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Last checked: October 2026.
Zanzibar is a healthy place to spend a week if you prepare for three things: mosquitoes, sun and water. None of them is unusual for the tropics, but the island's reputation as a soft beach finish to a safari tempts people into treating it more casually than the Serengeti. The mosquitoes do not know the difference. What follows is what the travel-health sources say, and what to raise with a clinic before you fly.
The detail
Malaria. Zanzibar sits well below the 1,800-metre line above which CDC and TravelHealthPro no longer map malaria risk in Tanzania, and the parasite here is primarily Plasmodium falciparum, the dangerous kind. A long elimination programme brought the island close to elimination in the 2010s, which is why older guidebooks sound relaxed. That has changed: the November 2023 to March 2024 epidemic alone counted 23,569 confirmed cases over 21 weeks, according to a 2025 analysis in Malaria Journal, and the cases clustered in the urban south-west of Unguja. The Zanzibar government's plan aims to end malaria by 2029, which is why the picture is changing quickly. CDC and TravelHealthPro both recommend antimalarial tablets for the whole of Tanzania below 1,800 metres, Zanzibar included. The usual options are atovaquone-proguanil, doxycycline or mefloquine, with tafenoquine also listed by CDC; which suits you depends on your health, your other medicines and how long you are away, and that is a clinician's decision. Whatever you take, the first line is not getting bitten: long sleeves at dusk, a repellent with DEET or picaridin, and a net or a screened room.
Yellow fever, by routing. Tanzania requires a yellow fever vaccination certificate from travellers aged one and over who arrive from a country with risk of transmission, or who have spent more than twelve hours in transit in one. Tanzania itself is not on the WHO risk list. Tanzania's published list names Ethiopia, and secondary guides also name Kenya and Uganda. Rwanda is not on Tanzania's published list, although one operator's guidance does include it, so carry proof of vaccination if your clinic recommends it. Check the current list with the Tanzanian high commission before you travel. Where it applies, the certificate is checked on arrival; without it you can be refused entry or vaccinated and observed. The vaccine must be given at least ten days before arrival.
| Where you fly in from | Certificate needed? |
|---|---|
| Europe, the UK or the US, direct or via Doha or Istanbul | No |
| Via Addis Ababa, connection of twelve hours or less | No, provided the connection stays under twelve hours |
| Via Addis Ababa for longer, or after time in Ethiopia | Yes |
| After a safari or stay in Kenya or Uganda | Yes |
| A Nairobi connection of twelve hours or less, staying airside | Usually no; sources disagree on airside transits, so ask your clinic — see our Nairobi–Zanzibar guide |
| After gorilla trekking in Rwanda | Rwanda is not on Tanzania's published list; ask your clinic about the full routing |
| From mainland Tanzania | No |
Other vaccinations. TravelHealthPro recommends hepatitis A for all previously unvaccinated travellers and typhoid for most; hepatitis B, rabies and cholera are considered according to the length and nature of your stay. Dengue is present, and the dengue vaccine is offered only to some people who have had it before, which is one more reason to avoid bites by day as well as by night.
Water and food. Drink boiled, filtered or bottled water rather than tap water, and be wary of ice away from hotels. Zanzibar's food — grilled seafood at Forodhani, urojo soup, pilau — is one of the joys of the island and we would not have you miss it: choose stalls that are busy and cook to order, eat seafood hot, and be sensible about salads and cut fruit from street vendors. An oral rehydration sachet is worth more than most of the pharmacy.
Sun and sea. The island sits about six degrees south of the equator, and the glare off white sand and water adds to an already strong sun. Burns happen on the dhow, on the reef and in the first hour on the beach after a safari spent under a canopy roof. A hat, a rash vest for snorkelling and midday shade are not fussing. At low tide the exposed reef hides sea urchins and sharp coral, so wear reef shoes and keep to the sand channels. In the reef's own interest, never stand on or touch coral, and never chase, touch or feed a turtle in the water; our reef conservation story explains why the marine areas around Mnemba are protected.
If something goes wrong. Stone Town has the Tasakhtaa Global Hospital, a private hospital open since 2015 with 24-hour emergency doctors, a CT scanner and surgery; Mnazi Mmoja is the government referral hospital and is being upgraded. Both are in Stone Town, a long drive from the north and east coasts. For serious cases, evacuation by air, usually to Nairobi or Dar es Salaam, is the usual route, so make sure your own policy covers medical evacuation. The insurance terms that apply to you are in our mandatory insurance guide.
Key facts
Malaria: present year-round across the island; antimalarials recommended by CDC and TravelHealthPro; mainly P. falciparum; 23,569 confirmed cases in the November 2023–March 2024 epidemic. Yellow fever: certificate required if arriving from, or transiting more than 12 hours in, a risk country (Ethiopia is on Tanzania's published list; Kenya and Uganda are named by secondary guides; Rwanda is not on that list; your routing decides it); not for direct arrivals from Europe or the US. Clinic: at least four to six weeks before travel. Usual vaccines to discuss: hepatitis A, typhoid; hepatitis B, rabies, cholera case by case. Dengue: present. Water: boiled, filtered or bottled. Hospitals: Tasakhtaa Global (private, 24h), Mnazi Mmoja (public), both Stone Town. Evacuation: by air to Nairobi or Dar es Salaam.
Planning it with Nobu
A tailored journey includes the dull paperwork, and the health rules are where a safari-then-island routing needs the most care. We review your routing and dates against the current rules, and flag where your clinic needs to know the full itinerary. See Travel with confidence.
Is it right for you?
Zanzibar is right for almost everyone willing to take malaria seriously. If you are pregnant, travelling with a baby or small child, immunosuppressed, or on medicines that interact with antimalarials, speak to a clinic before you commit to dates rather than after; some travellers are advised against malaria areas altogether, and we will not pretend otherwise. If a clinic has advised against tablets for you, tell us, and we will talk through the alternatives — including whether a different destination suits you better this year.
Journeys to consider
- Shores of Zanzibar — the shorter island journey: Stone Town and the coast. → Shores of Zanzibar journey
- Southern Safari & Spice — a Tanzania safari followed by Zanzibar. → Southern Safari & Spice journey
- Gorillas and Zanzibar — the routing where the yellow fever question needs a closer look. → Gorillas and Zanzibar journey