|
|
 |
Malaria
Information and Prevention
The
ABCD of
Malaria Treatment |
|
 A:
be
Aware
of the risk of malaria if
you are travelling to a foreign
country.
 B:
avoid
mosquito Bites
by taking appropriate measures.
Reducing the number of Bites
reduces the chances of getting
malaria.
 C:
Comply
with the appropriate prophylactic
drug regimen for the area
you are visiting. This is
vitally important since failure
to comply places you at great
risk. Studies have shown that
there is a reduced risk of
contracting malaria even if
you take the wrong regimen.
 D:
early
Diagnosis
of malaria if symptoms manifest
following travel to a malarious
region is vital. Malaria can
be fatal but early diagnosis
and treatment is usually 100%
effective.
|
Malaria
is a serious
and sometimes fatal disease which
is widespread in many tropical and
subtropical countries. It is caught
by being bitten by an infected mosquito
that is carrying the malaria parasites
in its saliva.
The malaria parasite is a microscopic
organism called a Plasmodium
and it belongs to the group of tiny
organisms known as protozoans. There
are four types of plasmodium: P. falciparum
(the most dangerous), P. vivax, P.
ovale and P. malariae. The species
of mosquito that carries the malaria
parasites is the Anopheles
mosquito.
 These
parasites enter the host's bloodstream
when bitten by an infected mosquito
and then migrate to the liver where
they multiply before returning back
into the bloodstream to invade the
red blood cells. The parasites continue
to multiply inside the red cells until
they burst releasing large numbers
of free parasites into the blood plasma
causing the characteristic fever associated
with the disease. This phase of the
disease occurs in cycles of approximately
48 hours.
The free parasites are then
able to infect any mosquito that feeds
on the host's blood during this phase.
The cycle then continues as the parasites
multiply inside the mosquito and eventually
invade its salivary glands. (see the
plasmodium life cycle below).
Malaria
occurs in over 100 countries and
more than 40% of the people in the
world are at risk. Large areas of
Central and South America, Hispaniola
(Haiti and the Dominican Republic),
Africa, the Middle East, the Indian
subcontinent, Southeast Asia, and
Oceania are considered malaria-risk
areas.
|
| |
|
|
| |
| The
World Health Organisation
estimates that each year 300-500
million cases of malaria occur
worldwide and more than two
million people die of malaria. |
 Symptoms
of malaria include
fever and flu-like illness, including
shaking chills, headache, muscle aches,
and tiredness. Nausea, vomiting, and
diarrhoea may also occur. Malaria
may cause anaemia and jaundice (yellow
colouring of the skin and eyes) because
of the loss of red blood cells. Infection
with one type of malaria, P. falciparum,
if not promptly treated, may cause
kidney failure, seizures, mental confusion,
coma, and death.
For most people, symptoms begin
10 days to 4 weeks after infection,
although a person may feel ill as
early as 8 days or up to 1 year later.
Two kinds of malaria, P. vivax and
P. ovale, can relapse; some parasites
can rest in the liver for several
months up to 4 years after a person
is bitten by an infected mosquito
. When these parasites come out of
hibernation and begin invading red
blood cells, the person will become
sick.
Any
traveller who becomes ill with
a fever or flu-like illness while
travelling and up to one year after
returning home should immediately
seek professional medical care. You
should tell your GP that you have
been travelling in a malaria-risk
area.
Malaria can be cured with prescription
drugs. The type of drugs and length
of treatment depend on which kind
of malaria is diagnosed, where the
patient was infected, the age of the
patient, and how severely ill the
patient was at start of treatment.
 Anybody
travelling
to an area where malaria is endemic
is at risk of catching the disease.
Lately there has been an increase
in the cases of malaria reported in
the UK - in 1993 there were 1922 reported
cases in the UK, including five deaths.
All caught the disease abroad and
almost all cases could have been prevented.
Be
aware of the fact that adventure
travellers are usually more exposed
to malaria than ordinary travellers
due to the nature of their activities
and the fact that they travel to the
more remote locations.
|
|
The
Malaria Cycle
(Plasmodium
life cycle)
 |
| |
 Ruptured
blood cells release free parasites
(gametocytes) into the
host's bloodstream.
The human host shows the classic
malaria symptoms at this stage.
The gametocytes are sucked up
by a feeding mosquito and the
cycle begins again. |
|
|
|
The
Prevention and
Treatment of Malaria
|
Malaria
is a preventable infection that
can be fatal if left untreated.
You
cannot be vaccinated against
malaria, but you can protect
yourself
|
Avoidance
of Bites
Mosquitoes
cause much inconvenience because
of local reactions to the bites themselves
and from the infections they transmit.
Mosquito bites spread other diseases
such as yellow fever, dengue fever
and Japanese B encephalitis.
 Mosquitoes
bite at
any time of day but the anopheles
bites in the night with most activity
at dawn and dusk. If you are out
at night wear long-sleeved clothing
and long trousers.
Mosquitoes
may bite through thin clothing,
so spray an insecticide or repellent
on them. Insect repellents should
also be used on exposed skin.
Spraying insecticides in the room,
burning pyrethroid coils and heating
insecticide impregnated tablets all
help to control mosquitoes. If you
are sleeping in an unscreened room
a mosquito net (which should be impregnated
with insecticide) is a sensible precaution.
If sleeping out of doors it is essential.
Portable, lightweight nets are available.
NOTE: Things like Garlic, Vitamin
B and ultrasound devices do not prevent
mosquito bites.
Taking
Anti-Malaria Tablets
 It
should be noted
that no prophylactic regimen is
100% effective and advice on malaria
prophylaxis changes frequently.
There are currently five prophylactic
regimens used (A,B,C,D & E),
due to the differing resistance
that exists by the malaria parasites
to the various drugs used. (See
the above map of Malaria Endemic
Areas).
The
tablets you require depend on
the country to which you are travelling
(see the table page). Start taking
the tablets before travel take them
absolutely regularly during your stay,
preferably with or after a meal and
continue to take them after you have
returned. This is extremely important
to cover the incubation period of
the disease.
Prompt
Treatment
If
you develop a fever between one
week after first exposure and up to
two years after your return, you should
seek medical attention and inform
the doctor that you have been in a
malarious area.
 Anyone
with suspected malaria should
be treated under medical supervision
as soon as possible. If malaria
is diagnosed then treatment is a
matter of urgency. Treatment should
not normally be carried out by unqualified
persons.
The drug treatment of malaria
depends on the type and severity of
the attack. Typically, Quinine Sulphate
tablets are used and the normal adult
dosage is 600mg every twelve hours
which can also be given by intravenous
infusion if the illness is severe.
Remember: Prevention is better
than cure and over two million people
die from malaria every year. It is
a very serious illness!
 Side
Effects of Anti-Malarials
Like
all medicines,
anti-malarials can sometimes cause
side-effects:
Proguanil
(Paludrine) can cause nausea and simple
mouth ulcers.
Chloroquine
(Nivaquine or Avloclor) can cause
nausea, temporary blurred vision and
rashes.
Patients
with a history of psychiatric
disturbances (including depression)
should not take mefloquine as it may
precipitate these conditions. It is
now advised that mefloquine be started
two and a half weeks before travel.
 Doxycycline
does carry some risk of photosensitisation
i.e. can make you prone to sunburn.
Malarone
is a relatively new treatment and
is virtually free of side effects.
It is licensed for use in stays of
up to 28 days but there is now experience
of it being taken safely for up to
three months.
No
other tablets are required with
mefloquine or doxycycline or Malarone.
 Drug
Resistance
It is the plasmodia that cause malaria
that develop resistance to anti-malarial
drugs not the mosquitoes that transmit
the disease.
Resistance to antimalarial drugs is
proving to be a challenging problem
in malaria control in most parts of
the world. Since the early 60s the
sensitivity of the parasites to chloroquine,
the best and most widely used drug
for treating malaria, has been on
the decline.
Drug resistance is the ability of
a parasite species to survive and
multiply despite the administration
of a drug in doses equal to or higher
than those usually recommended but
within the limit of tolerance.
 Newer
antimalarials have been developed
in an effort to tackle this problem,
but all these drugs are either expensive
or have undesirable side effects.
The discovery of chloroquine revolutionalised
the treatment of malaria, pushing
quinine to the sidelines.
However, after a variable length of
time, the parasites, especially the
falciparum species, have started showing
resistance to these new drugs.
Resistance is most commonly seen in
P. falciparum whereas only sporadic
cases of resistance have been reported
in P. vivax malaria.
Resistance to chloroquine is most
prevalent, while resistance to most
other antimalarials has also been
reported.
Resistance to chloroquine began from
two epi-centres; Columbia (South America)
and Thailand (South East Asia) in
the early 1960s. Since then, resistance
has been spreading world wide.
Recently, cases of mefloquine resistance
have been reported from areas of Thailand
bordering with Burma and Cambodia
(see map above). Travellers to Thailand
are therefore advised to avoid using
mefloquine when travelling to these
risk areas.
 Because
mefloquine is structurally similar
to chloroquine, cross resistance
is possible due to the prolonged
half life of mefloquine. 
|
|
| |
| | |
|
Countries
requiring malaria prophyllaxis
should be regarded as being at risk
all year round and you should
also assume that the whole country
is at risk unless otherwise indicated.
The 1st malaria regimen (MAL
1) is the preferred regimen
for a country. The 2nd malaria
regimen (MAL 2) is an alternative
that should only be used when the
1st Regimen is either unavailable
or badly tolerated. The preferred
regimen should always be used whenever
possible. Use of the 2nd regimen in
some instances may not provide adequate
cover.
When
there are two different regimens
for the same country, they are area
specific. Read the text to find out
which regimen is suitable for the
area you require.
Where regimen 1 is indicated
there is Chloroquine resistance in
that region and it is very likely
to be the Falciparum malaria which
is the most serious form of the disease.
In this instance it is vitally important
that travellers take adequate prophylaxis.
Remember:- No prophylaxis is
100% effective but not taking anti-malarials
where they are indicated will put
you at greater risk should you get
the disease. Malaria is a killer!
|
|
| |
|
The
Different Drug Regimens
|
| Regimen
1 |
Mefloquine
one 250mg tablet weekly.
OR
Doxycycline one 100mg capsule daily.
OR
Malarone one tablet daily. |
| Regimen
2 |
Chloroquine
300mg
weekly
(2x150mg tablets).
PLUS
Proguanil 200mg
daily
(2x100mg tablets). |
| Regimen
3 |
Chloroquine
300mg
weekly
(2x150mg tablets) OR
Proguanil 200mg daily
(2x100mg tablets). |
| Regimen
4 |
No
prophylactic tablets
required but anti mosquito measures
such as insect repellents, mosquito
nets, long sleeved clothing, etc. should
be strictly observed. |
| . |
|
| |
| Proguanil
|
100mg
tablets are supplied as Paludrine
Tablets |
| Chloroquine
|
150mg
tablets are supplied as Nivaquine
or Avloclor Tablets |
| Mefloquine
|
250mg
tablets are supplied as Lariam
Tablets |
| Malarone
|
is
a combination of Atovaquone 250mg
and Proguanil 100mg |
|
| |
|
Length
of Prophylaxis
|
| Chloroquine,
Proguanil & Maloprim |
Start
one week before travel, throughout
your stay in an endemic area and continue
for four weeks after return. |
| Mefloquine
(Lariam) |
Start
two and a half weeks before travel,
throughout your stay in an endemic area
and continue for four weeks after
return. |
| Doxycycline |
Start
two days before travel, throughout
your stay in an endemic area and continue
for four weeks after return. |
| Malarone |
Start
two days before travel, throughout
your stay in an endemic area and continue
for one week after return. |
|
IMPORTANT!
Take
the tablets absolutely regularly,
preferably with or after a meal.
|
|
| |
|
Long
Term Use of Anti-Malaria Drugs
|
| Chloroquine |
May
be taken for periods exceeding five
years. |
| Paludrine |
May
be taken for periods exceeding five
years. |
| Maloprim |
Can
be taken for periods up to one year. |
| Mefloquine |
Can
be taken for periods up to one year. |
| Doxycycline |
Can
be taken for periods up to six months. |
| Malarone |
Can
be used for travel periods up to three
months. |
|
| |
|
Compatibility
of Anti-Malaria Drugs
|
| |
Pregnancy
|
Breast
Feeding
|
Epilepsy
|
Psoriasis
|
Altitude
|
Scuba
Diving
|
| Chloroquine |
OK
|
OK
|
NO
|
NO
|
OK
|
OK
|
| Paludrine |
OK
|
OK
|
OK
|
OK
|
OK
|
OK
|
| Mefloquine
|
OK*
|
NO
|
NO
|
OK
|
NO
|
NO
|
| Doxycycline |
NO
|
NO
|
OK
|
OK
|
OK
|
OK
|
| Malarone |
NO
|
NO
|
OK
|
OK
|
OK
|
OK
|
|
*
These drugs are not suitable during
the first trimester of pregnancy.
|
|
| |
|
Childrens'
Dosages:
Calculate
the dose by weight rather than by
age if possible
|
|
Age/Weight
|
Chloroquine
150mg base
(once weekly)
|
Proguanil
100mg
(once daily)
|
Mefloquine
250mg
(once weekly)
|
Doxycycline
100mg
(once daily)
|
Malarone
250mg/100mg
(once daily)
|
|
0
- 12 weeks
under 6kg
|
¼
tablet
|
¼
tablet
|
-
|
-
|
-
|
|
3
- 12 months
6 - 10kg
|
½
tablet
|
½
tablet
|
¼
tablet
|
-
|
-
|
|
1
- 3 years
10 - 16kg
|
¾
tablet
|
¾
tablet
|
¼
tablet
|
-
|
1
child's
tablet
|
|
4
- 7 years
16 - 25kg
|
1
tablet
|
1
tablet
|
½
tablet
|
-
|
1
child's
tablet
|
|
8
- 12 years
25 - 45 Kg
|
1½
tablets
|
1½
tablets
|
¾
tablet
|
-
|
2
child's
tablets
|
|
13
years and over
45kg and over
|
2
tablets
|
2
tablets
|
1
tablet
|
1
capsule
|
1
adult
tablet
|
|
The
above dosages are based upon the guidelines
issued by
the Advisory Committee on Malaria
Prevention.
|
|
| |
|
Adult
Dosages
|
|
Regimen
|
Dose
for
Chemoprophylaxis
|
Usual
amount
per tablet (mg)
|
| Areas
without drug resistance: |
|
Chloroquine
Proguanil
|
2
tablets weekly
2
tablets daily
|
150mg
(base)
100mg
|
| Areas
of little chloroquine resistance (poorly
effective where marked resistance): |
Chloroquine
plus
Proguanil |
2
tablets weekly
2 tablets daily |
150mg
(base)
100mg |
| Areas
of chloroquine resistant P. falciparum: |
|
Mefloquine
Doxycycline
Malarone
(atovaquone & proguanil)
|
1
tablet weekly
1
tablet/capsule daily
1
tablet daily
|
250mg
(228 in USA)
100mg
250mg
atovaquone &
100mg proguanil
|
|
| |
| Countries
where there is currently no risk
of malaria: |
|
|
|
|
| |
| Malaria
prophylaxis for Sub-Saharan Africa
|
|
|
Risk
|
Country
|
Preferable
regimen
|
Alternative
regimen
|
| Low
risk |
- Cape
Verde - Remember, low risk if fever
develops.
- Mauritius
- Except a few rural areas where
chloroquine prophylaxis is appropriate.
|
Avoid
insect bites. |
|
| Risk
in parts of the country Some chloroquine
resistance present. |
- Botswana
- Only in the northern half of the
country - November to June.
- Mauritania
- All year round in the south. November
to June in the north.
- Namibia
- The northern third of the country
- November to June. All year long
around the Kavango and Kunene rivers.
- Zimbabwe
- Areas below 1,200 metres - November
to June. All year long in the Zambezi
Valley where Doxycycline, Mefloquine
or Malarone are preferable. Risk
is negligible in Harare and Bulawayo.
|
Chloroquine
PLUS
Proguanil |
Doxycycline
OR
Mefloquine
OR
Malarone |
| Risk
very high, or locally very high. Chloroquine
resistance very widespread. |
- Angola
- Benin
- Burkina
Faso
- Burundi
- Cameroon
- Central
African Republic
- Chad
- Comoros
- Congo
- Djibouti
- Equatorial
Guinea
- Eritrea
|
- Gabon
- Gambia
- Ghana
- Guinea
- Guinea
Bissau
- Ivory
Coast
- Kenya
- Liberia
- Madagascar
- Malawi
- Mali
- Mozambique
- Niger
- Nigeria
|
- Principe
- Rwanda
- Sao
Tome
- Senegal
- Sierra
Leone
- Somalia
- Sudan
- Swaziland
- Tanzania
- Togo
- Uganda
- Zaire
- Zambia
|
- Ethiopia
- Areas below 2,200 metres. No risk
in Addis Ababa
- South
Africa - North east, low altitude
areas of Mpumalanga and Northern
Provinces, Northeast KwaZulu-Natal
as far south as the Tugela river.
Risk present in Kruger National
Park.
- Zimbabwe
- The Zambezi Valley.
|
Doxycycline
OR
Mefloquine
OR
Malarone
|
Chloroquine
PLUS
Proguanil - (limited protection)
|
|
| |
| Malaria
prophylaxis for Sub-Saharan Africa
|
|
|
Risk
|
Country
|
Preferable
regimen
|
Alternative
regimen
|
| Low
risk |
- Cape
Verde - Remember, low risk if fever
develops.
- Mauritius
- Except a few rural areas where
chloroquine prophylaxis is appropriate.
|
Avoid
insect bites. |
|
| Risk
in parts of the country Some chloroquine
resistance present. |
- Botswana
- Only in the northern half of the
country - November to June.
- Mauritania
- All year round in the south. November
to June in the north.
- Namibia
- The northern third of the country
- November to June. All year long
around the Kavango and Kunene rivers.
- Zimbabwe
- Areas below 1,200 metres - November
to June. All year long in the Zambezi
Valley where Doxycycline, Mefloquine
or Malarone are preferable. Risk
is negligible in Harare and Bulawayo.
|
Chloroquine
PLUS
Proguanil |
Doxycycline
OR
Mefloquine
OR
Malarone |
| Risk
very high, or locally very high. Chloroquine
resistance very widespread. |
- Angola
- Benin
- Burkina
Faso
- Burundi
- Cameroon
- Central
African Republic
- Chad
- Comoros
- Congo
- Djibouti
- Equatorial
Guinea
- Eritrea
|
- Gabon
- Gambia
- Ghana
- Guinea
- Guinea
Bissau
- Ivory
Coast
- Kenya
- Liberia
- Madagascar
- Malawi
- Mali
- Mozambique
- Niger
- Nigeria
|
- Principe
- Rwanda
- Sao
Tome
- Senegal
- Sierra
Leone
- Somalia
- Sudan
- Swaziland
- Tanzania
- Togo
- Uganda
- Zaire
- Zambia
|
- Ethiopia
- Areas below 2,200 metres. No risk
in Addis Ababa
- South
Africa - North east, low altitude
areas of Mpumalanga and Northern
Provinces, Northeast KwaZulu-Natal
as far south as the Tugela river.
Risk present in Kruger National
Park.
- Zimbabwe
- The Zambezi Valley.
|
Doxycycline
OR
Mefloquine
OR
Malarone
|
Chloroquine
PLUS
Proguanil - (limited protection)
|
|
| |
| Malaria
prophylaxis for North Africa,
Middle East & South West Asia
|
|
|
Risk
|
Country
|
Preferable
regimen
|
Alternative
regimen
|
| Risk
very low. |
- Algeria
- Virtually no risk
- Egypt
- Main tourist areas are malaria
free.
- Georgia
- Some south eastern villages July
to October.
- Kyrgystan
- Some southern and western areas.
- Libya
- Morocco
- A few rural areas only limited
risk.
- Turkey
- Most tourist areas.
- Uzbekistan
- Sporadic cases in extreme south
east only.
|
Avoid
mosquito bites |
|
| Risk
low |
- Armenia
- The whole country June to October.
- Azerbaijan
- Southern border area June to October.
- Egypt
- El Faiyum region only, June to
October.
- Iraq
- Basrah and rural north, May to
November.
- Syria
- Northern border, May to October.
- Turkey
The plain around Adana, Side &
south east Anatolia, March to November.
- Turkmenistan
- The south east only, June to October.
|
Chloroquine |
Proguanil |
| Risk
present. Some chloroquine resistance
present. |
- Afghanistan
- Areas below 2,000 metres, May
to November.
- Iran
- Oman
- Remote rural areas only.
- Saudi
Arabia - The whole country except
northern, eastern and central provinces,
Asir plateau, and western border
cities where there is very little
risk. No risk in Mecca.
- Tajikistan
- Southern border areas, June to
October.
- Yemen
- No risk in Sana'a city.
|
Chloroquine
PLUS
Proguanil |
|
|
| |
| Malaria
prophylaxis for South Asia (Indian
Subcontinent) |
|
|
Risk
|
Country
|
Preferable
regimen
|
Alternative
regimen
|
| Very
low risk. |
- Maldives
- no risk
- India
- No risk in parts of mountain states
of the north.
|
Avoid
mosquito bites |
|
| Risk
variable. Chloroquine resistance usually
moderate. |
- Bangladesh
- The whole country except Chittagong
Hill Tracts. No risk in Dhaka City.
- Bhutan
- Southern districts only.
- India
- All areas below 2,000 metres,
including Goa.
- Nepal
- Areas below 1,500 metres, especially
Terai districts. No risk in Kathmandu.
- Pakistan
- Areas below 2,000 metres.
- Sri
Lanka - No risk in Colombo.
|
Chloroquine
PLUS
Proguanil |
Will
vary locally. |
Risk
high.
Chloroquine resistance high. |
- Bangladesh
- Chittagong Hill Tract Districts
only.
- India
- Assam region.
|
Doxycycline
OR
Mefloquine
OR
Malarone
|
Chloroquine
PLUS
Proguanil |
|
| |
| Malaria
prophylaxis for South East Asia |
|
|
Risk
|
Country
|
Preferable
regimen
|
Alternative
regimen
|
| Risk
very low. Remember malaria is possible
if fever develops. |
- Bali
- Part of Indonesia
- China
- Main tourist areas.
- Hong
Kong
- Indonesia
- Jakarta, main cites and tourist
resorts including Java.
- Malaysia
- except Sabah (see below)
- North
Korea - A few southern areas have
limited risk.
- Philippines
- Low risk in main cities, Cebu,
Bohol & Catanduanes. No risk
in Manilla.
- South
Korea - Limited risk in the extreme
northwest.
- Sarawak
- Part of Malaysia
- Thailand
- Bangkok and main tourist areas
including Pattaya, Phuket, Krabi,
Hua Hin, Koh Samui, Kanchanaburi,
Damnoen Sadouak, Ayutthaya, Sukhothai,
Khon Kaen & Chiang Mai.
|
Avoid
mosquito bites |
|
| Risk
variable. Some chloroquine resistance. |
- Indonesia
- Areas other than Bali and low
risk cities, or Irian Jaya and Lombok
where the risk is high and chloroquine
resistance is present.
- Philippines
- Rural areas below 600 metres.
- Malaysia
and Sarawak - Deep forest regions
of penninsular Malaysia and Sarawak.
|
Chloroquine
PLUS
Proguanil |
Will
vary locally. |
Risk
substantial.
Chloroquine resistance common. |
- Cambodia
- Most of the country except Phnom
Penh where there is no risk.
- China
- Yunnan and Hainan provences only.
All other remote areas use chloroquine.
- East
Timor
- Irian
Jaya & Lombok
- Laos
- except Vientiane where there is
no risk.
- Myanmar
- (formerly Burma).
- Sabah
- Part of Malaysia
- Vietnam
- Most rural areas, no risk in cities,
Red River delta area and the coastal
plain north of Nha Trang.
|
Doxycycline
OR
Mefloquine
OR
Malarone
|
Chloroquine
PLUS
Proguanil |
|
Risk
great.
Chloroquine resistance prevalent.
Some mefloquine resistance reported
|
- Cambodia
- Western provences.
- Thailand
- Near borders with Cambodia &
Myanmar. Koh Chang.
- Myanmar
- Eastern part of Shan state.
|
Doxycycline
OR
Malarone |
|
|
| |
| Malaria
prophylaxis for Oceania |
|
|
Risk
|
Country
|
Preferable
regimen
|
Alternative
regimen
|
Risk
high.
Chloroquine resistance high. |
- Papua
New Guinea - below 1,800 metres.
- Solomon
Islands
- Vanuatu
|
Doxycycline
OR
Mefloquine
OR
Malarone
|
Maloprim
PLUS
Chloroquine |
|
| |
| Malaria
prophylaxis for South & Central
America & the Caribbean |
|
|
Risk
|
Country
|
Preferable
regimen
|
Alternative
regimen
|
| Risk
variable to low, no chloroquine resistance
present. |
- Argentina
- Rural areas along northern borders
only.
- Belize
- Rural areas except Belize district.
- Costa
Rica - Rural areas below 500m.
- Dominican
Republic
- El
Salvador - Only Santa Ana province
in the West.
- Guatamala
- Areas below 1,500 metres.
- Haiti
- The whole country.
- Honduras
- The whole country.
- Mexico
- Some rural areas rarely stayed
in by tourists.
- Nicaragua
- The whole country.
- Panama
- West of the canal.
- Paraguay
- Some rural areas.
|
Chloroquine |
Proguanil |
| Risk
variable or high, some chloroquine resistance
present. |
- Bolivia
- Rural areas below 2,500 metres
- Ecuador
- Areas below 1,500 metres. No malaria
in Galapagos Islands nor in Guayaquil.
- Panama
- East of the canal.
- Peru
- Rural areas below 1,500 metres.
- Venezuela
- Rural areas other than the coast.
Caracas is free of malaria.
|
Maloprim
PLUS
Chloroquine |
Doxycycline
OR
Mefloquine
OR
Malarone |
Risk
high,
marked chloroquine resistance. |
- Brazil
- Amazon basin region, Mato Grosso
& Maranhao only. Very low risk
and no chemoprophylazis required
elsewhere.
- Colombia
- Most areas below 800m
- Ecuador
- Esmeraldas Province.
- French
Guiana - Especially border areas.
- Guyana
- All interior regions.
- Surinam
- Except Paramaribo and coast.
- Amazon
basin areas of Bolivia, Venezuela
and Peru
|
Doxycycline
OR
Mefloquine
OR
Malarone
|
Maloprim
PLUS
Chloroquine |
|
|
|
|
