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Updated: December 2015 Malaria


Destination Libya


Liechtenstein Lithuania


Macedonia Madagascar Madeira Malawi


Malaysia


Maldives Mali


Malta and Gozo Martinique Mauritania


Mauritius Mayotte Mexico


Moldova Mongolia


Montenegro Montserrat Morocco


Mozambique Myanmar (Burma)


Namibia Nepal


Neth Antilles Netherlands


New Caledonia New Zealand Nicaragua


Niger


Nigeria Norway Oman


Pakistan Panama


Papua New Guinea Paraguay Peru


S R R R


R S S


S R S


R R R


R R S S R S


S R R R S


R R S R


R R


R R S R


S R R


R R R R S


R R S R R S


S S S S C S S S


S S


R S S S S C S S S C


S S S S C


S S S S M S S


S S S C C


S S S


S S S S S S S S S S


S S S R S S S C R R S R R S S S C


S S S S C R S S S C


S S


C C


S C R S S S M S


R R S R R S S S R S S R


R R S R R S S S C R R


S S


R R S R R R R


R S S S C S S


S S C S R


S R S S S R S S S C C


R S S S R S S


C C


S No risk


S No S No No


Yes, high risk No


Yes, high risk Le Le ME or DO or MON PC Sh


Minimal risk coastal areas. Low W risk Sabah & Sarawak


No


Yes, high risk No No


Yes, high risk all year in south Low risk in far north


No Yes, high risk


S No S No S No No No


Yes, high risk


ME or DO or MON PC Ta Le Sh


ME or DO or MON PC Sh Le W Yes, southern rural areas only W


ME or DO or MON PC Le Tc


Le W


Yes, Kayin and East Shan state DO or MON Yes, elsewhere


Low/no risk Mandaley & Rangoon W Yes, NE third only


Elsewhere low risk S Vivax risk all year round.


Falciparum risk In Western pocket in Terai


No No No No


Yes, variable risk in north, low risk in south


Yes, high risk Yes, high risk


S No Sporadic imported risk Yes, significant below 2000m


Yes, highest risk Darien & San Blas, low risk elsewhere


Yes, high risk below 1800m Low risk


Yes, high risk in Amazonian


Loreto Dept. Variable risk SE area bordering


Brazil & Bolivia, and around Tumbes & Piura


Philippines Poland Portugal


Puerto Rico Qatar


Reunion Romania


Russian Federation Rwanda Sabah


Samoa Sao Tome R


S R R


S R S R


R R S R R S


S R R R S S


S S S S S


S S S S S S S S S S M S S S S S C S S C S S S S benefit to the mother outweighs risk to foetus.


Children use paediatric tablets. Regimen PC


Proguanil (Paludrine) 200mg daily plus chloroquine 300mg or 310mg base weekly (=Avloclor 2x250mg). Begin 1 week before travel and


continue for 4 weeks after return. Regimen ME


Mefloquine, 1x250mg tablet weekly. ACMP suggest it is safe in continuous use for at least 3 years. Begin at least 21⁄2 weeks before travel (at least 3 doses before arriving in malarious area). Caution in first trimester but inadvertent use is not an indication for termination. Mefloquine may be considered if planning to conceive in high risk endemic zone after careful risk assessment. In general suggest defer planned pregnancy until 3 months after stopping


mefloquine. Regimen C


Chloroquine 300mg or 310mg base weekly (=Avloclor 2x250mg). Begin 1 week before travel and continue


for 4 weeks after return. Regimen P


Proguanil (Paludrine) 200mg daily. Begin 1-2 C R R S S S S S C S S Very low risk most areas


Low risk Palawan, Tawi Tawi, Zambales, Zamboanga del Norte


S No No No No No


S No


S S No S


No Yes, high risk ME or DO or MON PC Sh Le Yes, high risk ME or DO or MON PC Sh Ta


Minimal risk coastal areas & Kota W Kinabulu. Low risk inland


ME or DO or MON PC for high risk groups


W ME or DO or MON PC


for high risk travellers only


Sh Le Le Sh


Vietnam


Virgin Islands West Papua


Zimbabwe R R S S S S S C S


(formerly Irian Jaya) Yemen Zambia


R R S R R S


R R S R R S


R S S S C R S S S C


S S S S S S S S S C


S S W


ME or DO or MON PC C


P


ME or DO or MON PC W


P Le Tc


ME or DO or MON PC Le Tc C


Sh Le ME or Do or MON PC PC C P Le Tc


ME or DO or MON PC Sh Ta ME or DO or MON PC Sh Ta


W ME or DO or MON PC


ME or DO or MON PC Sh W


Le Le


ME or DO or MON PC Sh Ta PC


Spain Sri Lanka


St Helena & Ascension St Kitts & Nevis St Lucia


St Vincent & Grenadines Sudan


South Sudan Surinam


Swaziland Sweden


Switzerland Syria


Taiwan


Tajikistan Tanzania


Thailand Tibet


Tobago Togo


Trinidad Tunisia Turkey


Turkmenistan Uganda Ukraine


United Arab Emirates Uruguay USA


Uzbekistan Vanuatu


Venezuela


R R S R R S R R S


R R S R R S


R R S R R S


S R S


S R S R R S R R


R R


R R S S R S R R


R


S R S R


R R


S S S C S S S S


C C C C


R S S S R S R S S S R S S S S S C


S R S S S R S S C


S S S S S S


R S S S S S S S S S C


S


S S S C S S C


S S S S M S S


S S S S S C S S


S S S S


R R S S S S


S S S S


R S S S R S S S


S S C S S


S S R S S S S


ME or DO or MON PC Sh Ta PC


ME or DO or MON for high risk groups


Destination Saudi Arabia


Senegal Serbia


Seychelles


Sierra Leone Singapore Slovakia Slovenia


Solomon Islands Somalia


South Africa S R


R R S R


R R R R S R R R S S C S/M


R S S S R S S


S


S S S S


R R S R R S S S R S R S


S S S S C S S S S C


R S S S M S S


C C


S


Although every effort is made to ensure that information in these pages is correct, the compilers and Pulse cannot accept responsibility for the consequences of errors. © PULSE 2016


Malaria Yes SW region


Elsewhere (no risk Mecca and Medina)


Yes, high risk


S No No


Yes, high risk No


S No S No


Yes, high risk Yes, high risk


Yes, NE rim including Kruger


bordering Zimbabwe, Mozambique and northern Swaziland


No


No – imported cases only No No No No


Yes, high risk


S No S No No No


S Yes – variable June-Oct Yes, on extreme fringe of


international borders Elsewhere


No No


Yes, high risk No No


Low risk Mardin province No


Yes, high risk


S No No No No


Yes, very low risk extreme SE W Yes, moderate risk


Yes, high risk to south of


Orinoco River Variable/low risk north of Orinoco C No risk Caracas or Margarita W


Low risk in cities, coast between W Ho Chi Minh & Hanoi, Mekong Delta Elsewhere


No Yes, high risk below 1800m


Yes, but no risk in Sana’a City Yes, high risk


Yes, high risk Zambezi valley Yes, elsewhere below 1200m Nov-Jun


Negligible risk Harare and Bulawayo


ME or DO or MON PC Sh Ta


ME or DO or MON PC Sh Le ME or DO or MON PC Sh Ta ME or DO or MON PC Sh Ta


ME or DO or MON PC W


ME or DO or MON PC


ME or DO or MON PC LE Tc P


C P


High risk Afghan border in SW ME or Do or MON PC Yes, high risk


W Tc


ME or DO or MON PC Sh Ta Tc


W


Le Le


ME or DO or MON PC Sh Ta


Le Tc


Le


ME or DO or MON PC Sh Ta DO or MON


W No ME or DO or MON PC


ME or DO or MON PC Sh Le ME or DO or MON PC Sh Ta


ME or DO or MON PC Sh Le W


ME or DO or MON PC Sh Ta Le


ME or DO or MON PC Sh Ta


Yes, high risk but low seasonal ME or DO or MON PC Sh Le in north


ME or DO or MON PC Sh Le


Yes (except Paramaribo and coast) ME or DO or MON PC Sh Le Yes, high risk, eastern areas


ME or DO or MON PC Sh Sh Le


ME or DO or MON PC


days before travel and continue for 4 weeks


after return. Regimen W


No chemoprophylaxis but be aware of risk. Avoid mosquito bites and carry standby treatment if


going to be far from medical facilities. Regimen DO


Doxycycline, 1 tablet of 100mg daily. Begin 1-2 days before travel and continue for 4 weeks after return. Not for children or pregnant women. Be aware of oesophageal ulceration, photosensitivity and very rare intracranial hypertension risk. Take with food, but not milk (37% reduction in AUC) and avoid ingestion in


late evening. Regimen DRF


= ME or DO or MON Primaquine


In the alternative regimen column, DRF is Drug-Resistant-Falciparum regimen. DRF


Causal prophylactic for use in travellers for whom other anti-malarials are contra- indicated after excluding G6PD deficiency. 5-10% poor response rate due to CYP450 metabolic defect. Active against all species. Adult dose 30mg daily. Start 1-2 days before departure and continue for 7 days after return.


in kg


Children’s doses of antimalarial prophylactics Weight


Chloroquine Proguanil


Under 6.0 6.0 to 9.9


10.0 to 15.9 16.0 to 24.9 25.0 to 44.9


Mefloquine


0.125 adult dose not ¼ tablet


Age


0.25 adult dose 0.25 adult dose 3 months to ½ tablet


0.375 adult dose 0.25 adult dose ¾ tablet


0.5 adult dose 1 tablet


0.75 adult dose 1½ tablets


45kg and over Adult dose 2 tablets


0.5 adult dose ½ tablet


0.75 adult dose ¾ tablet


Adult dose 1 tablet


recommended 12 weeks ¼ tablet ¼ tablet


12 years 11 months 13 years and over


Doxycycline only above 12 years and the adult dose is given


Children’s doses Paediatric malarone for prophylaxis Weight in kg


Number of tabletsdaily 5-10


11-20 21-30 31-40


Above 40


½ paediatric tablet (ACMP recommendation but off licence)


1 paediatric tablet 2 paediatric tablets 3 paediatric tablets 1 adult tablet


7 years 11 months 8 years to


3 years 11 months 4 years to


11 months 1 year to


term to


Specialist advice


For advice on complex itineraries and other queries, use the following helplines: Birmingham 0121 424 0357/ 3354/2357 Edinburgh, Western General Hospital 0131 537 2822 National Travel Health Network and Centre (Monday to Friday, 9am-12pm, 2pm-4.30pm) 0845 602 6712 (local call rate)


For malaria advice: Malaria Reference Laboratory 020 7636 3924 (health


professionals only) Birmingham 0121 424 0357/ 3354/2357 Edinburgh 0131 537 2822 Glasgow 0141 300 1130 Liverpool 0151 708 9393 Oxford 01865 225 214


Pulse February 2016 81


Main parasitic hazards Alternative regimen


Recommended regimen


Risk areas and seasons Tick-borne encephalitis Hepatitis B


Hepatitis A Typhoid


Cholera


Tuberculosis Diptheria Polio


Japanese enceph Mening/ACWY Yellow fever Rabies


Main parasitic hazards Alternative regimen


Recommended regimen


Risk areas and seasons Tick-borne encephalitis Hepatitis B


Hepatitis A Typhoid


Cholera


Tuberculosis Diptheria Polio


Japanese enceph Mening/ACWY Yellow fever Rabies


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