To enter Madadagascar, no vaccinations are required, unless you are coming from a yellow fever infected country in Africa.
The illnesses you are most likely to contract are colds and diarrhea. Bring along the medicines you would usually take at home.
In the case of Diphtheria, Polio and Tetanus, updating your vaccinations, if needed, would be a good idea.
As protection against Hepatitis A + B , I received 3 injections of thecombination vaccine Twinrix. This is rather expensive at the rate of 63 Euro per shot.
On Madagascar, cases of Cholera occur from time to time, as it did in 1999. In general, a vaccination against cholera is controversial and not recommended, due to lack of effectiveness. The best protection against the disease is to be careful to consume only clean water and food. Water purification tablets like MicroPur are a good idea. Bottled mineral water is availalbe all over the country at appr. 0.65Euro / 1.5l.
To protect yourself againt Malaria, the local Institute Pasteur in Tana recommends taking Chinin or Chloriquin tablets. They explicitly recommend against taking the expensive Lariam, which may cause a considerable number of side effects. Local experts claim that the insects are not yet resistant to Chinin. Taking Lariam will have the effect of causing the insects to become resistant to it in the future, thus rendering useless the only medicine which helps today in serious cases. In addition, due to its frequent side effects, it is not recommended to be taken by biker drivers.
In standing waters, the causative agent Bilharziose may await you. Avoid staying in these longer than five minutes.
In 2005-2006, the chikungunya-fever has, due to a large number of infected people on the french departement Réunion island, 800 km east of Madagascar, made it into concerned news papers. In January 2006, there was not yet a confirmed case in Madagascar. The chikungunya-fever is a virus infection, transfered by day active mosquitos, which, after a short delay, causes a high fever and pain in the joints. In most cases, the decease is over after 1-2 weeks. There is no special treat against the virus. There are not yet proven cases of people killed be this fever on Réunion islands. To protect you, you should consequently defend you against mosiquitos by applying repellent during the day, as well as covering most parts of the body (long trousers/sleeves). Who wants to go further, can plan his bike tour to go into the dry west and south west.
Leprosy and Plague do not pose a danger for tourists.