Madagascar
Travel Destination – Madagascar
Madagascar sits off Africa's southeastern coast in the Indian Ocean and is one of the world's most biologically unique destinations. There are more than 100 species of lemur, colourful chameleons, and the iconic baobab trees that line the Avenue of the Baobabs near Morondava. National parks attract adventurous visitors to places such as Andasibe-Mantadia, Ranomafana, Isalo, and the striking limestone formations of Tsingy de Bemaraha.
The country also offers exceptional landscapes beyond its wildlife. Travellers can explore tropical beaches, the rainforests of the east coast, the highlands surrounding Antananarivo, and the vast deserts and sandstone canyons of the south.
Despite its growing tourism appeal, Madagascar remains a destination where infrastructure can be limited and healthcare services outside major cities are basic. Serious illness or injury frequently requires evacuation to another country, so comprehensive travel insurance with medical evacuation cover is essential.
Health Risks
Pre-travel preparation
Australians planning a trip to Madagascar should arrange a travel health consultation at least six to eight weeks before departure whenever possible. This allows sufficient time to review routine vaccinations and obtain destination-specific immunisations if required. If departure is imminent, a travel health appointment is still useful for advice tailored to planned activities and destinations.
Malaria remains one of the most important health risks in Madagascar and travellers visiting risk areas should obtain prescription prevention medication before leaving Australia. Pharmacies and medical services can be difficult to access outside major centres, so all prescription medicines should be carried in sufficient quantities for the entire trip.
Given the limited healthcare infrastructure across much of the island, travellers should ensure their insurance policy specifically covers emergency medical evacuation and hospital treatment overseas.
Insect avoidance
Mosquito-borne diseases are widespread in Madagascar. Malaria, dengue, and chikungunya occur in many parts of the country, making mosquito bite prevention a priority throughout the entire trip. Yellow fever vaccination is not required for travel to Madagascar, but may be required if arriving to Madagascar from endemic countries.
Repellent containing DEET or picaridin should be applied to exposed skin regularly during both daytime and evening hours. Long sleeves, long trousers, and accommodation with screened windows or air conditioning add additional protection. Travellers staying in rural areas, eco-lodges, or national parks should consider sleeping under a permethrin-treated mosquito net if insect screening is inadequate.
Clothing treated with permethrin can further reduce bite risk, particularly for visitors trekking in rainforests or spending extended periods outdoors.
Food and water hygiene
Madagascan cuisine blends African, Southeast Asian, and French influences, with rice, seafood, zebu beef, tropical fruit, and fragrant stews featuring prominently across the country. While trying local food is one of the highlights of a visit, maintaining strict hygiene precautions is important to prevent gastroenteritis.
Tap water should not be consumed. Bottled or properly treated water should be used for drinking and brushing teeth. Ice from unknown sources should be avoided. Food should be thoroughly cooked and served hot wherever possible, while raw or undercooked dishes require caution. Hand sanitiser is useful when soap and water are unavailable.
Fruit that can be peeled is generally safer than pre-cut fruit sold by street vendors. Consistent attention to food and water safety significantly reduces the risk of gastroenteritis and other gastrointestinal infections.
Rabies prevention
Rabies occurs in Madagascar and is carried primarily by dogs and other mammals, including bats.
Rabies is a viral infection that attacks the brain and nervous system after being transmitted through the saliva of an infected animal, most commonly through bites or scratches. Once symptoms develop, rabies is almost always fatal, making it one of the deadliest infectious diseases in the world.
The illness typically starts with non-specific symptoms such as fever, headache, and weakness before progressing to severe neurological symptoms including confusion, agitation, paralysis, difficulty swallowing, and eventually death. Fortunately, rabies can be prevented if appropriate treatment is given promptly after an exposure.
Travellers should avoid contact with all animals, including apparently healthy pets and wildlife. Pre-exposure rabies vaccination should be discussed with a travel doctor, particularly for people spending extended periods in Madagascar, visiting remote regions, undertaking outdoor activities, or working with animals.
Any bite or scratch must be washed immediately with soap and running water and followed by prompt medical assessment, regardless of vaccination status.
Our Travel Doctors
Our fully qualified doctors have an interest in travel medicine and immunisations. And they know travel. Their expert advice will be tailored for you, your travel companions and your trip.
Which shots do I need for Madagascar?
Hepatitis A
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Hepatitis A is a viral infection that affects the liver and is spread through food, water, or surfaces contaminated with human waste. Even travellers staying in good-quality accommodation can be exposed through contaminated food preparation, making vaccination one of the most important preventive measures for travel to Madagascar.
Symptoms can include fever, fatigue, nausea, loss of appetite, abdominal pain, dark urine, and jaundice. While many people recover completely, illness can be prolonged and may cause severe disease, particularly in older adults.
Hepatitis A vaccination is recommended for most unvaccinated travellers to Madagascar. Protection begins developing within a few weeks of the first dose, while a second dose provides long-term immunity that usually lasts for decades. Good food and water hygiene remains important even after vaccination.
Typhoid
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Typhoid fever is a potentially serious bacterial infection caused by Salmonella Typhi. It spreads through contaminated food and water and remains a risk in many parts of Madagascar where sanitation infrastructure is limited.
Typhoid fever commonly causes prolonged fever, headache, weakness, loss of appetite, and abdominal discomfort. In severe cases, it can lead to intestinal complications requiring hospital treatment.
Vaccination for typhoid fever is recommended for many travellers, particularly those spending significant time outside major tourist facilities, visiting friends and relatives, travelling for extended periods, or heading to rural areas. Vaccination reduces risk but does not provide complete protection, making careful food and water precautions equally important. Eating food that is cooked and served hot, drinking sealed bottled water, and maintaining good hand hygiene remain essential preventive measures.
Rabies
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Rabies occurs in Madagascar and is carried primarily by dogs and other mammals, including bats.
Rabies is a viral infection that attacks the brain and nervous system after being transmitted through the saliva of an infected animal, most commonly through bites or scratches. Once symptoms develop, rabies is almost always fatal, making it one of the deadliest infectious diseases in the world.
The illness typically starts with non-specific symptoms such as fever, headache, and weakness before progressing to severe neurological symptoms including confusion, agitation, paralysis, difficulty swallowing, and eventually death. Fortunately, rabies can be prevented if appropriate treatment is given promptly after an exposure.
Travellers should avoid contact with all animals, including apparently healthy pets and wildlife. Pre-exposure rabies vaccination should be discussed with a travel doctor, particularly for people spending extended periods in Madagascar, visiting remote regions, undertaking outdoor activities, or working with animals.
Any bite or scratch must be washed immediately with soap and running water and followed by urgent medical assessment, regardless of vaccination status.
Measles
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Measles is one of the most contagious infectious diseases known and continues to cause outbreaks worldwide. The virus spreads through coughing, sneezing, and simply sharing air in enclosed spaces with an infected person.
Symptoms include fever, cough, runny nose, red eyes, and a characteristic rash. Serious complications such as pneumonia and brain inflammation can occur, particularly in young children, pregnant women, and immunocompromised individuals.
All Australians travelling internationally should ensure they are covered before departure. Travellers born during or after 1966 require two documented doses of a measles-containing vaccine. Reviewing vaccination records before travel is important, particularly as immunity gaps remain common among adults who received incomplete childhood vaccination.
Mpox
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Mpox (formerly monkeypox) is a viral infection spread through close physical contact with an infected person, contaminated materials, or infected animals. Symptoms can include fever, swollen lymph nodes, and a characteristic rash.
Mpox vaccination may be appropriate for some travellers based on their destination, planned activities, and individual risk factors. Discuss your suitability for vaccination with a travel doctor before departure.
Prevention also includes avoiding close contact with anyone with a rash or suspected mpox infection, practising good hand hygiene, and seeking medical attention if symptoms develop during or after travel.
Hepatitis B
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Hepatitis B is a viral infection that targets the liver and may cause both acute illness and lifelong chronic infection.
Unlike hepatitis A, it spreads through blood and bodily fluids rather than contaminated food or water.
Potential sources of exposure to Hepatitis B include sexual contact, medical or dental procedures, tattooing, piercing, and contact with contaminated needles or instruments.
While the average tourist may perceive their risk as low, travellers can unexpectedly require medical care following illness, accidents, or injuries. Hepatitis B vaccination is recommended for many travellers to Madagascar, particularly those staying for extended periods, undertaking volunteer work, participating in healthcare activities, having new sexual partners, or travelling extensively in remote regions. The vaccine provides highly effective long-term protection.
Yellow Fever
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Yellow fever is a serious viral disease spread by infected mosquitoes and can cause fever, liver failure, bleeding complications, and death in severe cases.
Yellow fever does not occur in Madagascar, so vaccination is not required for routine travel to the country. However, travellers arriving from, or transiting through, a country where yellow fever is present may be required to show a valid International Certificate of Vaccination on arrival.
If your itinerary includes travel through parts of sub-Saharan Africa or South America before arriving in Madagascar, discuss yellow fever requirements with your travel doctor before departure.
The yellow fever vaccine must generally be administered at least 10 days before travel and provides long-lasting protection for most recipients. Travellers should carry their vaccination certificate throughout their journey in case it is requested by border authorities.
Routine vaccinations
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Travel to Madagascar provides an excellent opportunity to review routine immunisations and ensure they are fully up to date. Many vaccine-preventable illnesses continue to circulate globally and may be encountered during international travel or transit through major airports.
Travellers should review protection against measles, mumps, rubella, tetanus, diphtheria, pertussis, influenza, COVID-19, hepatitis B, and polio. Adults who have not received a tetanus booster in the previous ten years may wish to discuss one with their doctor before departure. Maintaining current routine vaccinations helps protect both the traveller and the communities they come home to.
Madagascar
Other health risks in Madagascar
Malaria
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Malaria remains one of the most important health risks for travellers in Madagascar. The disease is caused by parasites transmitted through the bites of infected Anopheles mosquitoes, which are most active between dusk and dawn.
Risk exists across much of the country, although some higher-altitude regions of the central plateau experience lower transmission.
Symptoms commonly include fever, chills, headache, muscle aches, fatigue, and vomiting. Early symptoms can resemble influenza or other common viral infections, but malaria can rapidly progress to severe illness affecting the brain, lungs, kidneys, and other organs.
Prevention requires a combination of prescription antimalarial medication and rigorous mosquito avoidance measures. Depending on individual circumstances, a travel doctor may recommend a suitable option for antimalarial prophylaxis.
Any fever that develops during travel or within four weeks of returning from Madagascar should be treated as medically urgent until malaria has been excluded. Travellers should always inform healthcare providers about recent travel history.
Gastroenteritis
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Gastroenteritis and other gastrointestinal illnesses are some of the most common health problems affecting travellers in Madagascar. Contaminated food, untreated water, poor sanitation, and inadequate food storage can expose visitors to bacteria, viruses, and parasites that cause diarrhoea, vomiting, nausea, abdominal cramps, and fever.
The risk exists throughout the country, particularly in rural areas and locations where access to safe water and sanitation is limited.
Most cases improve within a few days with rest and adequate fluid replacement. Oral rehydration solutions can help prevent dehydration, which is particularly important in children and older adults.
Prevention centres on drinking bottled or treated water, avoiding ice from unknown sources, eating food that is freshly cooked and served hot, practising careful hand hygiene, and avoiding raw or undercooked foods. Medical attention should be sought if symptoms are severe, persistent, involve blood, or are accompanied by high fever.
Dengue and chikungunya
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Dengue and chikungunya are viral illnesses spread by Aedes mosquitoes, which bite predominantly during daylight hours. Both diseases occur in Madagascar and can affect travellers in urban, coastal, and rural environments.
Dengue frequently causes sudden fever, severe headache, eye pain, rash, and intense muscle and joint aches. In some people, it can progress to more serious complications involving bleeding and shock.
Chikungunya produces many similar symptoms but is particularly known for severe joint pain that may persist for weeks or months after the initial infection has resolved.
No specific antiviral treatment exists for either disease. Prevention focuses on avoiding mosquito bites through regular use of insect repellent, covering exposed skin, eliminating standing water around accommodation where possible, and choosing accommodation with effective insect screening.
Bubonic plague
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Madagascar is one of the few countries in the world where plague remains naturally present. The disease is caused by the bacterium Yersinia pestis, which typically circulates among rodents and is transmitted by infected fleas.
Most human cases occur in rural highland regions and outbreaks generally affect local communities rather than international tourists.
Symptoms often include fever, headache, weakness, and painful swollen lymph nodes. A more serious form affecting the lungs can spread directly between people and requires immediate medical treatment.
Travellers can reduce risk by avoiding contact with rodents, preventing flea bites, maintaining good accommodation hygiene, and avoiding handling sick or dead animals. Any unexplained fever developing after time in rural Madagascar should prompt medical assessment.
Tuberculosis
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Tuberculosis (TB) is present in Madagascar and remains an important public health issue, particularly in densely populated urban areas where access to healthcare may be limited.
TB spreads through the air when a person with active tuberculosis coughs, sneezes, speaks, or sings. The risk for most short-term tourists is low, but travellers spending extended periods in Madagascar, working in healthcare, volunteering in community settings, or having prolonged close contact with local populations may face increased exposure.
Symptoms of TB can include a persistent cough, fever, night sweats, fatigue, and unexplained weight loss. Travellers at higher risk should discuss tuberculosis screening with their doctor before and after travel. Any prolonged cough or unexplained illness developing during or after a visit to Madagascar should be medically assessed, with travel history disclosed.
Non-infectious conditions
Crime and unrest
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Australians visiting Madagascar should exercise caution due to the threat of civil unrest, crime, and natural disasters.
Travellers should avoid protests, remain aware of their surroundings, secure valuables, and avoid walking alone after dark. Regular power and water outages can also affect daily life.
Petty crime, including pickpocketing, bag snatching, and theft from vehicles, is common in major cities such as Antananarivo and in popular tourist areas. Violent crime, including armed robbery, also occurs, particularly after dark.
Refer to the Australian Government's Smartraveller website before and during your trip for up to date safety information and advice.
Safety on the roads and elsewhere
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Road travel is often challenging in Madagascar. Many roads are poorly maintained, particularly outside major cities, and driving standards can be unpredictable. Long travel times between destinations are common even over relatively short distances. Night driving should be avoided where possible.
Visitors planning to explore remote parks or coastal regions should allow generous travel times and prepare for limited emergency assistance.
Deep vein thrombosis
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Long periods of sitting on long haul flights to Madagascar reduce blood flow in the deep veins of the legs, increasing the risk of deep vein thrombosis (DVT). DVT is a condition where blood clots form in the legs, causing symptoms of swelling, pain, tenderness, warmth, and redness in one leg. The greatest danger arises when part of a clot breaks free and travels to the lungs, causing a pulmonary embolism, which can potentially be life threatening.
To reduce risk, travellers should stand up and walk throughout long flights, perform ankle circles and calf exercises while seated, stay well hydrated, and avoid excessive alcohol intake. Compression stockings may be beneficial for people with risk factors such as previous DVT, recent surgery, pregnancy, obesity, cancer, smoking, or hormone therapy. Anyone with significant risk factors should seek personalised advice from their doctor before travel.