules: yellow fever and the question of connecting flights

If you arrive directly from Germany, the Foreign Office says no proof of vaccination is needed. If you arrive from a yellow fever country, however, Madagascar requires yellow fever vaccination for everyone over nine months. Madagascar itself is not a yellow fever area.

One point affects many travellers: numerous flight connections go via Addis Ababa or Nairobi. According to the Foreign Office, proof of yellow fever vaccination may be requested after such a transit, regardless of how long you spent at the connecting airport. The WHO list, by contrast, refers to a twelve-hour transit limit. Check your flight route before your consultation and ask your doctor to assess the question. In Germany, yellow fever vaccination is only given at approved yellow fever vaccination centres.

If you combine Madagascar with a stay in Kenya or Tanzania, the yellow fever rules of both countries apply as well.

Recommended vaccinations according to the Foreign Office

The table at the top of this page summarises the recommendations:

• All travellers: hepatitis A and polio. Polio (cVDPV-1) has been detected in Madagascar. For stays of more than four weeks, WHO rules require vaccination within a set period before departure, although according to the Foreign Office proof is not currently enforced. Your practice will check whether you need a booster.
• Based on individual risk: dengue, hepatitis B, typhoid and rabies.
• Cholera: advice is only worthwhile if you will work for longer periods in cholera epidemic areas, for example in healthcare or disaster relief.
• Routine vaccinations: keep up to date with the STIKO schedule, the official German vaccination calendar; the Foreign Office specifically highlights measles.

Rabies is mainly transmitted by dogs. According to the Foreign Office, vaccines and immunoglobulins are not available or only to a very limited extent, which matters on long overland journeys and in remote regions. STIKO only recommends dengue vaccination for people aged four and over who have had a laboratory-confirmed dengue infection in the past. For the available dengue and chikungunya vaccines, the Foreign Office advises individual counselling.

Malaria, dengue and other insect-borne risks

According to the Foreign Office and the DTG, there is a high malaria risk all year throughout the country, cities included, and a moderate risk in Antananarivo. More than 99 per cent of cases are falciparum malaria. In high-risk areas the Foreign Office considers preventive medication useful in addition to mosquito protection. For moderate-risk areas more than 48 hours away from a facility that can diagnose malaria, it recommends emergency standby treatment. What suits your trip is something to agree with your doctor; our guide to malaria prevention covers the basics.

Chikungunya, dengue and Rift Valley fever occur nationwide all year, according to the Foreign Office. Protect yourself by day and night: wear long clothing, apply repellent regularly and sleep under a bed net. Practical tips are in our guide to dengue and mosquito protection. Plague is also endemic in the central highlands, mostly as bubonic plague transmitted by rat fleas, so avoid contact with rats and other rodents.

A fever during or after your trip is a warning sign. Have it checked by a doctor straight away and mention your stay in Madagascar.

What depends on your type of trip

Hygiene, water and animals

According to the Foreign Office, travellers’ diarrhoea, hepatitis A and E, shigellosis, typhoid and worm infections also affect travellers. Drink only water from a safe source and take care with food and hand hygiene. Do not swim in lakes or rivers, as schistosomiasis can be transmitted after even brief contact with fresh water. Because of ciguatera, a form of poisoning from contaminated fish, the Foreign Office advises avoiding sea fish and seafood.

There are no venomous snakes in Madagascar, the Foreign Office notes, but there are venomous spiders, scorpions, centipedes and certain caterpillars and frogs. Shake out shoes, clothing and bedding before use. If an animal bites or scratches you, wash the wound with soap and water for at least 15 minutes and seek medical help immediately. Avoid meat of unknown origin and raw animal products, as Rift Valley fever can also be transmitted via infected ruminants.

Medical care in Madagascar

According to the Foreign Office, medical care is unsatisfactory even in the capital, and qualified staff are often lacking outside Antananarivo. Emergency and basic care is available, with limitations, at the large state hospitals and some private clinics. Pharmacies stock only a very limited range, and counterfeits occur. Put together a complete travel health kit, bring your regular medication and make sure your travel health insurance covers medical evacuation.

Timing: when to see a travel health specialist

Book your consultation early, because vaccinations, malaria prevention and your travel health kit need to be planned together. Following STIKO and DTG, travel vaccinations should be completed at least two weeks before departure. The travel vaccine check gives you a first overview, and our directory of travel clinics helps you find a practice in Germany.