Malaria prophylaxis
The ABC of Malaria
Be
Aware of the malaria risk. No prophylaxis is totally effective. Malaria must be considered in anyone with a fever who has visited an endemic area within the last year.Avoid being
BittenTake appropriate
Chemoprophylaxis for one week before travel (2 1/2 weeks in the case of mefloquine), while abroad, and for four weeks after travel.Appropriate chemoprophylaxis is given below. Note: even if every precaution is taken, malaria is still a possibility. No protection can be 100% effective.
Therefore any fever or 'flu-like illness within a year of overseas travel (and especially within the first three months) could be malaria and needs IMMEDIATE medical attention.
|
Destination |
Recommended regimen |
Alternative regimen |
Destination |
Recommended regimen |
Alternative regimen |
|
Abu Dhabi |
W |
|
Libya |
W |
|
|
Afghanistan |
PC |
« |
Madagascar |
ME or DO or MON |
PC |
|
Algeria |
W |
|
Malawi |
ME or DO or MON |
PC |
|
Angola |
ME or DO or MON |
|
Malaysia Sabah Deep forests of peninsular Malaysia Sarawak and elsewhere in Malaysia |
ME or DO or MON PC W |
PC |
|
Argentina small area NW only |
C |
P |
Mali |
ME or DO or MON |
PC |
|
Armenia |
C |
« |
Mauritania |
PC |
DRF |
|
Azerbaijan south border |
C |
P |
Mauritius rural areas Elsewhere |
C W |
P |
|
Bali |
W |
|
Mayotte |
ME or DO or MON |
PC |
|
Bangladesh East and Chittagong Hill Tracts Elsewhere (no risk in Dhaka City) |
ME or DO or MON PC |
« « |
Mexico Main tourist areas Rural areas rarely visited by tourists |
W C |
P |
|
Belize rural |
C |
P |
Morocco |
W |
|
|
Benin Republic |
ME or DO or MON |
PC |
Mozambique |
ME or DO or MON |
PC |
|
Bhutan |
PC |
« |
Myanmar (Burma) |
ME or DO or MON |
PC |
|
Bolivia Amazon Basin Other rural below 1500m |
ME or DO or MON PC |
PC DRF |
Namibia |
PC |
MPM |
|
Botswana northern half November-June |
PC |
DRF |
Nepal below 1300m (no risk in Kathmandu) |
PC |
« |
|
Brazil Amazon basin, Mato Grosso & Maranhao Elsewhere in Brazil |
ME or DO or MON W |
PC |
Nicaragua |
C |
P |
|
Burkina Faso |
ME or DO or MON |
PC |
Niger |
ME or DO or MON |
PC |
|
Burundi |
ME or DO or MON |
PC |
Nigeria |
ME or DO or MON |
PC |
|
Cambodia Phnom Penh Western Provinces Elsewhere |
W DO ME or DO or MON |
« « |
Oman (Rural areas only) |
PC |
« |
|
Cameroon |
ME or DO or MON |
PC |
Pakistan below 2000m |
PC |
« |
|
Cape Verde Islands |
W |
|
Panama East of Canal West of Canal |
PC C |
DRF P |
|
Central African Republic |
ME or DO or MON |
PC |
Papua New Guinea |
DO |
ME |
|
Chad |
ME or DO or MON |
PC |
Paraguay rural only October - May |
C |
P |
|
China Main tourist areas Yunnan and Hainan Remote rural areas |
W ME or DO or MON C |
PC P |
Peru below 1500m |
PC |
DRF |
|
Colombia below 800m |
ME or DO or MON |
PC |
Philippines rural areas below 600m Cebu, Leyte, Bohol, Catanduanes |
PC W |
DRF |
|
Comoros |
ME or DO or MON |
PC |
Rwanda |
ME or DO or MON |
PC |
|
Congo |
ME or DO or MON |
PC |
Sabah |
ME or DO or MON |
PC |
|
Congo Dem. Rep |
ME or DO or MON |
PC |
Sao Tome & Principe |
ME or DO or MON |
PC |
|
Costa Rica rural below 700m |
C |
P |
Saudi Arabia (no risk N, E, central provinces, Asir) Western border cities Elsewhere |
W W PC |
« |
|
Djibouti |
ME or DO or MON |
PC |
Senegal |
ME or DO or MON |
PC |
|
Dominican Republic |
C |
P |
Sierra Leone |
ME or DO or MON |
PC |
|
Ecuador below 1500m |
PC |
DRF |
Solomon Islands |
DO |
MPM |
|
Egypt El Faiyum June - October Elsewhere in Egypt |
C W |
P |
Somalia |
ME or DO or MON |
PC |
|
El Salvador |
C |
P |
South Africa Lowlands of NE Transvaal and Natal Elsewhere |
ME or DO or MON W |
MPM |
|
Equatorial Guinea |
ME or DO or MON |
PC |
Sri Lanka (no risk in Colombo) |
PC |
« |
|
Eritrea |
ME or DO or MON |
PC |
Sudan |
ME or DO or MON |
PC |
|
Ethiopia |
ME or DO or MON |
PC |
Surinam |
ME or DO or MON |
PC |
|
French Guiana |
ME or DO or MON |
PC |
Swaziland |
ME or DO or MON |
PC |
|
Gabon |
ME or DO or MON |
PC |
Syria rural north May - October |
C |
P |
|
The Gambia |
ME or DO or MON |
PC |
Tajikistan |
C |
P |
|
Ghana |
ME or DO or MON |
PC |
Tanzania |
ME or DO or MON |
PC |
|
Goa |
PC |
« |
Thailand Bangkok, tourist centres and rural areas away from borders Staying on Cambodia or Myanmar border |
W DO |
« |
|
Guatemala below 1500m |
C |
P |
Togo |
ME or DO or MON |
PC |
|
Guinea Bissau |
ME or DO or MON |
PC |
Turkey (No risk west of Antalya) Antalya, Side, Alanya and east coast, plain around Adana SE Anatolia, March - November |
C |
P |
|
Guinea |
ME or DO or MON |
PC |
Turkmenistan (SE only, Mary District) |
C |
P |
|
Guyana |
ME or DO or MON |
PC |
United Arab Emirates rural north |
PC |
« |
|
Haiti |
C |
P |
Vanuata |
DO |
MPM |
|
Honduras |
C |
P |
Venezuela Amazon basin Rural (no risk Caracas or Margarita) |
ME or DO or MON PC |
PC DRF |
|
Hong Kong only in borders New Territories |
W |
|
Vietnam (no risk in cities and Red River delta) |
ME or DO or MON |
« |
|
India (no risk in mountain states) |
PC |
« |
Yemen |
PC |
ME |
|
Indonesia Irian Jaya Bali and Cities Elsewhere in Indonesia |
ME or DO or MON W PC |
PC DRF |
Zambia |
ME or DO or MON |
PC |
|
Iran March - November |
PC |
« |
Zimbabwe Zambezi Valley Elsewhere below 1200m November - June |
ME or DO or MON PC |
« DRF |
|
Irian Jaya |
ME or DO or MON |
« |
|
|
|
|
Ivory Coast |
ME or DO or MON |
PC |
« = Seek Advice from malaria laboratory for alternative regimens |
|
|
|
Kenya |
ME or DO or MON |
PC |
|
|
|
|
Laos (minimal risk in Vientiane) |
ME or DO or MON |
« |
|
|
|
|
Liberia |
ME or DO or MON |
PC |
|
|
|
|
Key to regimens |
|
MON Malarone (atovaquone / proguanil), one tablet daily. Begin 2 days before departure, continue while in malarious area and for 7 days after return (still one tablet daily). Not licensed for children, nor for more than 1 month in malarious areas. |
|
PC Proguanil (Paludrine) 200mg daily (= 2x100mg tablets) Plus Chloraquine 300mg base weekly (= Avlocler 2x250mg or Nivaquine 2x200mg) |
|
ME Mefloquine, one 250mg tablet weekly for visits up to one year. Avoid first trimester of pregancy, lactation, or if pregnancy likely within three months of stopping mefloquine. Contraindicated if previous serious psychiatric illness, previous fir or family history of epilepsy in first-degree relatives. Metoclopramide accelerates absorption. Travellers should start mefloquine 2½ weeks before travel (three doses before leaving UK). |
|
C Chloroquine 200mg base weekly (= Avlocler 2x250mg or Nivaquine 2x200mg) |
|
P Proguanil 200mg (= 2x100mg tablets) daily |
|
W No chemoprophylaxis but be aware of risk. Avoid mosquito bites and carry standby treatment if going to be far from medical facilities |
|
MPM Maloprim, one tablet weekly (= Avlocler 2x250mg or Nivaquine 2x200mg). Seek specialist advice for stays over six months |
|
DO Doxycycline, one table of 100mg daily. Not for children or pregnant women. Be aware of photosensitivity risk. Seek specialist advice for stays over three months |
|
DRF In the alternative regimen column, the letters DRF stand for Drug-Resistant-Falciparum regimen. DRF = MR or DO or MON |
|
« Seek Advice from malaria laboratory for alternative regimens |
|
Telephone sources of advice |
|
Malaria Reference Laboratory 09065 508 906 (24-hour helpline). £1 per minute at all times. |
|
Birmingham 0121 424 0357 / 3354 / 2357, Glasgow 0141 300 1130, Liverpool 0151 708 9393, Oxford 01865 225 214 |
|
This chart is based on advice given by the London School of Hygiene and Tropical Medicine, and the Malaria Reference Laboratory, June 2001. It will not be updated, so seek out more up to date advice before you travel. The information presented here should be used as a guide to help planning, and must not be used as professional or expert advice. We cannot accept any responsibility for your use of this chart or consequences of using it - you must see your Doctor for professional advice on Malaria and other preventative measures. |
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