Madagascar's malaria advice covers every stop outside the capital.
The CDC recommends malaria prevention medicine for all of Madagascar except the city of Antananarivo, which takes in Nosy Be's beaches, the Andasibe and Ranomafana rainforests, Isalo and the baobabs at Morondava. The dry season is easier on bites, and the rainforest adds leeches.
Are there mosquitoes in Madagascar? Yes, all year, and the CDC recommends malaria prevention medicine for all of Madagascar except the city of Antananarivo. That puts every classic stop inside the advice, from the beaches of Nosy Be to the Andasibe and Ranomafana rainforests, Isalo and the Avenue of the Baobabs at Morondava.
Malaria medicine everywhere but the capital
The CDC's wording is "CDC recommends that travelers going to certain areas of Madagascar take prescription medicine to prevent malaria." The options it lists are atovaquone-proguanil, doxycycline, mefloquine and tafenoquine, and transmission is mostly Plasmodium falciparum, resistant to chloroquine.
Travelers do bring malaria home. In an April 2026 bulletin, Santé publique France, the French national public-health agency, reported that 61 imported malaria cases on nearby Réunion from January 2024 to March 2026, 64% of those with a known travel history, followed a trip to Madagascar. About one in five of Réunion's imported cases each year was a tourist, and none of those tourists had taken prevention medicine for the full recommended period. If you're prescribed malaria medicine, ask the clinic when to start and when to stop.
What we suggest you do with this: the CDC recommends malaria medicine for "All areas (except the city of Antananarivo)," so book a travel-medicine appointment 4–6 weeks before departure and bring the full route. Yellow fever vaccine is not recommended, but proof is required from travelers 9 months or older arriving from a country with yellow fever risk, including airport transits or layovers of more than 12 hours there. Mention any long connection through an African hub such as Nairobi. Our malaria-zone checklist covers everything around the prescription.
Malaria mosquitoes bite from dusk to dawn, so put repellent on at sunset, cover ankles and lower legs at dinner and sleep under a net unless the room is screened and air-conditioned. The CDC also lists dengue, though Madagascar isn't on its global dengue list. Dengue's Aedes bite by day, so add a morning coat before a hike.
Leeches, ticks, fleas and fresh water
Andasibe and Ranomafana are wet rainforest. After rain, leeches work the trails and can drop from the leaves overhead, so tuck pants into socks and treat hiking clothes with permethrin, which also helps against ticks. The CDC lists two tick-borne diseases, African tick-bite fever and Crimean-Congo hemorrhagic fever. It also lists plague, spread by flea bites and contact with infected people or animals, and advises avoiding bug bites and sick animals and people. For schistosomiasis, its advice is to "Avoid swimming in fresh, unchlorinated water, such as lakes, ponds, or rivers."
When to go: dry season or rains
The cooler dry season, roughly May to October, tends to be easiest on bites, especially June to August in the highlands and around Isalo and Morondava. The hot rainy season, roughly December to March, tends to bring the most mosquitoes and leeches, plus cyclones. In 2026, Cyclone Fytia in late January and Cyclone Gezani on February 10–11 left hundreds of thousands of people affected, WHO's Madagascar office reported. Nosy Be is humid all year, with evening mosquitoes the main complaint, and the CDC's malaria advice applies in every month.
Where you're going
Antananarivo
The one place the CDC carves out. Malaria transmission is rare in the city and no prevention medicine is recommended for it, but nearly every tour circuit leaves the capital, so the clinic question still applies.
Nosy Be
Inside the CDC's malaria advice and humid all year. Many bars and restaurants are open-air under thatch, and evenings there are the bite hour, so cover ankles and lower legs at dinner.
Andasibe-Mantadia
Rainforest inside the malaria advice, with mosquitoes on night walks and leeches on the trails after rain. Tuck pants into socks and wear permethrin-treated clothes.
Morondava & the Avenue of the Baobabs
On the dry west coast, inside the malaria advice. Sunset at the baobabs runs into the start of the malaria hours, so put repellent on before you head out.
Pairing Madagascar with Réunion or Mauritius? The CDC recommends no malaria medicine for either island. Our Réunion and Mauritius briefings cover their chikungunya and dengue picture.
The Madagascar kit
- Picaridin 20% travel sprays: odorless, light in a day pack and quick to reapply at sunset. One 3.4 oz bottle covers about a week of daily use for one person.
- Permethrin for hiking clothes: treat trousers, socks and a long-sleeved shirt at home 48 hours before you fly. It lasts several washes and never goes on skin.
- A travel bed net for rooms without screens or air conditioning.
What travelers report
Paraphrased from TripAdvisor threads and reviews and linked so you can read them in full. Only one is dated, and rain changes the rainforest trails from one day to the next.
- Nosy Be (Hell-Ville and Ambatoloaka) · June (planned trip) · 2025
A visitor planning a June trip asked whether mosquitoes are a problem at night in Nosy Be's open-air bars. A Madagascar destination expert replied that most places are open-air under thatch, that mosquitoes gather under tables after dusk so ankles and lower legs should be covered, and recommended sleeping under a net and using DEET. They noted malaria is endemic across Madagascar and suggested discussing Malarone with a doctor. TripAdvisor ↗
- Ranomafana National Park · rainy day
A reviewer on a rainy hike said about 50 leeches tried to climb on them, and was also unhappy with the guide and how few animals they saw. TripAdvisor ↗
- Andasibe · early November
In a thread about leech socks, a poster said they definitely had leeches in Andasibe in early November after rain the night before, with leeches dropping from higher leaves, so leech socks were little help. TripAdvisor ↗
One more rule outlasts the trip. Any fever during or after your trip means a doctor visit, and you tell them you were in Madagascar. Malaria can show up weeks later, and a fever with swollen glands needs care quickly.
Traveler questions
Do I need malaria pills for Madagascar?
The CDC recommends malaria prevention medicine for "All areas (except the city of Antananarivo)," which covers Nosy Be, Andasibe, Ranomafana, Isalo and Morondava in every month. Which medicine fits you is a call for a travel clinic, made with your full route 4–6 weeks before departure. Our malaria-zone checklist covers the rest of the preparation.
Is there malaria in Antananarivo?
Very little. The CDC says malaria transmission is rare in the capital and recommends no prevention medicine for the city, only "insect bite precautions and mosquito avoidance." The exception covers the city alone. Once your route heads to the coast, the rainforest or the national parks, you're inside the CDC's recommendation.
Do I need a yellow fever vaccine for Madagascar?
The CDC's recommendation is "Vaccine is not recommended," and on direct travel from the United States, "Vaccine is not required." From countries with yellow fever risk, Madagascar's rule is "Vaccine is required for travelers ≥9 months old; this includes >12-hour airport transits or layovers in countries with risk for YF virus transmission." Check your connection against that rule, especially a long layover in an African hub such as Nairobi.
Is Zika a concern in Madagascar if I'm pregnant?
CDC's Madagascar page lists Zika. If you're pregnant or planning a pregnancy, talk to a travel clinic before you book, and bring your full route.
Sources
Health authorities, surveillance reports and news coverage of official bulletins used for this briefing, last checked October 2026. Traveler reports are linked where they appear. This page summarizes public-health guidance and is not medical advice.
- CDC destination page for travelers
- CDC Travel Health Notice
- European Centre for Disease Prevention and Control
- World Health Organization
- World Health Organization
- European Centre for Disease Prevention and Control
- World Health Organization
- CDC Travelers' Health
- Health authority (santepubliquefrance.fr)
- fr.allafrica.com
- mesvaccins.net
- World Health Organization