Vaccination and Travel Information for Madagascar

MADAGASCAR

 Information current as at:  February 2009 by The D2 Medical Centre No 1 Fitzwilliam Street upper dublin 2 Ph 6314500. The experts in travel vaccines Dublin 2.


Climate: Hot and subtropical climate, colder in the mountains. Rainy season: November to March. Dry season: April to October. The south and west regions are hot and dry. Monsoons bring storms and cyclones to the east and north from December to March. The mountains, including Antananarivo, are warm and with thunder from November to April and dry, cool and windy the rest of the year.
Capital City: Antananarivo
Altitude: 1300 metres above sea level
Main Cities: Fianarantsoa, Toamasina
Population: 13,702,000
Land Area (sq km): 587,040
Currency: 1 Malagasy franc (FMG) = 100 centimes
Languages: Malagasy, French
Religions: Animist, Christian, Muslim
Economy: Meat processing, soap, tanneries, sugar, textiles, petroleum



 The D2 Medical Centre advises all travellers to be 'up-to-date' for:

CHOLERA Immunisation is neither required or recommended.
DIPHTHERIA We recommend the initial childhood series of vaccinations in the first five years of life, with booster doses at ages 11 years, 45 years, and 65 years. Travellers are recommended to have the vaccine 10 yearly esp. if travelling to developing countries, or where there may be a risk of contracting the disease.

HEPATITIS 'A' Immunisation is strongly recommended but not compulsory.


HEPATITIS 'B' Immunisation is recommended for travellers who will be in the area for 1 month or more.
Transmission of Hepatitis B is through sex or contact with contaminated blood, needles and syringes.


JAP.B.ENCEPHALITIS Immunisation is recommended for travellers who will be in rural or remote areas for 1 month or more at a time.


POLIO Adults who are travelling to areas where poliomyelitis cases are occurring, or where the contracting the disease is possible, and who have received a primary series with either IPV or OPV should receive another dose of IPV before departure. For adults, available data do not indicate the need for more than a single lifetime booster dose with IPV.



RABIES Immunisation is recommended for travellers who will be in rural or remote areas for 1 month or more at a time.


TUBERCULOSIS (TB) Immunisation is not compulsory, and is not routinely recommended for adults.
Children should be immunised at any age.
A skin test is available if immune status is in doubt.


TETANUS We recommend the initial childhood series of vaccinations in the first five years of life, with booster doses at ages 11 years, 45 years, and 65 years. Travellers are recommended to have the vaccine 10 yearly esp. if travelling to developing countries, or where there may be a risk of contracting the disease.

TYPHOID FEVER Immunisation is recommended for travellers who will be in the area for 1 month or more.


YELLOW FEVER A yellow fever vaccination certificate is required from travellers coming from, or having been in transit in, areas considered to be infected ( see * below ).

* World Health Organization:
The following countries and areas are regarded as Yellow Fever infected areas:

Africa: Angola, Benin, Burkina Faso, Burundi, Cameroon, Central African Republic, Chad, Congo, Côte d'Ivoire, Democratic Republic of the Congo, Equatorial Guinea, Ethiopia, Gabon, Gambia, Ghana, Guinea, Guinea-Bissau, Kenya, Liberia, Mali, Niger, Nigeria, Rwanda, Sao Tome and Principe, Senegal, Sierra Leone, Somalia, Sudan (south of 15°N), Togo, Uganda, United Republic of Tanzania, Zambia.
America: Belize, Bolivia, Brazil, Colombia, Costa Rica, Ecuador, French Guiana, Guyana, Panama, Peru, Suriname, Trinidad and Tobago, Venezuela.




Malaria risk—predominantly due to P. falciparum—exists throughout the year in the whole country, with the highest risk in the coastal areas.

There are five common medications for malaria prevention available in Ireland. They are: chloroquine, doxycycline, malarone, mefloquine, paludrine. To determine the appropriate antimalarial, it is advised that the traveller discuss this with a D2 medical centre Travellers Health Specialist or other Travel Health Professional. None of the medicines are 100% effective against the disease at all times, and each has its own side effects. These need to be discussed with the intending traveller.

 

General Advice on Mosquito Prevention.
Malaria is transmitted by mosquito bite, so recommend all travellers to the country to:

  • cover exposed skin after dusk when they are at most risk for getting bitten
  • use insect repellent with DEET in it.
  • return before dusk from country areas where malarial mosquitoes are the most active
  • sleep in screened room or use a bed net, remembering to tuck in the edges & spray inside.
  • sleep in air conditioned rooms or rooms with fans. Vapour pads and smoke coils also help. Insect buzzers are useless.

Malaria map of Madagascar




GENERAL
Medical facilities outside the capital city offer only rudimentary medical care and can be quite different, and or poorer standard, than western standards. Visitors should carry comprehensive health insurance. Public health facilities are basic, and hospitals are not recommended for anything but immediate stabilisation prior to a medical evacuation or for minor medical concerns. Clinique des Soeurs Ankadifotsy, a privately-owned mission hospital, Is well-equipped, comfortable and clean. The clinic offers basic diagnostic services, including ultrasound and X-ray facilities. The government-owned Hopital Universitaire is an additional option for obtaining medical care in Antananarivo. Patients with critical illnesses are commonly evacuated to South Africa or Reunion Island where more advanced diagnostic testing and treatment options are available.

Medications, generally of French origin, were readily available in Antananarivo before the current crisis broke out. Supplies of medicine are now low. If a prescription needs filling, it may be difficult to determine the French equivalent of the medication unless the active ingredient is listed on previous medication. Outside of Antananarivo, medications may not be available.

HEALTH, ACCIDENTS AND INSURANCE
Accidents and injuries are the leading cause of death among travellers under the age of 55. Most are caused by motor vehicle and motorcycle crashes; and to a lesser degree, drowning, aircraft crashes, murders, and burns.

Heart attacks cause most fatalities in older travellers, but infections cause only 1% of fatalities in overseas travellers. Generally, infections are the most common cause of travel-related illness.

Travellers are advised to obtain, before departure, travel health insurance with specific overseas coverage. The policy should include a medical evacuation benefit. Check for any exclusions that are part of the policy, and keep in mind that many insurance policies have terrorism exclusion clauses. The D2 Medical centre recommends that the policy also provide 24-hour access to an assistance centre that can help arrange and monitor delivery of medical care, and determine if air ambulance services are required.

 

Yellow Fever Map

                                                                                                                                           DR JOHN J RYAN MEDICAL DIRECTOR

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