Table 1. Recommended Prophylactic Regimens according to Chloroquine Resistance Patterns^^ and Sites of Action
|
Chloroquine Resistance * |
Options ^ |
Sites of Action |
|
Yes |
Atovaquone/Proguanil or
Doxycycline or Mefloquine *** |
Blood-Stage (Suppressive) and Liver-Stage (Causal) ***** Blood-Stage (Suppressive) Blood-Stage (Suppressive) |
|
No |
Chloroquine or Atovaquone/Proguanil or
Doxycycline or Mefloquine or Primaquine ** |
Blood-Stage (Suppressive) Blood-Stage (Suppressive) And Liver-Stage (Causal) Blood-Stage (Suppressive) Blood-Stage (Suppressive) Liver-Stage (Causal) and Blood-Stage **** |
^ Equal efficacy; choice depends on traveler, itinerary, safety profiles, individual choices, and convenience
^^Resistance to chloroquine is based on P. falciparum. However, chloroquine resistant P. vivax has been widely identified in Indonesia, Papua New Guinea and sporadic cases in other Southeastern countries
*Many countries with both urban and rural malaria transmission may not have malaria risk in the most frequently visited major cities
** Need to perform G-6PD level before prescribing. Sometimes used in travelers with prolonged stays in countries with P. vivax or P. ovale as terminal prophylaxis
***Not recommended for traveling to Thailand borders with Cambodia and Burma (Myanmar) due to mefloquine resistance
****Primaquine has an effect on the liver-stage (primary schizont) of all four Plasmodia species, and the sexual blood stages of all four species but only the asexual blood stages of P. vivax but not P. falciparum.
*****Tafenoquine, atovaquone can act also on the liver stage; Doxycycline and proguanil have limited activity in the liver-stage of plasmodia.
Table 2. Recommendations for Travelers to Malaria Risk
Countries in the Americas and the Caribbean ***
|
Country |
Comments |
Recommended Options |
|
Argentina |
Selected Areas |
Chloroquine Atovaquone/Proguanil Doxycycline Mefloquine |
|
Belize |
All areas except Belize city |
Chloroquine Atovaquone/Proguanil Doxycycline Mefloquine |
|
Bolivia |
Selected Areas |
Atovaquone/Proguanil Doxycycline Mefloquine |
|
Brazil |
Selected Areas |
Atovaquone/Proguanil Doxycycline Mefloquine |
|
Colombia |
Selected Areas. |
Atovaquone/Proguanil Doxycycline Mefloquine |
|
Costa Rica |
Selected Areas |
Chloroquine Atovaquone/Proguanil Doxycycline Mefloquine |
|
Dominican Republic |
Selected Areas ** |
Chloroquine Atovaquone/Proguanil Doxycycline Mefloquine |
|
Ecuador |
Selected Areas |
Atovaquone/Proguanil Doxycycline Mefloquine |
|
El Salvador |
Selected Areas |
Chloroquine Atovaquone/Proguanil Doxycycline Mefloquine |
|
French Guyana |
Every Area |
Atovaquone/Proguanil Doxycycline Mefloquine |
|
Guatemala |
Selected Areas |
Chloroquine Atovaquone/Proguanil Doxycycline Mefloquine |
|
Guyana |
Selected Areas |
Atovaquone/Proguanil Doxycycline Mefloquine |
|
Haiti |
Selected Areas |
Chloroquine Atovaquone/Proguanil Doxycycline Mefloquine |
|
Honduras |
Selected Areas |
Chloroquine Atovaquone/Proguanil Doxycycline Mefloquine |
|
Mexico |
Selected Areas |
Chloroquine Atovaquone/Proguanil Doxycycline Mefloquine |
|
Nicaragua |
Selected Areas |
Chloroquine Atovaquone/Proguanil Doxycycline Mefloquine |
|
Panama |
Selected Areas |
(Bocas del Toro) Chloroquine Atovaquone/Proguanil Doxycycline Mefloquine
Atovaquone/Proguanil Doxycycline Mefloquine (Darien and San Blas) |
|
Paraguay |
Selected Areas |
Chloroquine Atovaquone/Proguanil Doxycycline Mefloquine |
|
Peru |
Selected Areas |
Atovaquone/Proguanil Doxycycline Mefloquine |
|
Suriname |
Selected Areas |
Atovaquone/Proguanil Doxycycline Mefloquine |
|
Venezuela |
Selected Areas |
Atovaquone/Proguanil Doxycycline Mefloquine |
** Sources of information: Centers for Disease Control and Prevention (http://www.cdc.gov/travel), World Health Organization web site (http://www.who.int/ith/), and Health Canada (http://www.phac-aspc.gc.ca/tmp-pmv/info/pal_mal_e.html)
*** New reports of cases in Provinces of Altagracia (Resorts in Punta Cana) and Duarte (San Francisco de Macoris)
Table 3. Recommendations for Traveler’s to Malaria Risk
Countries in Africa ***
|
Country |
Comments |
Recommended Drug |
|
Angola |
Every Area |
Atovaquone/Proguanil Doxycycline Mefloquine |
|
Botswana |
Selected Area |
Atovaquone/Proguanil Doxycycline Mefloquine |
|
Burkina Faso |
Every Area |
Atovaquone/Proguanil Doxycycline Mefloquine |
|
Benin |
Every Area |
Atovaquone/Proguanil Doxycycline Mefloquine |
|
Burundi |
Every Area |
Atovaquone/Proguanil Doxycycline Mefloquine |
|
Cameroon |
Every Area |
Atovaquone/Proguanil Doxycycline Mefloquine |
|
Cape Verde |
Sao Tiago Island |
Atovaquone/Proguanil Doxycycline Mefloquine |
|
Central African Republic |
Every Area |
Atovaquone/Proguanil Doxycycline Mefloquine |
|
Chad |
Every Area |
Atovaquone/Proguanil Doxycycline Mefloquine |
|
Comoros |
Every Area |
Atovaquone/Proguanil Doxycycline Mefloquine |
|
Congo |
Every Crea |
Atovaquone/Proguanil Doxycycline Mefloquine |
|
Cote d’Ivore |
Every Area |
Atovaquone/Proguanil Doxycycline Mefloquine |
|
Democratic Republic of Congo |
Every Area |
Atovaquone/Proguanil Doxycycline Mefloquine |
|
Djibouti |
Every Area |
Atovaquone/Proguanil Doxycycline Mefloquine |
|
Equatorial Guinea |
Every Area |
Atovaquone/Proguanil Doxycycline Mefloquine |
|
Eritrea |
Selected Areas |
Atovaquone/Proguanil Doxycycline Mefloquine |
|
Ghana |
Every Area |
Atovaquone/Proguanil Doxycycline Mefloquine |
|
Guinea |
Every Area |
Atovaquone/Proguanil Doxycycline Mefloquine |
|
Guinea-Bissau |
Every Area |
Atovaquone/Proguanil Doxycycline Mefloquine |
|
Ethiopia |
Selected Areas |
Atovaquone/Proguanil Doxycycline Mefloquine |
|
Gabon |
Every Area |
Atovaquone/Proguanil Doxycycline Mefloquine |
|
The Gambia |
Every Area |
Atovaquone/Proguanil Doxycycline Mefloquine |
|
Kenya |
Every Area |
Atovaquone/Proguanil Doxycycline Mefloquine |
|
Liberia |
Every Area |
Atovaquone/Proguanil Doxycycline Mefloquine |
|
Madagascar |
Every Area |
Atovaquone/Proguanil Doxycycline Mefloquine |
|
Malawi |
Every Area |
Atovaquone/Proguanil Doxycycline Mefloquine |
|
Mali |
Every Area |
Atovaquone/Proguanil Doxycycline Mefloquine |
|
Mauritania |
Selected Areas |
Atovaquone/Proguanil Doxycycline Mefloquine |
|
Mauritius |
Selected Areas |
Chloroquine Atovaquone/Proguanil Doxycycline Mefloquine |
|
Mayotte |
Every Area |
Atovaquone/Proguanil Doxycycline Mefloquine |
|
Mozambique |
Every Area |
Atovaquone/Proguanil Doxycycline Mefloquine |
|
Namibia |
Selected Areas |
Atovaquone/Proguanil Doxycycline Mefloquine |
|
Nigeria |
Every Area |
Atovaquone/Proguanil Doxycycline Mefloquine |
|
Niger |
Every Area |
Atovaquone/Proguanil Doxycycline Mefloquine |
|
Rwanda |
Every Area |
Atovaquone/Proguanil Doxycycline Mefloquine |
|
Somalia |
Every Area |
Atovaquone/Proguanil Doxycycline Mefloquine |
|
South Africa |
Selected Areas |
Atovaquone/Proguanil Doxycycline Mefloquine |
|
Sudan |
Every Area |
Atovaquone/Proguanil Doxycycline Mefloquine |
|
Swaziland |
All low lands |
Atovaquone/Proguanil Doxycycline Mefloquine |
|
Sao Tome and Principe |
Every Area |
Atovaquone/Proguanil Doxycycline Mefloquine |
|
Senegal |
Every Area |
Atovaquone/Proguanil Doxycycline Mefloquine |
|
Sierra Leone |
Every Area |
Atovaquone/Proguanil Doxycycline Mefloquine |
|
Tanzania |
Every area at altitudes < 1800 m |
Atovaquone/Proguanil Doxycycline Mefloquine |
|
Togo |
Every area |
Atovaquone/Proguanil Doxycycline Mefloquine |
|
Uganda |
Every area |
Atovaquone/Proguanil Doxycycline Mefloquine |
|
Zambia |
Every area |
Atovaquone/Proguanil Doxycycline Mefloquine |
|
Zimbabwe |
Selected Areas |
Atovaquone/Proguanil Doxycycline Mefloquine |
*** Sources of information: Centers for Disease Control and Prevention (http://www.cdc.gov/travel), World Health Organization web site (http://www.who.int/ith/), and Health Canada (http://www.phac-aspc.gc.ca/tmp-pmv/info/pal_mal_e.html)
Table 4. Recommendations for Traveler’s to Malaria Risk
Countries in Eastern Europe and the Independent States of the former Soviet
Union **
|
Country |
Comments |
Recommended Drug |
|
Armenia |
Selected Areas |
Chloroquine Atovaquone/Proguanil Doxycycline Mefloquine |
|
Azerbaijan |
Selected Areas |
Chloroquine Atovaquone/Proguanil Doxycycline Mefloquine |
|
Georgia |
Selected Areas |
Chloroquine Atovaquone/Proguanil Doxycycline Mefloquine |
|
Kyrgyzstan |
Selected Areas |
Chloroquine Atovaquone/Proguanil Doxycycline Mefloquine |
|
Tajikistan |
Selected Areas |
Chloroquine Atovaquone/Proguanil Doxycycline Mefloquine |
|
Turkey |
Selected Areas |
Chloroquine Atovaquone/Proguanil Doxycycline Mefloquine |
|
Turkmenistan |
Selected Areas |
Chloroquine Atovaquone/Proguanil Doxycycline Mefloquine |
|
Uzbekistan |
Selected Areas |
Chloroquine Atovaquone/Proguanil Doxycycline Mefloquine |
** Sources of information: Centers for Disease Control and Prevention (http://www.cdc.gov/travel), World Health Organization web site (http://www.who.int/ith/), and Health Canada (http://www.phac-aspc.gc.ca/tmp-pmv/info/pal_mal_e.html)
Table 5. Recommendations for Traveler’s to Malaria Risk
Countries in Asia (Including the Middle East, Indian Subcontinent, and Southeast
Asia) **
|
Country |
Comments |
Recommended Options |
|
Afghanistan |
Selected Areas |
Atovaquone/Proguanil Doxycycline Mefloquine |
|
Bangladesh |
Selected Areas |
Atovaquone/Proguanil Doxycycline Mefloquine |
|
Bhutan |
Selected Areas |
Atovaquone/Proguanil Doxycycline Mefloquine |
|
Myanmar (Burma) |
Selected Areas |
Atovaquone/Proguanil Doxycycline (Mefloquine not Recommended in eastern Burma due to reported resistance to mefloquine) |
|
Cambodia |
Selected Areas |
Atovaquone/Proguanil Doxycycline (Mefloquine Not Recommended in Western Cambodia due to reported resistance to mefloquine) |
|
China |
Selected Areas |
Atovaquone/Proguanil Doxycycline Mefloquine in Hainan/ Yunnan, and Guangxi
Chloroquine in all other areas or Atovaquone/Proguanil Doxycycline Mefloquine |
|
East Timor |
Every Area |
Atovaquone/Proguanil Doxycycline Mefloquine |
|
Indonesia |
Selected Areas |
Atovaquone/Proguanil Doxycycline Mefloquine |
|
Iran |
Selected Areas |
Atovaquone/Proguanil Doxycycline Mefloquine |
|
Iraq |
Selected Areas |
Chloroquine Atovaquone/Proguanil Doxycycline Mefloquine |
|
Malaysia |
Selected Areas |
Atovaquone/Proguanil Doxycycline Mefloquine |
|
North Korea |
Selected Areas |
Chloroquine Atovaquone/Proguanil Doxycycline Mefloquine |
|
South Korea |
Selected Areas |
Chloroquine Atovaquone/Proguanil Doxycycline Mefloquine |
|
Laos |
Every area except Vientiane |
Atovaquone/Proguanil Doxycycline Mefloquine |
|
Nepal |
Selected Areas |
Atovaquone/Proguanil Doxycycline Mefloquine |
|
Pakistan |
Every Area |
Atovaquone/Proguanil Doxycycline Mefloquine |
|
Philippines |
Selected Areas |
Atovaquone/Proguanil Doxycycline Mefloquine (Islands of Basilan, Luzon Mindanao, Palawan, and Sulu Archipielago.
Chloroquine Atovaquone/Proguanil Doxycycline Mefloquine (All other areas) |
|
Saudi Arabia |
Selected Areas |
Atovaquone/Proguanil Doxycycline Mefloquine |
|
Sri Lanka |
Selected Areas |
Atovaquone/Proguanil Doxycycline Mefloquine |
|
Syria |
Selected Areas |
Chloroquine Atovaquone/Proguanil Doxycycline Mefloquine |
|
Thailand |
Selected Areas |
Atovaquone/Proguanil Doxycycline (Mefloquine not recommended for areas bordering with Burma and Cambodia) |
|
Vietnam |
Selected Areas |
Atovaquone/Proguanil Doxycycline Mefloquine |
|
Yemen |
Selected Areas |
Atovaquone/Proguanil Doxycycline Mefloquine |
** Sources of information: Centers for Disease Control and Prevention (http://www.cdc.gov/travel), World Health Organization web site (http://www.who.int/ith/), and Health Canada (http://www.phac-aspc.gc.ca/tmp-pmv/info/pal_mal_e.html)
Table 6. Recommendations for Traveler’s to Malaria Risk
Countries in Oceania ^ (Australia and the South Pacific Islands) **
|
Country |
Comments |
Recommended Options |
|
Papua New Guinea |
Selected Areas (<1800 m) |
Atovaquone/Proguanil Doxycycline Mefloquine |
|
Vanuatu |
Every area |
Atovaquone/Proguanil Doxycycline Mefloquine |
|
Solomon Islands |
Selected areas |
Atovaquone/Proguanil Doxycycline Mefloquine |
** Sources of information: Centers for Disease Control and Prevention (http://www.cdc.gov/travel), World Health Organization web site (http://www.who.int/ith/), and Health Canada (http://www.phac-aspc.gc.ca/tmp-pmv/info/pal_mal_e.html)
^ No identified malaria risk in Australia, New Zealand and the rest of the South Pacific Islands