Appendix 1: Malaria risk and recommended preventive measures by geographical area

This document was last updated 2020/10/01

Table of contents

Description

Appendix I is a country-by-country description of malaria risk and recommendations for malaria prevention. As appropriate, regional and/or city-specific and/or seasonality risk information is also provided. The recommendations made in this appendix are generally consistent with the World Health Organization's International Travel and Health report and the CDC's Yellow Book: Health Information for International Travel. These and other sources used to develop this appendix are listed in the references.

While this appendix is updated regularly, it is possible that it will not reflect the most up-to-date information about malaria for a country, e.g., recent cases in a hitherto malaria-free jurisdiction. For this reason, health care providers providing advice on malaria prevention are encouraged to visit the Public Health Agency of Canada's Travel Health website to monitor for the newest information related to malaria and other travel-associated health risks.

For certain countries, there is a duration-of-exposure component to recommendations, expressed along the lines of: "chemoprophylaxis for stays > 1 week; chemoprophylaxis or PPM [personal protective measures] for stays of ≤ 1 week." The intent of this approach is to allow for greater flexibility in areas where malaria risk is low.

The appendix includes information on species of malaria parasite present in endemic countries, described as Plasmodium falciparum (P. f.), Plasmodium vivax (P. vivax), Plasmodium ovale (P. ovale), Plasmodium malariae (P. malariae) and/or Plasmodium knowlesi (P. knowlesi). The most common species is listed first and indicated in bold (if several species predominate, then they are bolded), followed by the second most frequent species, often P. vivax, and then other species.

Notes

  • Chemoprophylaxis is recommended only in the risk areas and the transmission season (often year round) identified. Chemoprophylaxis should always be used in conjunction with personal protective measures (PPM); refer to Chapter 3: "Malaria Education for Travellers" and the CATMAT Statement on Personal Protective Measures to Prevent Arthropod Bites).
  • The decision whether to use atovaquone-proguanil, doxycycline or mefloquine should be made on a case by case basis, and based on an individual patient benefit - risk assessment.
  • There might be situations where alternative agents are considered, e.g., primaquine. Refer to Chapter 8: "Drugs for the Prevention and Treatment of Malaria" for advice in this regard. Primaquine for presumptive anti-relapse therapy is not considered in this table (and is rarely recommended). Also refer to Chapter 8 for advice in this regard.

Appendix 1: Malaria risk and recommended preventive measures by geographical area

Country Malaria transmission areas and other information Species of parasite present
(more common in bold)
Malaria prevention recommendation

Afghanistan

Risk in all areas at elevations < 2000 m.

Risk is lower in central Kabul and Kandahar.

May-November.

P. vivax
P. f.

PPM only may be considered for central Kabul and Kandahar.

Atovaquone-proguanil, doxycycline or mefloquine.

Albania

No malaria transmission.

n/a

None.

Algeria

No malaria transmission

n/a

None.

American Samoa

No malaria transmission.

n/a

None.

Andorra

No malaria transmission.

n/a

None.

Angola

All areas.
Year-round

P. f.
P. ovale
P. vivax

Atovaquone-proguanil, doxycycline or mefloquine.

Anguilla (UK)

No malaria transmission.

n/a

None.

Antigua and Barbuda

No malaria transmission.

n/a

None.

Argentina

No malaria transmission

n/a

None.

Armenia

No malaria transmission.

n/a

None.

Aruba (NL)

No malaria transmission.

n/a

None.

Australia

No malaria transmission.

n/a

None.

Austria

No malaria transmission.

n/a

None.

Azerbaijan

No malaria transmission

n/a

None.

Bahamas

No malaria transmission.

n/a

None.

Bahrain

No malaria transmission.

n/a

None.

Bangladesh

No malaria transmission in the city of Dhaka.

n/a

None.

Little or no risk in areas of the country not described below.

P. f.
P. vivax
P. malariae

PPM.

Transmission only in rural areas.

Low risk exists in the districts of Hobigonj, Kurigram, Moulvibazar,Mymensingh, Netrakona, Sherpur, Sunamgonj and Sylhet.

Year-round.

Atovaquone-proguanil, doxycycline or mefloquine.

Relatively higher risk in Chittagong Hill Tract districts (Bandarban, Rangamati and Khagrachari), Chattogram district and Cox Bazaar district.

Year-round.

Barbados

No malaria transmission.

n/a

None.

Belarus

No malaria transmission.

n/a

None.

Belgium

No malaria transmission.

n/a

None.

Belize

No∕low risk through most of the country.

n/a

None.

Small foci of transmission, primarily in some areas of Stan Creek. Rare locally transmitted cases in other districts.

Year-round.

P. vivax

PPM.

Benin

All areas.
Year-round.

P. f.
P. ovale
P. vivax

Atovaquone-proguanil, doxycycline or mefloquine.

Bermuda (UK)

No malaria transmission.

n/a

None.

Bhutan

No/low risk through most of the country.

P. vivax
P. f.

PPM.

Rare seasonal cases in Lhuentse, Monggar, Punakha, Trashigang, Trongsa, Tsirang, Yangtse and Wangdue.

May-September.

Low, but relatively higher risk in rural areas <1,700 m (5,577 ft) in districts of Chukha, Dagana, Pemagatshel, Samdrup Jongkhar, Samtse, Sarpang, and Zhemgang, along the border with India.

Year-round.

Bolivia (Plurinational State of)

No malaria transmission in areas at elevations > 2500m, including the city of La Paz.

n/a

None.

Risk in all areas at elevations < 2500 m. The risk is predominantly due to P. vivax, with exceptions listed below.

Year-round.

P. vivax
P. f.

Atovaquone-proguanil, doxycycline or mefloquine.

Transmission of P. f. occurs in the northern departments of Beni and Pando (especially in the localities of Guayaramerín, Riberalta and Sena).

Year-round.

Atovaquone-proguanil,doxycycline or mefloquine.

Bosnia and Herzegovina

No malaria transmission.

n/a

None.

Botswana

No malaria transmission in the city of Gaborone, or in other areas not listed below.

n/a

None.

Low risk in the districts of Kgalagadi North, Kweneng West, and Southern.

P. f.
P. ovale
P. vivax

PPM.

Risk is present in the following districts/sub-districts: Central, Kweneng East, North-East (including Francistown), North-West (including Chobe National Park) and Okavango delta.

Predominantly November-June.

Atovaquone-proguanil, doxycycline or mefloquine.

Brazil

Some cases of P.vivax have been reported in 2018, in the town of Wenceslau Guimarães in Bahia State.

There is also a residual risk of P. vivax in the Atlantic forest areas of the states of Espirito Santo, Minas Gerais, Rio de Janeiro and São Paulo.

Year-round.

P. vivax
P. f.

PPM.

In the states outside the administrative region of Amazonas the risk of malaria transmission is negligible or non-existent including Iguazu Falls; in the cities of Brasília, Recife, Rio de Janeiro, São Paulo, and Salvador.

Risk is low in the less forested areas in southern Mato Grosso including most of the Pantanal.

Year-round.

Risk exists in most forested areas below 900 m within the nine states of the Amazon region (Acre, Amapá, Amazonas, Maranhão [western part], Mato Grosso [northern part]), Pará [except Belém City], Rondônia, Roraima and Tocantins [western part]).

Transmission intensity varies from one municipality to another, and is higher in jungle mining areas, in agricultural settlements, in indigenous areas and in some peripheral urban areas of Cruzeiro do Sul, Manaus and Pôrto Velho.

Malaria also occurs on the periphery of large cities such as Boa Vista, Macapá, Maraba, Rio Branco and Santarém.

Atovaquone-proguanil, doxycycline or mefloquine.

British Virgin Islands (UK)

No malaria transmission.

n/a

None.

Brunei Darussalam

Human infection with P. knowlesi reported.

n/a

PPM.

Bulgaria

No malaria transmission.

n/a

None.

Burkina Faso

All areas.
Year-round.

P. f.
P. ovale
P. vivax

Atovaquone-proguanil, doxycycline or mefloquine.

Burma (Myanmar)

No malaria transmission at elevations > 1000 m or in urban areas.

n/a

None.

Areas at elevations < 1000 m, except urban areas.

The central plains and the dry zones are generally free of malaria but some pockets of transmission still exist.

Risk of transmission is higher in remote rural hilly and forested areas and some coastal areas of Rakhine State.

There is risk in Bagan. Human infection with P. knowlesi reported.

Year-round.

P.f.
P. vivax
P. knowlesi
P. malariae
P. ovale

Atovaquone-proguanil,doxycycline or mefloquine.

Mefloquine resistance reported in Kayin state and the eastern part of Shan state.

Atovaquone-proguanil or doxycycline for Kayin and the eastern part of Shan state.

Burundi

All areas.
Year-round.

P. f.
P. malariae
P. ovale
P. vivax

Atovaquone-proguanil,doxycycline or mefloquine.

Cabo Verde

Generally low to no risk.

An outbreak (423 cases) occurred in the capital Praia in 2017.

No autochthonous cases reported in 2018.

P. f.

PPM.

Cambodia

No malaria transmission in the city of Phnom Penh and the area around Lake Tonlé Sap (Siem Reap). Negligible transmission in the tourist area of Angkor Wat and the city of Siem Reap.

Year-round.

P. f.
P. vivax
P. knowlesi
P. malariae

PPM.

All other areas.
Year-round.

Atovaquone-proguanil, doxycycline or mefloquine.

Mefloquine resistance is reported in the western provinces of Banteay Meanchey, Battambang, Koh Kong, Odder Meanchey, Pailin, Kampot, PreahVihear, Pursat, and Siem Reap bordering Thailand.

Year-round.

Atovaquone-proguanil or doxycycline.

Cameroon

All areas.
Year-round.

P. f.
P. ovale
P. vivax

Atovaquone-proguanil, doxycycline or mefloquine.

Canada

No malaria transmission.

n/a

None.

Cayman Islands (UK)

No malaria transmission.

n/a

None.

Central African Republic

All areas.
Year-round.

P. f.
P. malariae
P. ovale
P. vivax

Atovaquone-proguanil, doxycycline or mefloquine.

Chad

All areas.
Year-round.

P. f.
P. malariae
P. ovale
P. vivax

Atovaquone-proguanil,doxycycline or mefloquine.

Chile

No malaria transmission.

n/a

None.

China

No malaria transmission in most of China.

Limited transmission along China-Burma (Myanmar) border in the western part of rural Yunnan Province and in Motuo County in Tibet.

Year-round.

P. vivax
P. f. reported only in Yunnan Province

PPM in risk areas.

Colombia

No risk in areas at 1700 m or higher, in the cities of Baranquilla, Bogota, Cartagena and on the islands of San Andres and Providencia.

n/a

None.

Lower risk in northern rural areas and along the Caribbean coast.

P. f.
P. vivax

PPM only for lower risk areas.

 

Risk is higher in rural and jungle areas below 1700m.

Risk exists on excursions on the Magdalena River south of Baranquilla, on the Pacific coast, in the valleys of the Andes and east of the Cordillera Oriental.

Year-round.

Atovaquone-proguanil, doxycycline or mefloquine.

Comoros

All areas.
Year-round.

P. f.

Atovaquone-proguanil, doxycycline or mefloquine.

Congo

All areas.
Year-round.

P. f.
P. ovale
P. vivax

Atovaquone-proguanil, doxycycline or mefloquine.

Congo, Democratic Republic of the (formerly Zaïre)

All areas.
Year-round.

P. f.
P. ovale
P. vivax

Atovaquone-proguanil, doxycycline or mefloquine.

Cook Islands (NZ)

No malaria transmission.

n/a

None.

Costa Rica

Rare cases in Matina Canton in Limón Province, Sarapiquí Canton in Heredia Province, Pital District in San Carlos Canton in Alajuela Province.

P. vivax

PPM.

Côte D'Ivoire (Ivory Coast)

All areas.
Year-round.

P. f.
P. ovale
P. vivax

Atovaquone-proguanil, doxycycline or mefloquine.

Croatia

No malaria transmission.

n/a

None.

Cuba

No malaria transmission.

n/a

None.

Curaçao (NL)

No malaria transmission.

n/a

None.

Cyprus

No malaria transmission.

n/a

None.

CzechRepublic

No malaria transmission.

n/a

None.

Denmark

No malaria transmission.

n/a

None.

Djibouti

All areas.
Year-round.

P. f.
P. vivax

Atovaquone-proguanil, doxycycline or mefloquine.

Dominica

No malaria transmission.

n/a

None.

Dominican Republic

Little to no malaria transmission in the resort areas of Romana and Samaná and the cities of Santo Domingo, Santiago, and Puerto Plata.

Year-round.

P. f.

PPM.

In 2015, transmission increased in the National District, the provinces of Santo Domingo (excluding the city of Santo Domingo) and La Altagracia, specifically in Bávaro district.

Risk is year-round, but considered higher during the rainy season (usually May-October).

PPM
plus optionally atovaquone-proguanil,
chloroquine,
doxycycline or mefloquine.

Rural areas, with the highest risk in the provinces of Dajabón, Elias Piña, and San Juan bordering Haiti.

Year-round.

Atovaquone-proguanil, chloroquine, doxycycline or mefloquine.

Ecuador

Low to no malaria transmission at elevations > 1500 m, including Cuenca, Quito, and other cities and villages in the Andean highlands; in the city of Guayaquil or on the Galápagos Islands.

P. vivax
P. f.

PPM.

All other areas at elevations < 1500 m.

Risk of P vivax malaria is present predominantly in the Amazon region, in particular the provinces of Morona Santiago, Pastaza, Orellana, and Sucumbíos.

Risk of P. f. malaria is present predominantly on the coast, particularly in the province of Esmeraldas, and in the Amazon region, especially the provinces of Pastaza and Morona Santiago.

Year-round.

Atovaquone-proguanil, doxycycline or mefloquine.

Egypt

No malaria transmission.

n/a

None.

El Salvador

Rare cases along the Guatemalan border.

Year-round.

P. vivax
P. f.

PPM.

Equatorial Guinea

All areas.
Year-round.

P. f.
P. malariae
P. ovale
P. vivax

Atovaquone-proguanil, doxycycline or mefloquine.

Eritrea

No malaria transmission at elevations ≥ 2200 m, including the city of Asmara.

n/a

None.

All areas at elevations < 2200 m.
Year-round.

P. f.
P. vivax
P. ovale

Atovaquone-proguanil, doxycycline or mefloquine.

Estonia

No malaria transmission.

n/a

None.

Ethiopia

Low to no malaria transmission at elevations ≥ 2200 m, including Addis Ababa.

n/a

PPM.

All areas at elevations < 2200 m, including Axum (2139 m), Dire Dawa (1262 m), Harar (1848 m), and Nazret (1725 m).

Year-round

P. f.
P. vivax
P. malariae
P. ovale

Atovaquone-proguanil, doxycycline or mefloquine.

Fiji

No malaria transmission.

n/a

None.

Finland

No malaria transmission.

n/a

None.

France

No malaria transmission.

n/a

None.

French Guiana

No malaria transmission in the city of Cayenne or on Devil's Island (Île du Diable).

n/a

None.

All other areas.

Risk along the coast is low but increases towards the interior.

High risk of transmission along the rivers in the interior, and in municipalities bordering Brazil (Oiapoque river valley) and Suriname (Maroni river valley).

Year-round.

P. vivax
P. f.

PPM only can be considered for coastal states.
Atovaquone-proguanil, doxycycline or mefloquine.

French Polynesia

No malaria transmission.

n/a

None.

Gabon

All areas.
Year-round.

P. f.
P. malariae
P. ovale
P. vivax

Atovaquone-proguanil, doxycycline or mefloquine.

Gambia

All areas.
Year-round.

P. f.

Atovaquone-proguanil, doxycycline or mefloquine.

Georgia

No malaria transmission.

n/a

None.

Germany

No malaria transmission.

n/a

None.

Ghana

All areas.
Year-round.

P. f.
P. ovale
P. vivax

Atovaquone-proguanil, doxycycline or mefloquine.

Gibraltar (UK)

No malaria transmission.

n/a

None.

Greece

Very limited local transmission associated with imported cases in agricultural areas.

None in tourist areas.

P. vivax

None; PPM for areas where cases are reported.

Greenland (Denmark)

No malaria transmission.

n/a

None.

Grenada

No malaria transmission.

n/a

None.

Guadeloupe (FR)

No malaria transmission.

n/a

None.

Guam (US)

No malaria transmission.

n/a

None.

Guatemala

No malaria transmission in urban areas or areas at elevations > 1500 m.

None in Guatemala City, Antigua, and Lake Atitlán.

n/a

None.

Rural areas below 1500 m.

Low risk in the rest of the departments (Chiquimula, Zacapa, Baja Verapaz, San Marcos, Peten, Jutiapa, Jalapa, El Progreso, Santa Rosa, Guatemala, Chimaltenango, Huehuetenango, and Quiche).

Risk is higher in the departments of Escuintla (municipalities of Gomera, Masagua, Santa Lucia Cotzumalguapa, and Tiquisate) and Alta Verapaz (municipalities of Telemán, Panzós, and La Tinta).

Moderate risk in the departments of Suchitepéquez, Retalhuleu and Izabal.

Year-round.

P. vivax
P. f.

PPM only for low-risk areas.

Atovaquone-proguanil,
chloroquine,
doxycycline or mefloquine.

Guinea

All areas.
Year-round.

P. f.
P. ovale
P. vivax

Atovaquone-proguanil, doxycycline or mefloquine.

Guinea-Bissau

All areas.
Year-round.

P. f.
P. ovale
P. vivax

Atovaquone-proguanil, doxycycline or
mefloquine.

Guyana

Rare cases in the cities of Amsterdam and Georgetown.

Low risk along the coast of Guyana, in regions 3 to 6.

Year-round.

P. f.
P. vivax

PPM.

All other areas at elevations < 900 m.

Risk is high in all parts of the interior.

Year-round.

Atovaquone-proguanil, doxycycline or mefloquine.

Haiti

All areas.
Year-round.

P. f.

Atovaquone-proguanil, chloroquine, doxycycline or mefloquine.

Holy See (Vatican City)

No malaria transmission.

n/a

None.

Honduras

No malaria transmission - in the cities of Tegucigalpa and San Pedro Sula.

Risk is low in higher mountainous areas in the west.

n/a

PPM in low risk areas.

Risk is high in departments of Colón and Gracias a Dios and moderate in Atlántida, El Paraiso, Olancho, and Yoro. P. f. transmission risk is high in Colón and Gracias a Dios.

There is malaria risk on the island of Roatan and other Bay Islands.

Year-round.

P. vivax
P. f.

Atovaquone-proguanil, chloroquine, doxycycline or mefloquine.

Hong Kong (China)

No malaria transmission.

n/a

None.

Hungary

No malaria transmission.

n/a

None.

Iceland

No malaria transmission.

n/a

None.

India

No malaria transmission at elevations > 2000 m and in parts of the states of Himachal Pradesh, Jammu and Kashmir, and Sikkim.

n/a

None.

Year round malarial risk in all areas below 2000 m.

Risk is relatively higher in the northeastern and central states, include Odisha, Chhattisgarh, Jharkhand, Madhya Pradesh, Maharashtra and some north-eastern states such as Tripura, Meghalaya and Mizoram

P. f.
P. vivax

Atovaquone-proguanil, doxycycline or mefloquine.

Risk is lower in central urban areas of Delhi, Agra, Mumbai, Nagpur, Nasik, Pune, Kolkata and Bangalore.

PPM alone can be considered for stays of <1 week in central urban areas of cities listed as low risk.

Indonesia

No risk in cities of Jakarta and Ubud, resort areas of Bali and Java, and Gili Islands and the Thousand Islands (Pulau Seribu).

P. f.
P. vivax
P. knowlesi
(Province of Kalimantan)
P. malariae
P. ovale

None.

All areas of eastern Indonesia (provinces of Maluku, Maluku Utara, Nusa Tenggara Timur, Papua, and Papua Barat), including the town of Labuan Bajo and Komodo Islands in the Nusa Tenggara region.

Rural areas of Kalimantan (Borneo), Nusa Tenggara Barat (includes the island of Lombok), Sulawesi, and Sumatra.Low transmission in rural areas of Java, including Pangandaran, Sukalumi, and Ujung Kulong.

Atovaquone-proguanil, doxycycline or mefloquine.

Iran, Islamic Republic of

No transmission through most of the country.

Low risk in rural areas bordering Pakistan and Afghanistan.

Very limited seasonal risk in therural areas of the provinces of Hormozgan, Kerman (tropical part only), and Sistan-Baluchestan (southern part only).

P. vivax
P. f.

PPM in risk areas.

Iraq

No malaria transmission.

n/a

None.

Ireland

No malaria transmission.

n/a

None.

Israel

No malaria transmission.

n/a

None.

Italy

No malaria transmission.

n/a

None.

Jamaica

No malaria transmission.

n/a

None.

Japan

No malaria transmission.

n/a

None.

Jordan

No malaria transmission.

n/a

None.

Kazakhstan

No malaria transmission.

n/a

None.

Kenya

Little to no malaria transmission at elevations > 2500 m or in the city of Nairobi.

P. f.
P. vivax
P. ovale

PPM.

All areas at elevations < 2500 m, except the city of Nairobi.

Year-round.

Atovaquone-proguanil, doxycycline or mefloquine.

Kiribati

No malaria transmission.

n/a

None.

Korea, Democratic People's Republic of (North Korea)

Limited risk in some southern areas.

Presumed to be March-December.

P. vivax

PPM.

Korea, Republic of (South Korea)

Limited risk in the demilitarized zone (DMZ); rural areas in the northern parts of the provinces of Gyeonggi-do (Kyonggi) and Gangwon-do (Kangwon-do); and the northern part of the city of Incheon.

March-December.

P. vivax

PPM.

Kosovo

No malaria transmission.

n/a

None.

Kuwait

No malaria transmission.

n/a

None.

Kyrgyzstan

No malaria transmission.

n/a

None.

Lao People's Democratic Republic (Laos)

Malaria risk due predominantly to P. f. exists throughout the year in the entire country except in Vientiane.

P. f.
P. vivax
P. malariae
P. ovale

Atovaquone-proguanil, doxycycline or mefloquine.

Mefloquine resistance has been reported along the Laos-Burma (Myanmar) border in the provinces of Bokeo and Louang Namtha, along the Laos-Thailand border in the province of Champasak and Saravan, along the Laos-Cambodia border, and along the Laos-Vietnam border.

Atovaquone-proguanil or doxycycline.

Latvia

No malaria transmission.

n/a

None.

Lebanon

No malaria transmission.

n/a

None.

Lesotho

No malaria transmission.

n/a

None.

Liberia

All areas.
Year-round.

P. f.
P. ovale
P. vivax

Atovaquone-proguanil, doxycycline or mefloquine.

Libyan Arab Jamahiriya (Libya)

No malaria transmission.

n/a

None.

Liechtenstein

No malaria transmission.

n/a

None.

Lithuania

No malaria transmission.

n/a

None.

Luxembourg

No malaria transmission.

n/a

None.

Macao (China)

No malaria transmission.

n/a

None.

Macedonia

No malaria transmission.

n/a

None.

Madagascar

All areas.
Risk is highest in coastal areas.
Year-round.

P. f.
P. vivax
P. ovale

Atovaquone-proguanil, doxycycline or mefloquine.

Rare cases in the city of Antananarivo.
Year-round.

PPM.

Malawi

All areas.

Year-round.

P. f.
P. malariae
P. ovale
P. vivax

Atovaquone-proguanil, doxycycline or mefloquine.

Malaysia

No malaria transmission in urban, suburban and coastal areas.

n/a

None.

Low risk in rural central areas of Peninsular Malaysia.

Low, but relatively higher risk in east Malaysian Borneo limited to deep hinterland in the states of Sabah and Sarawak.

Year-round.

P. vivax
P. f.
P. malariae
P. knowlesi
P. ovale

Atovaquone-proguanil, doxycycline or mefloquine.

Maldives

No malaria transmission.

n/a

None.

Mali

All areas.
Year-round.

P. f.
P. vivax
P. ovale

Atovaquone-proguanil, doxycycline or mefloquine.

Malta

No malaria transmission.

n/a

None.

Marshall Islands

No malaria transmission.

n/a

None.

Martinique (FR)

No malaria transmission.

n/a

None.

Mauritania

No malaria transmission in the northern provinces of Dakhlet-Nouadhibou, and Tiris-Zemmour.

n/a

None.

Present in southern provinces including Nouakchott.

Year-round, except July-October in Adrar and Inchiri.

P. f.
P. ovale
P. vivax

Atovaquone-proguanil, doxycycline or mefloquine.

Mauritius

No malaria transmission.

n/a

None.

Mayotte (FR)

All areas.
Rare cases.
Year-round.

P. f.
P. vivax
P. malariae
P. ovale

PPM.

Mexico

Low risk in Chiapas and southern part of Chihuahua.

P. vivax

Atovaquone-proguanil, doxycycline or mefloquine.

Very low risk in states of, Durango, Jalisco, Nayarit, Quintana Roo, San Luis Potosi, Sinaloa, Sonora, and Tabasco.

PPM.

Rare cases in Campeche, Durango, Jalisco, Nayarit, Quintana Roo, San Luis Potosi, Sinaloa, Sonora, and Tabasco.

No malaria along the United States-Mexico border.

PPM.

Micronesia, Federated States of

No malaria transmission.

n/a

None.

Moldova, Republic of

No malaria transmission.

n/a

None.

Monaco

No malaria transmission.

n/a

None.

Mongolia

No malaria transmission.

n/a

None.

Montenegro

No malaria transmission.

n/a

None.

Montserrat (UK)

No malaria transmission.

n/a

None.

Morocco

No malaria transmission.

n/a

None.

Mozambique

All areas.
Year-round.

P. f.
P. malariae
P. ovale
P. vivax

Atovaquone-proguanil, doxycycline or mefloquine.

Namibia

No malaria transmission in southern two-thirds of the country, including the city of Windhoek.

n/a

None.

The regions of Caprivi;Kunene (including Etosha National park), iareas along the Kunene River and Kavango.

Areas along the Zambezi river in the Zambezi region and Okavongo river in Kavango regions (east and West).

Year-round.

P. f.
P. malariae
P. ovale
P. vivax

Atovaquone-proguanil, doxycycline or mefloquine.

The regions of Ohangwena, Omaheke, Omusati, Oshana, Oshikoto, and Otjozondjupa.

November-June.

Nauru

No malaria transmission.

n/a

None.

Nepal

Kathmandu, typical Himalayan treks and all other areas not listed below to be risk-free.

n/a

None.

Year-round Malaria exists in rural areas of the 20 Terai districts bordering India, with occasional outbreaks of P. f. from July-October.

P. vivax
P. f.

Atovaquone-proguanil, doxycycline or mefloquine.

Seasonal transmission of P. vivax takes place in 45 districts of the inner Terai and mid-hills.

July-October.

P. vivax

Atovaquone-proguanil, doxycycline or mefloquine.

PPM alone may be considered for stays < 14 days.

Netherlands

No malaria transmission.

n/a

None.

New Caledonia (FR)

No malaria transmission.

n/a

None.

New Zealand

No malaria transmission.

n/a

None.

Nicaragua

Little to no malaria transmission in departments not listed below.
Rare cases reported in Boaco, Chinandega, Esteli, Jinotega, Leon, Matagalpa, and Nueva Segovia.

Year-round.

P. vivax
P. f

PPM.

Región Autónoma Atlántico Norte (RAAN), and Región Autónoma Atlántico Sur (RAAS), specifically in the municipalities of Rosita, Siuna, Bonanza, Puerto Cabezas and Waspán.

Year-round.

Chloroquine, atovaquone-proguanil, doxycycline or mefloquine.

Niger

All areas.
Year-round.

P. f.
P. ovale
P. vivax

Atovaquone-proguanil, doxycycline or mefloquine.

Nigeria

All areas.
Year-round.

P. f.
P. ovale
P. vivax

Atovaquone-proguanil, doxycycline or mefloquine.

Niue (NZ)

No malaria transmission.

n/a

None.

Northern Mariana Islands (US)

No malaria transmission.

n/a

None.

Norway

No malaria transmission.

n/a

None.

Oman

Sporadic transmission of P. f. and P. vivax may occur subsequent to international importations of parasites.

n/a

None.

Pakistan

Malaria risk exists throughout the year in all areas including cities below 2200 m.

P. vivax
P. f.

Atovaquone-proguanil, doxycycline or mefloquine.

Palau

No malaria transmission.

n/a

None.

Panama

Little to no malaria transmission in Panama City, the Canal zone, or regions not listed below.

Year-round.

P. vivax
P. f.

PPM.

Most transmission in provinces east of the Panama Canal toward the border with Colombia.

P. f. resistance to chloroquine has been reported in Darién and Kuna Yala (San Blas).

There is some risk in Ngäbe Buglé on the west side of the canal.

Year-round.

Atovaquone-proguanil, doxycycline or mefloquine.

In Ngabe Bugle Chloroquine, atovaquone-proguanil, doxycycline or mefloquine for stays > 2 week; chloroquine, atovaquone-proguanil, doxycycline or mefloquine or PPM alone for stays of < 2 weeks.

Papua New Guinea

All areas at elevations < 1900 m.

P. vivax
P.f.

Atovaquone-proguanil, doxycycline or mefloquine.

Paraguay

No autochthonous cases reported since 2012, certified malaria free in 2018.

n/a

None.

Peru

No malaria risk at elevations > 2000 m, including the highland tourist areas (Machu Picchu, Lake Titicaca, and the cities of Arequipa, Cuzco, Puno) or along the Pacific Coast Lima province, and the cities of Moquegua, Ica, Nazca, and Tacna have no risk.

n/a

None

All areas < 2000 m (except areas listed above). This includes the cities of Puerto Maldonado and Iquitos.

Most P.f. cases occur in the region of Loreto.

Year-round.

P. vivax
P. f.

Atovaquone-proguanil, doxycycline or mefloquine.

Philippines

None in metropolitan Manila and other urban areas.

P. f.
P. vivax
P. knowlesi

None

Malaria risk exists year round in Palawan and Mindanao Islands.

Atovaquone-proguanil, doxycycline or mefloquine.

Pitcairn Islands (UK)

No malaria transmission.

n/a

None.

Poland

No malaria transmission.

n/a

None.

Portugal

No malaria transmission.

n/a

None.

Puerto Rico (US)

No malaria transmission.

n/a

None.

Qatar

No malaria transmission.

n/a

None.

Réunion (FR)

No malaria transmission.

n/a

None.

Romania

No malaria transmission.

n/a

None.

Russian Federation (Russia)

No malaria transmission.

n/a

None.

Rwanda

All areas.
Year-round.

P.f.
P. vivax
P. ovale

Atovaquone-proguanil, doxycycline or mefloquine.

Saint-Barthélemy (FR)

No malaria transmission.

n/a

None.

Saint Helena (UK)

No malaria transmission.

n/a

 

Saint Kitts and Nevis

No malaria transmission.

n/a

None.

Saint Lucia

No malaria transmission.

n/a

None.

Saint Martin (FR)

No malaria transmission.

n/a

None.

Saint Pierre and Miquelon (FR)

No malaria transmission.

n/a

None.

Saint Vincent and the Grenadines

No malaria transmission.

n/a

None.

Samoa

No malaria transmission.

n/a

None.

San Marino

No malaria transmission.

n/a

None.

São Tomé and Príncipe

All areas.
Year-round.

P.f.
P. vivax
P. malariae
P. ovale

Atovaquone-proguanil, doxycycline or mefloquine.

Saudi Arabia

No transmission through most of the country.

Low risk in Asir and Jazan emirates by border with Yemen.

Year-round.

P. f.
P. vivax

PPM in risk areas.

Senegal

All areas.
Year-round.

P. f.
P. vivax
P. ovale

Atovaquone-proguanil, doxycycline or mefloquine.

Serbia

No malaria transmission.

n/a

None.

Seychelles

No malaria transmission.

n/a

None.

Sierra Leone

All areas.
Year-round.

n/a

Atovaquone-proguanil, doxycycline or mefloquine.

Singapore

No malaria transmission.

n/a

None.

Saint Maarten (NL)

No malaria transmission.

n/a

None.

Slovakia

No malaria transmission.

n/a

None.

Slovenia

No malaria transmission.

n/a

None.

Solomon Islands

All areas.
Year-round.

P. f.
P. vivax
P. ovale

Atovaquone-proguanil, doxycycline or mefloquine.

Somalia

All areas.
Year-round.

P. f.
P. vivax
P. malariae
P. ovale

Atovaquone-proguanil, doxycycline or mefloquine.

South Africa

No malaria transmission in most of the country including the Garden Route and major cities.

n/a

None.

Transmission occurs along the border with Zimbabwe and Mozambique.

Specifically in Mopani, Vhembe, and Waterberg district municipalities of Limpopo Province; Ehlanzeni district municipality in Mpumalanga Province; and Umknanyakude in Kwazulu-Natal Province.

Present in Kruger National Park.

Year-round.

P. f.
P. vivax
P. ovale

Atovaquone-proguanil, doxycycline or mefloquine.

South Sudan

All areas.
Year-round.

P. f.
P. vivax
P. malariae
P. ovale

Atovaquone-proguanil, doxycycline or mefloquine.

Spain

No malaria transmission.

n/a

None.

Sri Lanka

No malaria transmission.

n/a

None.

Sudan, Republic of

All areas, very low risk in Khartoum.
Year-round.

P. f.
P. vivax
P. malariae
P. ovale

Atovaquone-proguanil, doxycycline or mefloquine for all areas with exception of Khartoum (use PPM).

Suriname

No or low transmission through most of the country.

P. f.
P. vivax

PPM.

Tapanahony municipality in Sipaliwini Province.

Year-round.

Atovaquone-proguanil, doxycycline or mefloquine.

Swaziland (Eswatini)

Limited/no transmission through most of the country.

P. f.
P. vivax
P. ovale

PPM.

Present in eastern areas bordering Mozambique and South Africa, including all of Lubombo district and the eastern half of Hhohho, Manzini, and Shiselweni districts.

Year-round.

Atovaquone-proguanil, doxycycline or mefloquine.

Sweden

No malaria transmission.

n/a

None.

Switzerland

No malaria transmission.

n/a

None.

Syrian Arab Republic (Syria)

No malaria transmission.

n/a

None.

Tajikistan

No autochthonous cases reported since 2015.

n/a

None.

Tanzania, United Republic of

All areas at elevations < 1800 m.
Includes Zanzibar.
Year-round.

P. f.
P. vivax
P. malariae
P. ovale

Atovaquone-proguanil, doxycycline or mefloquine.

Thailand

Low/no risk through much of Thailand including the cities of Bangkok, Chang Mai, Chang Rai, Koh Phangan, Koh Samui, and Phuket. None in the islands of Krabi Province (Koh Phi Phi, Koh Yao Noi, Koh Yao Yai, and Ko Lanta) and Pattaya City.

 

PPM.

Risk exists in the provinces that border Burma (Myanmar), Cambodia, and Laos, as well as the provinces of Kalasin, Krabi (Plai Phraya District only), Nakhon Si Thammarat, Narathiwat, Pattani, Phang Nga (including Phang Nga City), Rayong, Sakon Nakhon, Songkhla, Surat Thani, and Yala.

Year-round.

P. f.
P. vivax
P. knowlesi
P. ovale

Atovaquone-proguanil or doxycycline.

There is resistance to mefloquine.

Timor-Leste (East Timor)

Low/no risk through much of country.

P. f.
P. vivax
P. malariae
P. ovale

PPM.

Higher risk in Oecuse district.

Atovaquone-proguanil, doxycycline or mefloquine.

Togo

All areas.
Year-round.

P. f
P. vivax
P. ovale

Atovaquone-proguanil, doxycycline or mefloquine.

Tokelau (NZ)

No malaria transmission.

n/a

None.

Tonga

No malaria transmission.

n/a

None.

Trinidad and Tobago

No malaria transmission.

n/a

None.

Tunisia

No malaria transmission.

n/a

None.

Turkey

No malaria transmission.

n/a

None.

Turkmenistan

No malaria transmission.

n/a

None.

Turks and Caicos Islands (UK)

No malaria transmission.

n/a

None.

Tuvalu

No malaria transmission.

n/a

None.

Uganda

All areas.
Year-round.

P. f.
P. vivax
P. malariae
P. ovale

Atovaquone-proguanil, doxycycline or mefloquine.

Ukraine

No malaria transmission.

n/a

None.

United Arab Emirates

No malaria transmission.

n/a

None.

United Kingdom

No malaria transmission.

n/a

None.

United States

No malaria transmission.

n/a

None.

US Virgin Islands

No malaria transmission.

n/a

None.

Uruguay

No malaria transmission.

n/a

None.

Uzbekistan

No malaria transmission.

n/a

None.

Vanuatu

All areas.
Year-round.

P. vivax
P. f.
P. ovale

Atovaquone-proguanil, doxycycline or mefloquine.

Venezuela, Bolivarian Republic of

All areas <1,700 m (5,577 ft).
Present in Angel Falls.
Year-round.

P. vivax
P. f.

Atovaquone-proguanil, doxycycline or mefloquine.

Vietnam

None in Da Nang, Haiphong, Hanoi, Ho Chi Minh City (Saigon), NhaTrang, Qui Nhon, and the Red River Delta.Rare cases in the Mekong Delta.

The common coastal itinerary between Ho Chi Minh City and Hanoi with overnights mainly in urban areas does not typically require chemoprophylaxis.

Year-round.

P. f.
P. vivax
P. knowlesi

PPM.

Other rural areas (except where there is resistance to mefloquine, see below).

Year round.

Atovaquone-proguanil, doxycycline or mefloquine.

Rural areas of Dac Lac, Gia Lai, Khanh Hoa, Kon Tum, Lam Dong, Ninh Thuan, Song Be, and Tay Ninh.

Year-round.

Atovaquone-proguanil or doxycycline.

There is resistance to mefloquine.

West Bank and Gaza Strip

No malaria transmission.

n/a

None.

Western Sahara

Malaria transmission very rare.
Unknown.

Unknown

PPM.

Yemen

No malaria transmission at elevations > 2000 m, including in the city of Sana'a.

n/a

None.

Very limited transmission on Socotra Island.

Year-round.

P. f.
P. vivax
P. malariae
P. ovale

PPM.

All areas at elevations < 2000 m.

Year-round.

Atovaquone-proguanil, doxycycline or mefloquine.

Zambia

All areas.
Year-round.

P. f.
P. vivax
P. ovale

Atovaquone-proguanil, doxycycline or mefloquine.

Zimbabwe

Low risk in Harare and Bulawayo and areas > 1200 m.

P. f.
P. vivax
P. ovale

PPM.

Atovaquone-proguanil, doxycycline or mefloquine.

Year-round in the Zambezi Valley, including Victoria Falls.

All other areas < 1200, transmission season is November-June.

Abbreviations: FR, France; n/a, not applicable; NL, Netherlands; NZ, New Zealand; PPM, personal protective measures; UK, United Kingdom; US, United States.

References

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