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Travel Vaccines and Advice for Madagascar

Passport Health offers a variety of options for travelers throughout the world.

Set amid the varying spectrum of blue jewel-toned waters of the Indian Ocean is Madagascar. The island nation features a unique array of wildlife, plants and culture.

For those who like to experience destinations by their cuisine, Madagascar offers a wide variety of options. Restaurants specialize in French, Creole and native Madagascan dishes.

Whether you’re traveling to ‘The Red Island’, for the landscape, the culture or the food, adventure is not in short supply.

Do I Need Vaccines for Madagascar?

Yes, some vaccines are recommended or required for Madagascar. The CDC and WHO recommend the following vaccinations for Madagascar: hepatitis A , hepatitis B , typhoid , yellow fever , rabies , meningitis , polio , measles, mumps and rubella (MMR) , Tdap (tetanus, diphtheria and pertussis) , chickenpox , shingles , pneumonia and influenza .

COVID-19 vaccination is recommended for travel to all regions, both foreign and domestic. Check with your local Passport Health clinic if immunization is offered in your area.

See the bullets below to learn more about some of these key immunizations:

  • COVID-19 – Airborne & Direct Contact – Recommended for all unvaccinated individuals who qualify for vaccination
  • Hepatitis A – Food & Water – Recommended for most travelers
  • Hepatitis B – Blood & Body Fluids – Recommended for travelers to most regions.
  • Typhoid – Food & Water – Recommended for travelers to most regions.
  • Yellow Fever – Mosquito – Required if traveling from a country where yellow fever is present.
  • Rabies – Saliva of Infected Animals – Moderate risk country. Vaccine recommended for certain travelers based on destination, activities and length of stay.
  • Measles Mumps Rubella (MMR) – Various Vectors – Given to anyone unvaccinated and/or born after 1957. One time adult booster recommended.
  • TDAP (Tetanus, Diphtheria & Pertussis) – Wounds & Airborne – Only one adult booster of pertussis required.
  • Chickenpox – Direct Contact & Airborne – Given to those unvaccinated that did not have chickenpox.
  • Shingles – Direct Contact – Vaccine can still be given if you have had shingles.
  • Pneumonia – Airborne – Two vaccines given separately. All 65+ or immunocompromised should receive both.
  • Influenza – Airborne – Vaccine components change annually.
  • Meningitis – Airborne & Direct Contact – Given to anyone unvaccinated or at an increased risk, especially students.
  • Polio – Food & Water – While there is no active polio transmission in Madagascar, it is vulnerable for outbreaks. Considered a routine vaccination for most travel itineraries. Single adult booster recommended.

See the tables below for more information:

Proof of yellow fever vaccination is required for entry to Madagascar if arriving from a region with the virus. Immunization is not otherwise recommended for the country.

There is a risk of contracting malaria in Madagascar. Your risk may vary based on where you are going. Share your itinerary with a travel health specialist to see if antimalarial are right for you.

There is medical care in larger Madagascan cities and towns. For those staying in rural areas, there may be a need to travel far to get to the nearest physician.

For more details on any of the above vaccinations, visit our vaccination pages or make an appointment with your local Travel Medicine Specialist. To book your appointment either call or start booking online now .

Is Cholera a Risk in Madagascar?

Cholera is present in Madagascar. Those most at risk are individuals staying with relatives or travelers to rural areas.

The best protection against cholera is through vaccination. Passport Health clinics offer the cholera vaccine. Book your cholera vaccination appointment today!

Learn more by visiting our cholera page or by calling .

Do I Need a Visa or Passport for Madagascar?

Yes, a visa is required for travel to Madagascar. While visas are available at entry, it is best to obtain before leaving for Madagascar.

Sources: Embassy of Madagascar and U.S. State Department

What Is the Climate Like in Madagascar?

Madagascar tends to have a hot and tropical climate. The country has two predominant seasons, hot and rainy from November to April, cool and dry from May to October.

While the island tends to experience a tropical environment, climate varies throughout due to the changes in elevation. The western coast tends to be drier than the east or the central, and the southwest and deep south have a drier, desert-like climate.

  • Antananarivo – As the capital of Madagascar has a humid and subtropical climate during the summer, with mild and dry winters.
  • Mahajunga – Located in northwestern Madagascar, this region has a wet and dry season. The rainy season lasts from December to February, during which the whole island experiences monsoon season.
  • Fianarantsoa – This southern city experiences less rain than the rest of the country. Warmer weather lasts from November through March and cooler climate ranges from May to September.

How Safe Is Madagascar?

While travel within the country is relatively safe, travelers should exercise caution during times of political turmoil.

Demonstrations and political violence are becoming more common in Madagascar. Track the news and information published by the U.S. Embassy in Antananarivo .

Madagascar armed attacks directed at citizens are on the rise. Travelers should keep a vigilant eye in highly populated areas.

Keep your purse, backpack and belongings close to your body when walking during the day as pick-pocketing and and purse-snatching are not uncommon.

Traveling to the Avenue of Baobabs

Avoid an embarrassing stop, over 70% of travelers will have diarrhea., get protected with passport health’s travelers’ diarrhea kit .

Hundreds of Baobabs, which are trees native to Madagascar, line the world-famous Avenue of Baobabs. Living up to 800 years, these trees have given rise to myths and stories.

Located in Morondava, a city on the west coast of the island, travel time can vary. Flying to the city from Antananarivo takes about an hour, while driving can take upwards of 10 hours.

Roads are narrow and winding. If you are planning on renting a car, be wary of sharp curves, cattle and avoid driving at night.

What Should I Take to Madagascar?

Some essential items to consider for your trip to Madagascar include:

  • French/Malagasy to English Dictionary – There are a variety of different dialects in Madagascar, but its official languages are French and Malagasy.
  • Water Purification Tablets – If you have plans on camping or visiting remote areas clean water may be rare. Carry purification tablets and use bottled water to drink, and brush teeth.
  • Lightweight and Sun Protective Clothing – Heat, humidity and sun are abundant in Madagascar. Avoid wearing synthetic fabrics as they can become uncomfortable in the heat. Long pants and long-sleeved tops will protect you not only from the sun, but also from the high supply of mosquitoes present everywhere.
  • Insect Repellent – Mosquitoes feast at night. Apply repellent whether you’re planning to go out on the town, or stay close to your lodging, especially during the country’s wet season.
  • Cash – Credit Cards are accepted throughout the capital at hotels, restaurants and some shops. ATM machines tend to be out of order. Keep some cash in bills smaller than $100.
  • Raincoat – Tropical climate also means plenty of rain. Make sure to pack either a raincoat or umbrella to shield you from wet weather.
  • Headlamp – In many rural areas of Madagascar, there is no electricity. You may find yourself relying on a headlamp or a hand-held lamp to see where you’re going.

U.S. Embassy in Madagascar

All Americans visiting Madagascar should register online with the Smart Traveler Enrollment Program.

If you plan to buy a local SIM card you can also enter your phone number to receive SMS updates from the office.

U.S. Embassy Antananarivo Lot 207 A, Point Liberty Andranoro – Antehiroka 105 Antananarivo Madagascar Tel: (+261) 20 23 480 00 [email protected]

Visit the U.S. Embassy in Madagascar website before your trip to confirm contact details.

The U.S. Department of State also operates a 24 hour Emergency Operations Center. The collect call number to reach the center while abroad is +1-888-407-4747 or +1-202-501-4444.

If you have any questions about traveling to Madagascar or are wondering what shots you may need for your trip, schedule an appointment by calling or book online now .

Customer Reviews

Passport health – travel vaccines for madagascar.

On This Page: Do I Need Vaccines for Madagascar? Is Cholera a Risk in Madagascar? Do I Need a Visa or Passport for Madagascar? What Is the Climate Like in Madagascar? How Safe Is Madagascar? Traveling to the Avenue of Baobabs What Should I Take to Madagascar? U.S. Embassy in Madagascar

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Madagascar Travel Restrictions

Traveler's COVID-19 vaccination status

Traveling from the United States to Madagascar

Open for vaccinated visitors

COVID-19 testing

Not required

Not required for vaccinated visitors

Restaurants

Required in public spaces.

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Can I travel to Madagascar from the United States?

Most visitors from the United States, regardless of vaccination status, can enter Madagascar.

Can I travel to Madagascar if I am vaccinated?

Fully vaccinated visitors from the United States can enter Madagascar without restrictions.

Can I travel to Madagascar without being vaccinated?

Unvaccinated visitors from the United States can enter Madagascar without restrictions.

Do I need a COVID test to enter Madagascar?

Visitors from the United States are not required to present a negative COVID-19 PCR test or antigen result upon entering Madagascar.

Can I travel to Madagascar without quarantine?

Travelers from the United States are not required to quarantine.

Do I need to wear a mask in Madagascar?

Mask usage in Madagascar is required in public spaces.

Are the restaurants and bars open in Madagascar?

Restaurants in Madagascar are open. Bars in Madagascar are .

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Madagascar Vaccination Requirements: Do I need a vaccine to travel to Madagascar?

Travelers don’t need to quarantine on arrival in Madagascar.

Travelers don’t need a negative COVID-19 test result before traveling to Madagascar.

To travel to Madagascar (called “the eighth continent” due to its extensive nature diversity) you will need to comply with certain requirements like a Landing Authorization which you can request through iVisa.com .

Madagascarpix

This Landing Authorization is available for 30 or 60 days. Aside from that, you must have had each vaccine on the list underneath (see Frequently Asked Questions (FAQs)).

Apply now for your Madagascar Landing Authorization .

How to get a travel document with iVisa.com

A Madagascar Landing Authorization will be required as well to have access to Madagascar territory. With the guidance of iVisa.com , you will be able to get this travel document for your trip.

  • Start by filling out the online application.
  • Select a handling speed and make the necessary payment with any of these methods: credit/debit card or PayPal account.
  • Upload a scanned image of your valid passport.
  • Submit it for completion to our expert team.
  • Receive your Landing Authorization in your email.
  • Print it or show it at the airport from your mobile phone or tablet.

Request your Landing Authorization now .

Frequently Asked Questions

Do i need a vaccine to travel to madagascar.

Yes, you will need some vaccine requirements before entering Madagascar. You will also have to apply for a Madagascar Landing Authorization .

What are the vaccine requirements to travel to Madagascar?

Recommended

  • Hepatitis A.
  • Hepatitis B.
  • Rabies (if your tour activities include being close to dogs or wildlife).
  • Yellow fever (if traveling from a place where the virus can be transmitted).
  • Meningitis.
  • Measles Mumps Rubella (MMR) .
  • TDAP (Tetanus, Diphtheria & Pertussis).
  • Chickenpox.

Get your Madagascar Landing Authorization .

What are the areas with a higher risk of Malaria in Madagascar?

All areas, except Antananarivo capital city where there have been isolated cases. So, it is suggested that you talk to your doctor before the travel date to get prescripted antimalarial medication.

Apply here for a Madagascar Landing Authorization .

Is Dengue a threat for travelers in Madagascar?

There is a presence of Dengue mosquitoes in Madagascar but cases are either sporadic and unpredictable.

Click here to request a Madagascar Landing Authorization .

Do I need to take a COVID-19 test to visit Madagascar?

  • COVID test prior to arrival: Pre-departure tests are not required.

Fill out the application for a Madagascar Landing Authorization .

Is it mandatory to quarantine on arrival to Madagascar?

  • Quarantine requirements: There are no quarantine requirements in Madagascar.

Can iVisa.com help me with the entry requirements?

We can help you get the Madagascar Landing Authorization within a few minutes.

What are your processing times and fees for Madagascar Landing Authorization?

iVisa.com has three (3) processing times and fees:

  • ( Standard Processing )
  • ( Rush Processing )
  • ( Super Rush Processing )

Apply today .

Will I need to fetch a lot of documentation for my iVisa.com application?

When you apply for a travel document with iVisa.com, you only need the following items:

  • Passport, with a scan of the information page.
  • A credit or debit card to pay the processing fee.
  • An email address to receive the eVisa. Start the application .

How safe is iVisa.com to get my Madagascar Landing Authorization?

The mission of iVisa.com is to promote an agile and safeguarded service online to permanently protect your personal information. If you read our references section you will notice that you are in the right place to get all your traveling documentation.

Go to iVisa.com’s informational page on Madagascar .

Where can I get more information?

Please get in touch with our customer support team which is 24/7 available for any questions, doubts, or concerns you may have regarding the Madagascar Landing Authorization or any other travel paperwork.

iVisa.com recommends

Madagascar: more than a children’s movie.

Madagascar is considered the biggest island country of Africa and the fourth largest in the world. This jungle land holds six different species of the baobab tree. These can measure between five and thirty meters high and live from 800 to 5000 years. Among its main tourist attractions are:

Ranomafana National Park One of the most popular parks where you can find the golden bamboo lemur.

Masoala National Park It houses three marine parks and ten species of lemur.

Andasibe-Mantadia National Park Close to Antananarivo.

Royal Hill of Ambohimanga A historical village that was the residence of the Madagascar royalty, the surrounding wall was constructed in 1847.

Ifaty An ideal beach for diving, snorkeling, and fishing.

Avenue of the Baobabs A long path of these magnificent trees (between Morondava and Belon’i Tsiribihina).

Nosy Be Small island with fine seafood restaurants that serve dinner on the sand.

Tsingy de Bemaraha Reserve Contains a large extension of mangroves.

Isalo National Park Well-known for its mixed terrain. Tour guide required.

Ile Sainte Marie The skeletons of many pirate ships can be seen from the Baie des Forbans. One of the best sites in Madagascar for diving and snorkeling.

Get ready to travel to Madagascar!

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  • iVisa is NOT affiliated with any government agency. This site does not provide legal advice and we are not a law firm. None of our customer service representatives are lawyers and they also do not provide legal advice. We are a private, internet-based travel and immigration consultancy provider dedicated to helping individuals travel around the world. You may apply by yourself directly on the various government websites. The source of information: https://www.diplomatie.gov.mg/index.php/le-ministere/passeport-et-visa

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Madagascar Travel Advisory

Travel advisory july 31, 2023, madagascar - level 2: exercise increased caution.

Reissued with obsolete COVID-19 page links removed, and updates to crime information in the Tsaratanana, Tsiroanomandidy, Maintirano, and Betroka areas.

Exercise increased caution in Madagascar due to crime and civil unrest.   Some areas have increased risk. Read the entire Travel Advisory.

Reconsider travel to the following areas due to violent crime and banditry:

  • The area in and around the city of Tsaratanana in the Betsiboka Region;
  • The area along the unnamed road connecting the city of Tsiroanomandidy in the Bongolava Region with the coastal city of Maintirano in the Melaky Region; and
  • The area in and around the city of Betroka in the Anosy Region.

Country Summary :  Most criminal activity is non-violent petty theft, pickpocketing, and other crimes of opportunity predominately in urban areas and in crowded markets.  Violent crime, such as armed robbery and assault, occurs throughout Madagascar, particularly after dark, in remote areas, and along major national roads in the south and western areas of the country.

Read the country information page for additional information on travel to Madagascar.

If you decide to travel to Madagascar:

  • Avoid walking alone, especially after dark.
  • Do not travel on the roads between cities after dark. [SJ3]
  • Be aware of your surroundings.  Thefts of items from vehicles is common and may involve ruses or distraction, particularly when stuck in traffic.
  • Stay alert in locations frequented by tourists.
  • Do not display signs of wealth, such as wearing expensive jewelry or watches.
  • Enroll in the Smart Traveler Enrollment Program ( STEP ) to receive Alerts and make it easier to locate you in an emergency.
  • Follow the Department of State on Facebook and Twitter .
  • Review the Country Security Report for Madagascar.
  • U.S. citizens who travel abroad should always have a contingency plan for emergency situations.  Review the Traveler’s Checklist .
  • Visit the CDC page for the latest Travel Health Information related to your travel.   

Mid-Sized Urban Areas   – Level 3: Reconsider Travel

Violent crime, such as armed carjacking, banditry, mugging, home invasion, and kidnapping can occur at any time.  Local police often lack the resources and training to respond effectively to serious criminal incidents in these areas:

Visit our website for  Travel to High-Risk Areas .

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vaccination advice? - Madagascar Forum

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' class=

I will be visiting Madagascar next month, and am trying to decide what vaccinations to take. I have checked the CDC site and got travel recommendations from a travel clinic. Some vaccines are recommended but not required. Thus, I would like to see whether you have some recommendations about them:

(1) Tdap booster: I got my booster in Oct 2016. Another booster is normally due in 10 years. Should I take another booster, just to be safe?

(2) MMR: I got one or two shots in the mid-1990s. I cannot remember whether it was one or two shots. Should I just get another shot now?

(3) Rabies: we will spend 2.5 weeks in the country, visiting typical tourist attractions. How many cases of human rabies infections are there in Madagascar per year? I am trying to decide whether to take the 3-dose series, which is supposedly to last a lifetime, but is very expensive (over $1,000 in the US) and needs to start right away in order to complete the 3 doses before departure if I want to get the shots.

(4) In addition, I will take Oral Typhoid pills and Malaria pills in 2-4 weeks before the start of the trip, as recommended by doctors. I also got my 2nd covid booster yesterday, and had yellow-fever shots 8 years ago.

I hope the combination of (1)-(4) would not lead to some serious side effect.

Any thoughts on this? Thanks.

' class=

(1) Tdap booster:

I would go for it, I would be mainly wanting to be sure my tetanus is up to date, this is a pathogen-rich place and it is so easy to get small scratch or puncture wounds in unsanitary places.

If you were born after 1956 you are supposed to have either one two shots depending on clinical matters that no one here can advise you about, only your doctor knows. Measles is endemic here and there are occasionally really serious outbreaks.

(3) Rabies:

I would not bother unless you plan to be working with animals (like, a veterinarian or something)... I have never heard of a tourist getting rabies.

(4) a.) Oral Typhoid pills:

Really? You just need to have some ciprofloxacin in your luggage, or, you can by it over the counter here it is really cheap.

(4) b.) Malaria pills

It is good, if you are going to take malaria prophylaxis, to start before you leave home, so you can change your medication if you have unpleasant effects.

(4) c.) Covid booster

No one here is going to ask about your vaccine, you do not need to be vaccinated to visit Madagascar, but, for your own health, to be or not to be vaccinated is your personal choice.

(4) d.) yellow-fever

There is no yellow fever in Madagascar and you do not need to be vaccinated unless you are coming from one of the African or South American nations where yellow fever is endemic.

Thanks. Your advice is very helpful.

' class=

I just got back, neither typhoid or yellow fever is needed. I did check my measles and hep A and B titers, which were both good. I took Malarone as a malaria med, and had zero issues. I would recommend taking a round of Flagyl with you, because diarrhea is common when you visit Africa. I had to go to a doc in tana to get an Rx.

This topic has been closed to new posts due to inactivity.

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Travel Vaccinations for Madagascar

Vaccinations, certificate requirements.

Yellow fever vaccination certificate required for travellers aged 9 months or over arriving from countries with risk of yellow fever transmission and for travellers having transited for more than 12 hours through an airport of a country with risk of yellow fever transmission.

How much will it cost?

Recommended for all travellers.

The vaccines in this section are recommended for all travellers visiting the country.

If you have grown up in the UK, you have received a diphtheria vaccine as a part of your childhood vaccination schedule. Before going to Vietnam you should check whether you need a booster for diphtheria - this is the case if it has been over ten years since your last booster.

Hepatitis A is a viral infection which causes an inflammation of the liver. In countries where hep A is prominent, many people catch it as a child. The infection tends to be mild in children but can occasionally cause complications. In adults, however, it can lead to liver damage or even liver failure. Although infection rates appear to be on the decrease, hepatitis A is endemic to Sri Lanka and the vaccination is recommended for all travellers.

The tetanus vaccine - or a booster - is recommended for all travellers who are planning to visit a country where access to medical assistance may be limited. You can get tetanus when tetanus bacteria get into your bloodstream, usually due to injury or a wound. You need a booster if your last tetanus jab was over ten years ago.

Like hepatitis A and typhoid, cholera is a food- and waterborne disease and you need to practise good food hygiene to reduce your risk of cholera. The cholera vaccine may be relevant for travellers going to rural areas as well as areas with poor sanitation. Your nurse or pharmacist will assess your cholera risk based on where you’re travelling to as well as the activities you have planned and make a recommendation as to whether you should have the vaccine.

Why do I need a consultation?

It is difficult to say which vaccines you need without asking a medical professional. Your itinerary, your medical history and the activities you have planned all affect which vaccinations you need. It is important that a trained travel nurse or pharmacist checks what you need.

Exactly the travel vaccinations you need - no more, no less.

During your consultation, our nurse or pharmacist will talk you through the health risks at your travel destinations to check which vaccines you need. If a vaccine is not essential, we will explain your options so you can decide whether you would like to have it.

Malaria is a serious and sometimes fatal disease transmitted by mosquitoes. You cannot be vaccinated against malaria.

Malaria Precautions

  • Malaria risk is high throughout the year in all areas.
  • Malaria precautions are essential .Avoid mosquito bites by covering up with clothing such as long sleeves and long trousers especially after sunset, using insect repellents on exposed skin and, when necessary, sleeping under a mosquito net.
  • Check with your doctor or nurse about suitable antimalarial tablets.
  • See malaria map – additional information can be found by clicking on the Regional Information icon below the map.
  • High risk areas: atovaquone/proguanil OR doxycycline OR mefloquine is usually advised.
  • If you have been travelling in a malarious area and develop a fever seek medical attention promptly. Remember malaria can develop even up to one year after exposure.
  • If travelling to an area remote from medical facilities, carrying standby emergency treatment for malaria may be considered.

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Travel vaccinations

When travelling outside Canada, you may be at risk for a number of vaccine preventable illnesses.

You should consult a health care provider or visit a travel health clinic preferably six weeks before you travel. This is an opportunity to:

  • review your immunization history
  • make sure your provincial/territorial vaccination schedule is up-to-date
  • discuss any trip-related health concerns you may have
  • assess your needs based on where you plan to travel and what you plan to do

You may need additional vaccinations depending on your age, planned travel activities and local conditions. Preventing disease through vaccination is a lifelong process.

Use the reference below to determine which vaccinations may be recommended or required for your destination.

Vaccination recommendations by destination

Yellow fever vaccination.

Some countries require proof that you have received a yellow fever vaccination before allowing you to enter the country. Consult an embassy or consulate of your destination country in Canada for up-to-date information on its entry and exit requirements before you travel abroad.

Other countries may require you to have been vaccinated for yellow fever if you have passed through an area where yellow fever may occur .

Proof of vaccination must be documented on an International Certificate of Vaccination or Prophylaxis . You must carry the original certificate with you.

In Canada, the vaccination is only given at designated yellow fever vaccination centres .

Immunization records

  • Download the free CANImmunize app from the iOS App Store or Google Play, and manage your family’s vaccination records on the go.
  • Carry copies of your family’s immunization records while you travel and leave the originals at home.
  • Sickness or injury
  • Travel Advice and Advisories
  • If you get sick after travelling
  • Receiving medical care in other countries
  • Travel health kit
  • Travel insurance
  • Well on Your Way - A Canadian’s Guide to Healthy Travel Abroad
  • Yellow Fever Vaccination Centres in Canada , Public Health Agency of Canada (PHAC)
  • Recommended Immunization Schedules , PHAC

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  • Section 2 - Vaccination & Immunoprophylaxis— General Principles
  • Section 2 - Yellow Fever Vaccine & Malaria Prevention Information, by Country

Interactions Between Travel Vaccines & Drugs

Cdc yellow book 2024.

Author(s): Ilan Youngster, Elizabeth Barnett

Vaccine–Vaccine Interactions

Travel vaccines & drugs, antimalarial drugs, drugs used for travel to high elevations, hiv medications, herbal & nutritional supplements.

During pretravel consultations, travel health providers must consider potential interactions between vaccines and medications, including those already taken by the traveler. A study by S. Steinlauf et al. identified potential drug–drug interactions with travel-related medications in 45% of travelers taking medications for chronic conditions; 3.5% of these interactions were potentially serious.

Most common vaccines can be given safely and effectively at the same visit, at separate injection sites, without impairing antibody response or increasing rates of adverse reactions. However, certain vaccines, including pneumococcal and meningococcal vaccines and live virus vaccines, require appropriate spacing; further information about vaccine–vaccine interactions is found in Sec. 2, Ch. 3, Vaccination & Immunoprophylaxis—General Principles .

Live Attenuated Oral Typhoid & Cholera Vaccines

Live attenuated vaccines generally should be avoided in immunocompromised travelers, including those taking antimetabolites, calcineurin inhibitors, cytotoxic agents, immunomodulators, and high-dose steroids (see Table 3-04 ).

Chloroquine and atovaquone-proguanil at doses used for malaria chemoprophylaxis can be given concurrently with oral typhoid vaccine. Data from an older formulation of the CVD 103-HgR oral cholera vaccine suggest that the immune response to the vaccine might be diminished when given concomitantly with chloroquine. Administer live attenuated oral cholera vaccine ≥10 days before beginning antimalarial prophylaxis with chloroquine. A study in children using oral cholera vaccine suggested no decrease in immunogenicity when given with atovaquone-proguanil.

Antimicrobial Agents

Antimicrobial agents can be active against the vaccine strains in the oral typhoid and cholera vaccines and might prevent adequate immune response to these vaccines. Therefore, delay vaccination with oral typhoid vaccine by >72 hours and delay oral cholera vaccine by >14 days after administration of antimicrobial agents. Parenteral typhoid vaccine is an alternative to the oral typhoid vaccine for travelers who have recently received antibiotics.

Rabies Vaccine

Concomitant use of chloroquine can reduce the antibody response to intradermal rabies vaccine administered as a preexposure vaccination. Use the intramuscular route for people taking chloroquine concurrently. Intradermal administration of rabies vaccine is not currently approved for use in the United States (see Sec. 5, Part 2, Ch. 19, . . . perspectives: Rabies Immunization ).

Any time a new medication is prescribed, including antimalarial drugs, check for known or possible drug interactions (see Table 2-05 ) and inform the traveler of potential risks. Online clinical decision support tools (e.g., Micromedex) provide searchable databases of drug interactions.

Atovaquone-Proguanil

Antibiotics.

Rifabutin, rifampin, and tetracycline might reduce plasma concentrations of atovaquone and should not be used concurrently with atovaquone-proguanil.

  • Anticoagulants

Patients on warfarin might need to reduce their anticoagulant dose or monitor their prothrombin time more closely while taking atovaquone-proguanil, although coadministration of these drugs is not contraindicated. The use of novel oral anticoagulants, including dabigatran, rivaroxaban, and apixaban, is not expected to cause significant interactions, and their use has been suggested as an alternative for patients in need of anticoagulation.

Antiemetics

Metoclopramide can reduce bioavailability of atovaquone; unless no other antiemetics are available, this antiemetic should not be used to treat vomiting associated with the use of atovaquone at treatment doses.

Antihistamines

Travelers taking atovaquone-proguanil for malaria prophylaxis should avoid using cimetidine (an H2 receptor antagonist) because this medication interferes with proguanil metabolism.

Atovaquone-proguanil might interact with the antiretroviral protease inhibitors atazanavir, darunavir, indinavir, lopinavir, and ritonavir, or the nonnucleoside reverse transcriptase inhibitors (NNRTIs) efavirenz, etravirine, and nevirapine, resulting in decreased levels of atovaquone-proguanil. For travelers taking any of these medications, consider alternative malaria chemoprophylaxis .

Selective Serotonin Reuptake Inhibitors

Fluvoxamine interferes with the metabolism of proguanil; consider an alternative antimalarial prophylaxis to atovaquone-proguanil for travelers taking this selective serotonin reuptake inhibitor (SSRI).

Chloroquine

Antacids & Antidiarrheals

Chloroquine absorption might be reduced by antacids or kaolin; travelers should wait ≥4 hours between doses of these medications.

Chloroquine inhibits bioavailability of ampicillin, and travelers should wait ≥2 hours between doses of these medications. Chloroquine should not be coadministered with either clarithromycin or erythromycin; azithromycin is a suggested alternative . Chloroquine also reportedly decreases the bioavailability of ciprofloxacin.

Concomitant use of cimetidine and chloroquine should be avoided because cimetidine can inhibit the metabolism of chloroquine and increase drug levels.

CYP2D6 Enzyme Substrates

Chloroquine is a CYP2D6 enzyme inhibitor. Monitor patients taking chloroquine concomitantly with other substrates of this enzyme (e.g., flecainide, fluoxetine, metoprolol, paroxetine, propranolol) for side effects.

CYP3A4 Enzyme Inhibitors

CYP3A4 inhibitors (e.g., erythromycin, ketoconazole, ritonavir) can increase chloroquine levels; concomitant use should be avoided.

Chloroquine can increase digoxin levels; additional monitoring is warranted.

Immunosuppressants

Chloroquine decreases the bioavailability of methotrexate. Chloroquine also can cause increased levels of calcineurin inhibitors; use caution when prescribing chloroquine to travelers taking these agents.

QT-Prolonging Agents

Avoid prescribing chloroquine to anyone taking other QT-prolonging agents (e.g., amiodarone, lumefantrine, sotalol); when taken in combination, chloroquine might increase the risk for prolonged QTc interval. In addition, the antiretroviral rilpivirine has also been shown to prolong QTc, and clinicians should avoid coadministration with chloroquine.

Doxycycline

Antacids, Bismuth Subsalicylate, Iron

Absorption of tetracyclines might be impaired by aluminum-, calcium-, or magnesium-containing antacids, bismuth subsalicylate, and preparations containing iron; advise patients not to take these preparations within 3 hours of taking doxycycline.

Doxycycline can interfere with the bactericidal activity of penicillin; thus, in general, clinicians should not prescribe these drugs together. Coadministration of doxycycline with rifabutin or rifampin can lower doxycycline levels; monitor doxycycline efficacy closely or consider alternative therapy.

Patients on warfarin might need to reduce their anticoagulant dose while taking doxycycline because of its ability to depress plasma prothrombin activity.

Anticonvulsants

Barbiturates, carbamazepine, and phenytoin can decrease the half-life of doxycycline.

Antiretrovirals

Doxycycline has no known interaction with antiretroviral agents.

Concurrent use of doxycycline and calcineurin inhibitors or mTOR inhibitors (sirolimus) can cause increased levels of these immunosuppressant drugs.

Mefloquine can interact with several categories of drugs, including anticonvulsants, other antimalarial drugs, and drugs that alter cardiac conduction.

Mefloquine can lower plasma levels of several anticonvulsant medications, including carbamazepine, phenobarbital, phenytoin, and valproic acid; avoid concurrent use of mefloquine with these agents.

Mefloquine is associated with increased toxicities of the antimalarial drug lumefantrine, which is available in the United States in fixed combination to treat people with uncomplicated Plasmodium falciparum malaria. The combination of mefloquine and lumefantrine can cause potentially fatal QTc interval prolongation. Lumefantrine should therefore be avoided or used with caution in patients taking mefloquine prophylaxis.

CYP3A4 Enzyme Inducers

CYP3A4 inducers include medications used to treat HIV or HIV-associated infections (e.g., efavirenz, etravirine, nevirapine, rifabutin) and tuberculosis (rifampin). St. John’s wort and glucocorticoids are also CYP3A4 inducers. All these drugs (rifabutin and rifampin, in particular) can decrease plasma concentrations of mefloquine, thereby reducing its efficacy as an antimalarial drug.

Potent CYP3A4 inhibitors (e.g., antiretroviral protease inhibitors, atazanavir, cobicistat [available in combination with elvitegravir], darunavir, lopinavir, ritonavir, saquinavir); azole antifungals (itraconazole, ketoconazole, posaconazole, voriconazole); macrolide antibiotics (azithromycin, clarithromycin, erythromycin); and SSRIs (fluoxetine, fluvoxamine, sertraline), can increase levels of mefloquine and thus increase the risk for QT prolongation.

Although no conclusive data are available regarding coadministration of mefloquine and other drugs that can affect cardiac conduction, avoid mefloquine use, or use it with caution, in patients taking antiarrhythmic or β-blocking agents, antihistamines (H1 receptor antagonists), calcium channel receptor antagonists, phenothiazines, SSRIs, or tricyclic antidepressants.

Concomitant use of mefloquine can cause increased levels of calcineurin inhibitors and mTOR inhibitors (cyclosporine A, sirolimus, tacrolimus).

Anti-Hepatitis C Virus Protease Inhibitors

Avoid concurrent use of mefloquine and direct-acting protease inhibitors (boceprevir and telaprevir) used to treat hepatitis C. Newer direct-acting protease inhibitors (grazoprevir, paritaprevir, simeprevir) are believed to be associated with fewer drug–drug interactions, but safety data are lacking; consider alternatives to mefloquine pending additional data.

Psychiatric Medications

Avoid prescribing mefloquine to travelers with a history of mood disorders or psychiatric disease; this information is included in the US Food and Drug Administration boxed warning for mefloquine.

Table 2-05 Drugs & drug classes that can interact with selected antimalarials

ANTIMALARIALS

DRUGS & DRUG CLASSES THAT CAN INTERACT

Atovaquone- proguanil

  • Fluvoxamine
  • Metoclopromide
  • Tetracycline
  • Calcineurin inhibitors
  • Ciprofloxacin
  • CYP2D6 enzyme substrates 1
  • CYP3A4 enzyme inhibitors 2
  • Methotrexate
  • QT- prolonging agents 3
  • Bismuth subsalicylate
  • Barbiturates
  • Carbamazepine
  • Iron- containing preparations
  • mTOR inhibitors
  • Antiarrhythmic agents
  • Beta blockers
  • Calcium channel receptor antagonists
  • CYP3A4 enzyme inducers 4
  • H1 receptor antagonists
  • Lumefantrine
  • Phenothiazines
  • Protease inhibitors
  • Tricyclic antidepressants

1 Examples include flecainide, fluoxetine, metoprolol, paroxetine, and propranolol.

2 Examples include antiretroviral protease inhibitors (e.g., atazanavir, darunavir, lopinavir, ritonavir, saquinavir); azole antifungals (e.g., itraconazole, ketoconazole, posaconazole, voriconazole); macrolide antibiotics (e.g., azithromycin, clarithromycin, erythromycin); selective serotonin reuptake inhibitors (SSRIs; e.g., fluoxetine, fluvoxamine, sertraline); and cobicistat.

3 Examples include amiodarone, lumefantrine, and sotalol.

4 Examples include efavirenz, etravirine, nevirapine, rifabutin, rifampin, and glucocorticoids.

Drugs Used to Treat Travelers’ Diarrhea

Antimicrobials commonly prescribed as treatment for travelers’ diarrhea have the potential for interacting with several different classes of drugs ( Table 2-06 ). As mentioned previously, online clinical decision support tools provide searchable databases that can help identify interactions with medications a person may already be taking.

Azithromycin

Increased anticoagulant effects have been noted when azithromycin is used with warfarin; monitor prothrombin time for people taking these drugs concomitantly.

Because additive QTc prolongation can occur when azithromycin is used with the antimalarial artemether, avoid concomitant therapy.

Drug interactions have been reported with the macrolide antibiotics, clarithromycin and erythromycin; antiretroviral protease inhibitors; and the NNRTIs, efavirenz and nevirapine. Concomitant use of azithromycin and these drugs can increase the risk of QTc prolongation, but a short treatment course is not contraindicated for those without an underlying cardiac abnormality. When azithromycin is used with the protease inhibitor nelfinavir, advise patients about possible drug interactions.

Concurrent use of macrolides with calcineurin inhibitors can cause increased levels of drugs belonging to this class of immunosuppressants.

Fluoroquinolones

Concurrent administration of ciprofloxacin and antacids that contain magnesium or aluminum hydroxide can reduce bioavailability of ciprofloxacin.

An increase in the international normalized ratio (INR) has been reported when levofloxacin and warfarin are used concurrently.

Asthma Medication

Ciprofloxacin decreases clearance of theophylline and caffeine; clinicians should monitor theophylline levels when ciprofloxacin is used concurrently.

Immunosuppresants

Fluoroquinolones can increase levels of calcineurin inhibitors, and doses should be adjusted for renal function.

Sildenafil should not be used by patients taking ciprofloxacin; concomitant use is associated with increased rates of adverse effects. Ciprofloxacin and other fluoroquinolones should not be used in patients taking tizanidine.

Rifamycin SV

No clinical drug interactions have been studied. Because of minimal systemic rifamycin concentrations observed after the recommended dose, clinically relevant drug interactions are not expected.

Rifaximin is not absorbed in appreciable amounts by intact bowel, and no clinically significant drug interactions have been reported to date with rifaximin except for minor changes in INR when used concurrently with warfarin.

Table 2-06 Drugs & drug classes that can interact with selected antibiotics

ANTIBIOTICS

  • HIV medications
  • Antacids containing magnesium or aluminum hydroxide
  • Theophylline

No clinical drug interactions have been studied; none are expected

Before prescribing the carbonic anhydrase inhibitor, acetazolamide, to those planning high elevation travel, carefully review with them the complete list of medications they are already taking ( Table 2-07 ).

Acetazolamide

Acetaminophen & Diclofenac Sodium

Acetaminophen and diclofenac sodium form complex bonds with acetazolamide in the stomach’s acidic environment, impairing absorption. Neither agent should be taken within 30 minutes of acetazolamide. Patients taking acetazolamide also can experience decreased excretion of anticholinergics, dextroamphetamine, ephedrine, mecamylamine, mexiletine, and quinidine.

Acetazolamide should not be given to patients taking the anticonvulsant topiramate because concurrent use is associated with toxicity.

Barbiturates & Salicylates

Acetazolamide causes alkaline urine, which can increase the rate of excretion of barbiturates and salicylates and could cause salicylate toxicity, particularly in patients taking a high dose of aspirin.

  • Corticosteroids

Hypokalemia caused by corticosteroids could occur when used concurrently with acetazolamide.

Diabetes Medications

Use caution when concurrently administering metformin and acetazolamide because of increased risk for lactic acidosis.

Monitor cyclosporine, sirolimus, and tacrolimus more closely when given with acetazolamide.

Dexamethasone

Using dexamethasone to treat altitude illness can be lifesaving. Dexamethasone interacts with several classes of drugs, however, including: anticholinesterases, anticoagulants, digitalis preparations, hypoglycemic agents, isoniazid, macrolide antibiotics, oral contraceptives, and phenytoin.

Table 2-07 Drugs & drug classes that can interact with selected altitude illness drugs

ALTITUDE ILLNESS DRUG

  • Acetaminophen
  • Anticholinergics
  • Aspirin, high dose
  • Dextroamphetamine
  • Diclofenac sodium
  • Mecamylamine
  • Anticholinesterases
  • Digitalis preparations
  • Hypoglycemic agents
  • Macrolide antibiotics
  • Oral contraceptives

Patients with HIV require additional consideration in the pretravel consultation (see Sec. 3, Ch. 1, Immunocompromised Travelers ). A study from Europe showed that ≤29% of HIV-positive travelers disclose their disease and medication status when seeking pretravel advice. Antiretroviral medications have multiple drug interactions, especially through their activation or inhibition of the CYP3A4 and CYP2D6 enzymes.

Several instances of antimalarial prophylaxis and treatment failure in patients taking protease inhibitors and both nucleoside and NNRTIs have been reported. By contrast, entry and integrase inhibitors are not a common cause of drug–drug interactions with commonly administered travel-related medications. Several potential interactions are listed above, and 2 excellent resources for HIV medication interactions can be found at  HIV Drug Interactions and HIV.gov . HIV preexposure prophylaxis with emtricitabine/tenofovir is not a contraindication for any of the commonly used travel-related medications.

Up to 30% of travelers take herbal or nutritional supplements. Many travelers consider them to be of no clinical relevance and might not disclose their use unless specifically asked during the pretravel consultation. Clinicians should give special attention to supplements that activate or inhibit CYP2D6 or CYP3A4 enzymes (e.g., ginseng, grapefruit extract, hypericum, St. John’s wort). Advise patients against coadministration of herbal and nutritional supplements with medications that are substrates for CYP2D6 or 3A4 enzymes, including chloroquine, macrolides, and mefloquine.

The following authors contributed to the previous version of this chapter: Ilan Youngster, Elizabeth D. Barnett

Bibliography

Frenck RW Jr., Gurtman A, Rubino J, Smith W, van Cleeff M, Jayawardene D, et al. Randomized, controlled trial of a 13-valent pneumococcal conjugate vaccine administered concomitantly with an influenza vaccine in healthy adults. Clin Vaccine Immunol. 2012;19(8):1296–303.

Jabeen E, Qureshi R, Shah A. Interaction of antihypertensive acetazolamide with nonsteroidal anti-inflammatory drugs. J Photochem Photobiol B. 2013;125:155–63.

Kollaritsch H, Que JU, Kunz C, Wiedermann G, Herzog C, Cryz SJ Jr. Safety and immunogenicity of live oral cholera and typhoid vaccines administered alone or in combination with antimalarial drugs, oral polio vaccine, or yellow fever vaccine. J Infect Dis. 1997;175(4):871–5.

Nascimento Silva JR, Camacho LA, Siqueira MM, Freire Mde S, Castro YP, Maia Mde L, et al. Mutual interference on the immune response to yellow fever vaccine and a combined vaccine against measles, mumps and rubella. Vaccine. 2011;29(37):6327–34.

Nielsen US, Jensen-Fangel S, Pedersen G, Lohse N, Pedersen C, Kronborg G, et al. Travelling with HIV: a cross sectional analysis of Danish HIV-infected patients. Travel Med Infect Dis. 2014;12(1):72–8.

Ridtitid W, Wongnawa M, Mahatthanatrakul W, Raungsri N, Sunbhanich M. Ketoconazole increases plasma concentrations of antimalarial mefloquine in healthy human volunteers. J Clin Pharm Ther. 2005;30(3):285–90.

Sbaih N, Buss B, Goyal D, Rao SR, Benefield R, Walker AT, et al. Potentially serious drug interactions resulting from the pre-travel health encounter. Open Forum Infect Dis. 2018;5(11):ofy266.

Stienlauf S, Meltzer E, Kurnik D, Leshem E, Kopel E, Streltsin B, et al. Potential drug interactions in travelers with chronic illnesses: a large retrospective cohort study. Travel Med Infect Dis. 2014;12(5):499–504.

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Travel safely to Mozambique with Passport Health's travel vaccinations and advice.

Travel Vaccines and Advice for Mozambique

Passport Health offers a variety of options for travellers throughout the world.

Mozambique is one of the fastest growing African holiday destinations. It is home to beautiful stretches of white sand seasides and pristine turquoise water. The waters are home to diverse marine animals and coral reefs.

The tropical climate makes it an ideal winter getaway. Besides marine activities, there are safari’s and historical monuments to explore. Mozambique offers travellers seeking an adventure plenty of opportunity to find one.

Do I Need Vaccines for Mozambique?

Yes, some vaccines are recommended or required for Mozambique. The National Travel Health Network and Centre and WHO recommend the following vaccinations for Mozambique: COVID-19 , hepatitis A , hepatitis B , typhoid , cholera , yellow fever , rabies , polio and tetanus .

See the bullets below to learn more about some of these key immunisations:

  • COVID-19 – Airborne – Recommended for all travellers
  • Hepatitis A – Food & Water – Recommended for most travellers to the region, especially if unvaccinated.
  • Hepatitis B – Blood & Body Fluids – Recommended for travellers to most regions.
  • Tetanus – Wounds or Breaks in Skin – Recommended for travelers to most regions, especially if not previously vaccinated.
  • Typhoid – Food & Water – Jab lasts 3 years. Oral vaccine lasts 5 years, must be able to swallow pills. Oral doses must be kept in refrigerator.
  • Cholera – Food & Water – Areas of active transmission include Cabo Delgado and Nampula.
  • Yellow Fever – Mosquito – Required if travelling from a country with risk of yellow fever transmission.
  • Rabies – Saliva of Infected Animals – High risk country. Vaccine recommended for long-stay travellers and those who may come in contact with animals.
  • Polio – Food & Water – Considered a routine vaccination for most travel itineraries. Single adult booster recommended.

See the tables below for more information:

Antimalarial medication is recommended to travellers visiting Mozambique. The must be taken before, during and after your trip. Dengue and chikungunya are also present and can be prevented through use of mosquito repellents and netting.

Traveller’s diarrhoea can easily ruin a trip. Be sure to bring a traveller’s diarrhoea kit with you to avoid this embarrassing symptom.

Visit our vaccinations page to learn more. Travel safely with Passport Health and schedule your appointment today by calling or book online now .

Do I Need a Visa or Passport for Mozambique?

A visa is required for all travel to Mozambique. Passports must have at least six months validity. Proof of yellow fever vaccination is required to enter the country. If you do not have proof of vaccination, you may be vaccinated on site, quarantined or returned to your previous location.

Sources: Embassy of Mozambique and GOV.UK

What is the Climate Like in Mozambique?

Mozambique is known for its warm and tropical climate. Temperatures along the coast remain sunny and warm even in the winter. From October to April, the weather is very hot, humid, and rainy. Whereas, from June to October the weather is cool and dry.

How Safe is Mozambique?

It is important to exercise a high degree of caution whilst travelling in Mozambique.

In 2015, the country was declared free of all known land mines. But, some could still remain in rural areas.

It is dangerous to travel outside the city after dark. Mugging is prevalent. Pedestrians have been mugged at all hours of the day. Avoid walking alone in isolated or wooded areas as these are common places for crimes to occur.

Bazaruto Archipelago

The Bazaruto Archipelago consists of six islands off the coast of Mozambique. These islands are known for their stretches of white sand seasides and beautiful turquoise waters. Beneath the water lies beautiful coral reefs that rare marine animals call home.

A diverse array of animals found only in Bazaruto, like the rare dugong.

Visitors to the Bazaruto Archipelago can partake in a variety of outdoor activities such as scuba diving, fishing, and sailing. To limit environmental damage, visitors must stay in one of the several private lodges on the island. The Bazaruto Archipelago is the perfect Indian Ocean adventure.

What Should I Pack for Mozambique?

Mozambique is a beautiful destination. But, it does require some extra preparation. See what you should ensure is in your luggage:

  • Mosquitoes are a problem in Mozambique and repellent should always be worn, especially after sunset.
  • Extra memory cards and batteries for your camera as these can be difficult to find whilst travelling.
  • Avoid wearing blue or black clothing. The tsetse flies are attracted to these colors.
  • Consider bringing a headlamp. Power outages are not uncommon in Mozambique.
  • Lightweight clothing that is suitable for hot weather.
  • Water can be expensive and drinking the tap water is not encouraged. Consider bringing a water filter or iodine tablets.

Embassy of the United Kingdom in Mozambique

If you are in Mozambique and have an emergency (for example, been attacked, arrested or someone has died) contact the nearest consular services. Contact the embassy before arrival if you have additional questions on entry requirements, safety concerns or are in need of assistance.

British High Commission Maputo Avenida Vladmir Lenine, 310 Maputo City Maputo P.O. Box 55 Mozambique Telephone: + 258 84 341 3620 ; + 258 84 341 3621 Emergency Phone: +258 21 35 60 00 Fax: +258 21 35 60 60 Email: [email protected]

Stay safe abroad with Passport Health. Ring or book online now and start travelling safely today!

On This Page: Do I Need Vaccines for Mozambique? Do I Need a Visa or Passport for Mozambique? What is the Climate Like in Mozambique? How Safe is Mozambique? Bazaruto Archipelago What Should I Pack To Mozambique? Embassy of the United Kingdom in Mozambique

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madagascar travel shots

A former Boeing employee who spoke out about safety concerns with the company's aircraft production was found dead in his car over the weekend in Charleston, South Carolina, according to officials and multiple reports.

John Barnett was found dead Saturday with what appeared to be a self-inflicted gunshot wound, the Charleston County Coroner's Office said. The 62-year-old was a quality manager who worked with Boeing for over 30 years before he retired in 2017, news outlets including the New York Times and BBC reported.

Barnett was in Charleston for legal interviews related to a case against Boeing, per the BBC , which spoke with Barnett's lawyer. He gave a formal deposition last week and was questioned by Boeing's lawyers, and then cross-examined by his lawyer.

When he didn't show up for further questioning on Saturday, authorities searched for him at his hotel. He was then found dead in his truck in the hotel parking lot, the BBC reported.

In a statement to USA TODAY, Boeing said it was “saddened by Mr. Barnett’s passing, and our thoughts are with his family and friends."

The Charleston City Police Department is investigating.

Whistleblower raised safety concerns in 2019

Barnett was one of several whistleblowers who raised concerns over quality control and safety at a Boeing production plant in South Carolina in 2019 articles published by the BBC and New York Times.

At that time, Barnett said he had concerns that safety was being compromised when workers were under pressure and rushing to get 787 Dreamliner jets ready.

Some of the concerns he raised include finding clusters of metal shavings left near electrical systems for flight controls which he said could lead to "catastrophic" results, and discovering serious problems with oxygen systems of the 787 Dreamliner.

He said that the issue with oxygen systems could mean 25% of breathing masks won't work in an emergency.

Barnett who began working at the South Carolina plant in 2010 as a quality manager, said he repeatedly raised concerns about his findings to his supervisors but was never listened to and was instead transferred to another plant, the BBC reported.

If you or someone you know may be struggling with suicidal thoughts, you can call  988  any time day or night, or chat online.   Crisis Text Line also provides free, 24/7, confidential support via text message to people in crisis when they dial 741741.

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