Every traveler to Zanzibar should take antimalarial medication — that’s not a cautious suggestion, it’s the position of the CDC, UK TravelHealthPro, and WHO alike, and the numbers back it up: the island recorded over 30,000 confirmed malaria cases between January 2023 and March 2024 alone. None of this should scare you off a trip that millions of people take safely every year, but it does mean the health prep is worth doing properly rather than winging it.
Malaria: What You Actually Need to Do
Zanzibar sits entirely within a malaria transmission zone, with P. falciparum the dominant species and chloroquine resistance reported — so chloroquine alone, if you’ve heard of it as an older standard, isn’t an effective option here. Risk is lower at breezy east-coast resorts than in more sheltered spots like Stone Town, but the mosquitoes that carry it are present island-wide, and transmission runs year-round with peaks during and after the long rains (March–June) and short rains (October–December). The main vector bites between dusk and dawn, which is why evening precautions matter more than daytime ones.
See a travel clinic 6–8 weeks before departure to get a prescription. The commonly recommended options:
Atovaquone-proguanil (Malarone): daily, starting 1–2 days before arrival and continuing 7 days after you leave. Usually the top choice for trips under two weeks, and the most expensive of the four.
Doxycycline: daily, starting 1–2 days before arrival and continuing 4 weeks after returning. Cheaper and better suited to longer trips, but it causes sun sensitivity and isn’t suitable for pregnant women or children under 8.
Mefloquine: weekly, starting a week before arrival and continuing 4 weeks after departure. Carries a risk of neuropsychiatric side effects, so it’s generally reserved for cases where the other options don’t fit.
Tafenoquine: requires a G6PD blood test beforehand, since people with G6PD deficiency can react dangerously to it. Its post-trip course is shorter, around one week.
Beyond medication: use 20%+ DEET or picaridin repellent on exposed skin from dusk onward, reapplying after swimming or heavy sweating; wear lightweight long sleeves and trousers in the evenings; sleep under an insecticide-treated net even in an air-conditioned room, and ask your accommodation for one if it isn’t already provided. Finish your full prophylaxis course even after you’re home and feeling fine, and if you develop a fever within a year of returning, see a doctor immediately and mention that you visited a malaria area — symptoms can take weeks to appear.
Vaccinations
Make sure routine vaccines and COVID-19 vaccination are current before you go. Beyond that, the CDC’s specific recommendations for Tanzania (which covers Zanzibar) are:
Hepatitis A — recommended for unvaccinated travelers age 1 and up.
Hepatitis B — recommended for unvaccinated travelers under 60 (those 60+ may still choose to get it).
Typhoid — recommended for most travelers, especially if you’re visiting smaller towns, rural areas, or staying with local families rather than resort hotels.
Yellow fever — not generally recommended for Tanzania itself, and not required for travelers arriving directly from the US or most non-endemic countries. It is required if you’re arriving from a country with yellow fever transmission risk, or after a 12+ hour transit through one (Kenya is the most common trigger).
Rabies — worth discussing pre-exposure vaccination with your doctor if you’ll be in rural areas; infected dogs are common, post-exposure treatment may only be available at larger urban facilities, and a bite or scratch from any unfamiliar animal should mean an immediate doctor visit regardless.
Cholera — transmission is widespread in Tanzania; vaccination may be worth considering depending on your itinerary, alongside the basics of safe food, water, and handwashing.
Measles and polio — confirm you’re fully vaccinated; adults with a completed childhood polio series may want a one-time booster, since poliovirus has been identified in Tanzania in the past year.
Food and Water Safety
Don’t drink tap water, and don’t brush your teeth with it — stick to bottled or filtered water for the whole trip. Watch for leptospirosis and schistosomiasis risk if you’re tempted to swim or wade in freshwater lakes, rivers, or unchlorinated pools rather than the ocean or a proper pool — schistosomiasis in particular comes from freshwater snails and is easy to avoid just by sticking to seawater and chlorinated pools.
Other Things Worth Knowing
Road safety is a bigger statistical risk on this trip than most of the above — motor vehicle crashes are common in Tanzania, traffic drives on the left, and avoiding motorbike taxis and night driving where you can is genuinely worthwhile advice, not just caution for its own sake.
Bring the medications you actually need with you rather than planning to buy them locally — some pharmaceuticals available in Tanzania are substandard or counterfeit. Medical evacuation insurance is worth having on top of standard travel insurance, given that serious cases on the island are typically evacuated to Dar es Salaam or Nairobi.
FAQ
Do I need malaria medication for Zanzibar?
Yes — the entire island is a malaria transmission zone, and antimalarial prophylaxis is recommended for every traveler. See a travel clinic 6–8 weeks before your trip to choose the right option.
Do I need a yellow fever vaccine for Zanzibar?
Only if you’re arriving from a country with yellow fever risk or after a long transit through one. It’s not generally required for direct travel from most non-endemic countries.
Is tap water safe to drink in Zanzibar?
No — stick to bottled or filtered water, and avoid brushing your teeth with tap water too.
What vaccines should I get before visiting Zanzibar?
Routine vaccines plus hepatitis A and typhoid are commonly recommended for most travelers; hepatitis B, rabies, and cholera vaccination depend on your specific itinerary and activities. Check with a travel clinic 6–8 weeks ahead.
Is malaria a serious risk in Zanzibar?
It’s a real risk that deserves real precautions — tens of thousands of cases are confirmed annually — but with prophylaxis, repellent, and a treated bed net, it’s a manageable one that doesn’t need to derail your trip.