Appendix 1: Malaria Risk and Recommended Chemoprophylaxis by Geographic Area

Geographic Areas as per WHO International Travel and Health^{Footnote 10}

This document was last updated November 15, 2018

Description
Appendix 1: Malaria Risk and Recommended Chemoprophylaxis by Geographical Area
References

Description

Appendix 1 shows a country-by-country characterization of malaria transmission areas based on elevation, seasonality and epidemiologic data. Regional and/or city-specific information may also be provided. While relatively accurate in the shorter term, in some areas, risk may vary from year to year and season to season. In other countries where risk for malaria is present year-round in all areas, there is little variation that would affect malaria chemoprophylaxis recommendations from year to year. The Public Health Agency of Canada's Travel Health website is available to keep travel health practitioners abreast of changes in risk.

In these guidelines, CATMAT has tried to balance the need for protection with the potential for adverse effects of chemoprophylaxis. For the most part, CATMAT guidelines are consistent with the World Health Organization's International Travel and Health report and the CDC's Yellow Book: Health Information for International Travel, but in some instances is reflective of European national recommendations ^{Footnote 1-Footnote 10}.

For certain countries, CATMAT now includes a duration-of-exposure component in its recommendations, expressed in the format: "Chloroquine for stays > 1 weeks; Chloroquine or PPM [personal protective measures] alone for stays of ≤ 1 weeks." The intent is to allow the travel health practitioner to be more flexible for those countries where malaria risk is particularly low. That is to say, practitioners may consider recommending PPM alone for stays equal to or shorter than the identified time period, but CATMAT continues to recommend chemoprophylaxis along with PPM for all longer stays. When no chemoprophylaxis has been used, urgent medical consultation should be sought in the event of a fever. The rationale for this decision is outlined in Chapter 2.

**Appendix 1: Malaria risk and recommended chemoprophylaxis by geographic area**
Country	Malaria transmission areas^{Footnote 1, Footnote 2, Footnote 6}	Chemoprophylaxis recommended by CATMAT^{Footnote †}^{Footnote 1-Footnote 8}	Season^{Footnote 1-Footnote 2}	Plasmodium falciparum^{Footnote 1, Footnote 2, Footnote 6} %
Footnotes Footnote † Chemoprophylaxis is recommended only in the risk areas identified during the transmission season identified. Chemoprophylaxis should always be used in conjunction with PPM. Return to footnote † referrer Footnote ‡ 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. Return to first footnote ‡ referrer Abbreviations: FR, France; n/a, not applicable; NL, Netherlands; NZ, New Zealand; PPM, personal protective measures; UK, United Kingdom; US, United States; Note: PPM are outlined in Chapter 3: "Malaria Education for Travellers" and the CATMAT Statement on Personal Protective Measures to Prevent Arthropod Bites.
A
Countries: A B C D E F G H I J K L M N O P Q R S T U V W Y Z
Afghanistan	All areas at elevations < 2000 m. Risk is considered lower in central Kabul where PPM can be considered as an alternative to chemoprophylaxis.	Atovaquone-proguanil, doxycycline or mefloquine.^{Footnote ‡}	May-Nov	10-20
Albania	No malaria transmission.	None.	n/a	n/a
Algeria	No malaria transmission.	None.	n/a	n/a
American Samoa	No malaria transmission.	None.	n/a	n/a
Andorra	No malaria transmission.	None.	n/a	n/a
Angola	All areas.	Atovaquone-proguanil, doxycycline or mefloquine.^{Footnote ‡}	Year-round	90
Anguilla (UK)	No malaria transmission.	None.	n/a	n/a
Antigua and Barbuda	No malaria transmission.	None.	n/a	n/a
Argentina	No malaria transmission.	None.	n/a	n/a
Armenia	No malaria transmission.	None.	n/a	n/a
Aruba (NL)	No malaria transmission.	None.	n/a	n/a
Australia	No malaria transmission.	None.	n/a	n/a
Austria	No malaria transmission.	None.	n/a	n/a
Azerbaijan	Areas at elevations < 1500 m in the rural lowlands mainly between the Kura and Arax rivers. No indigenous cases reported in 2013. No risk in Baku.	Use PPM	Jun-Oct	0
B
Countries: A B C D E F G H I J K L M N O P Q R S T U V W Y Z
Bahamas	No malaria transmission.	None.	n/a	n/a
Bahrain	No malaria transmission.	None.	n/a	n/a
Bangladesh	No malaria transmission in the city of Dhaka.	None.	n/a	n/a
	Little or no risk in areas of the country not described below.	PPM	Year-round	> 50
	Low risk exists in the districts of Hobigonj, Kurigram, Moulvibazar,Mymensingh, Netrakona, Sherpur, Sunamgonj and Sylhet.	Atovaquone-proguanil, doxycycline or mefloquine.^{Footnote ‡}
	The risk is high in Chittagong Hill Tract districts (Bandarban, Rangamati and Khagrachari), Chittagong district and Cox Bazaar district.
Barbados	No malaria transmission.	None.	n/a	n/a
Belarus	No malaria transmission.	None.	n/a	n/a
Belgium	No malaria transmission.	None.	n/a	n/a
Belize	No malaria transmission in Belize City and islands frequented by tourists.	None.	n/a	n/a
Belize	Small foci of transmission, primarily in Stann Creek and Toledo. Rare locally transmitted cases in other districts.	None; use PPM.	Year-round	5
Benin	All areas.	Atovaquone-proguanil, doxycycline or mefloquine.^{Footnote ‡}	Year-round	85
Bermuda (UK)	No malaria transmission.	None.	n/a	n/a
Bhutan	Districts of Bumthang, Gaza, Paro, and Thimphu: no risk.	None.	n/a	n/a
	Rare seasonal cases in districts of Ha, Lhuentse, Monggar, Punakha, Trashigang, Trongsa, Tsirang, Yangtse, and Wangdue.	PPM.	May-September	50
	All rural areas <1,700 m (5,577 ft) in districts of Chukha, Dagana, Pemagatshel, SamdrugJongkhar, Samtse, Sarpang, and Zhemgang.	Atovaquone-proguanil, doxycycline or mefloquine.^{Footnote ‡}	Year-round	50
Bolivia (Plurinational State of)	No malaria transmission in areas at elevations > 2500m, including the city of La Paz.	None.	n/a	n/a
	All areas at elevations < 2500 m. The risk is predominantly due to P. vivax, with exceptions listed below.	Atovaquone-proguanil, chloroquine, doxycycline or mefloquine.^{Footnote ‡}	Year-round	6
	Transmission of P. falciparum malaria occurs in the northern departments of Beni and Pando (especially in the localities of Guayaramerín and Riberalta) and in Santa Cruz.	Atovaquone-proguanil,doxycycline or mefloquine.^{Footnote ‡}	Year-round	6
Bosnia and Herzegovina	No malaria transmission.	None.	n/a	n/a
Botswana	No malaria transmission in the cities of Francistown or Gaborone or in other areas not listed below.	None.	n/a	n/a
Botswana	Bobirwa, Boteti, Chobe, Kgatleng, Kweneng, Ngamiland, North East, Mahalapye, Moshupa, Okavango, Palapye, Serowe, Tonata, Tutume districts/sub-districts.	Atovaquone-proguanil, doxycycline or mefloquine.^{Footnote ‡}	Predominantly Nov-Jun	90
Brazil	Some cases of P.vivax have been reported in 2018, in the town of Wenceslau Guimarães in Bahia State.	None; use PPM.	Year-round	15
	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.	None; use PPM.
	Malaria risk - P. vivax (84%), P. falciparum (15%), mixed infections (1%) - 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.^{Footnote ‡}
British Virgin Islands (UK)	No malaria transmission.	None.	n/a	n/a
Brunei Darussalam	Human infection with P. knowlesi reported.	None; use PPM.	n/a	n/a
Bulgaria	No malaria transmission.	None.	n/a	n/a
Burkina Faso	All areas.	Atovaquone-proguanil, doxycycline or mefloquine.^{Footnote ‡}	Year-round	80
Burma (Myanmar)	No malaria transmission at elevations > 1000 m or in urban areas.	None.	n/a	n/a
	Areas at elevations < 1000 m, except urban areas. Risk of transmission is higher in remote rural hilly and forested areas and some coastal areas of Rakhine State. There is risk in Bagan.	Atovaquone-proguanil,doxycycline or mefloquine.^{Footnote ‡}	Year-round	60
	Mefloquine resistance reported in Kayin state and the eastern part of Shan state.	Atovaquone-proguanil or doxycycline.	Year-round	60
Burundi	All areas.	Atovaquone-proguanil, doxycycline or mefloquine.^{Footnote ‡}	Year-round	86
C
Countries: A B C D E F G H I J K L M N O P Q R S T U V W Y Z
Cabo Verde	Some cases have been reported in 2017 in the capital city of Praia, São Tiago (Santiago) Island.	Atovaquone-proguanil, doxycycline or mefloquine.^{Footnote ‡}
Cabo Verde	Limited cases in other areas of São Tiago (Santiago) Island.	None; use PPM.	Aug-Nov	Primarily P. Falciparum
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 Siem Reap.	None; use PPM.	Year-round	86
	Mefloquine resistance is reported in the western provinces of Banteay Meanchey, Battambang, Koh Kong, Odder Meanchey, Pailin, Kampot, PreahVihear, Pursat, and Siemreap bordering Thailand.	Doxycycline or atovaquone-proguanil.
	All other areas.	Atovaquone-proguanil, doxycycline or mefloquine.^{Footnote ‡}
Cameroon	All areas.	Atovaquone-proguanil, doxycycline or mefloquine.^{Footnote ‡}	Year-round	85
Canada	No malaria transmission.	None.	n/a	n/a
Cayman Islands (UK)	No malaria transmission.	None.	n/a	n/a
Central African Republic	All areas.	Atovaquone-proguanil, doxycycline or mefloquine.^{Footnote ‡}	Year-round	85
Chad	All areas.	Atovaquone-proguanil,doxycycline or mefloquine.^{Footnote ‡}	Year-round	85
Chile	No malaria transmission.	None.	n/a	n/a
China	No malaria transmission in urban areas or northern China. No malaria risk above 1500 m.	None.	n/a	n/a
	Limited transmission in rural areas of Anhui, Hubei, Guangxi, and Motuo County in Tibet, including river cruises that pass through malaria-endemic parts of Anhui and Hubei.	Use PPM	Year-round	9
	Along China-Burma (Myanmar) border in the western part of rural Yunnan Province.	Atovaquone-proguanil, or doxycycline.
	Other rural parts of Yunnan Province.	Atovaquone-proguanil, doxycycline or mefloquine^{Footnote ‡}
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.	None.	n/a	n/a
Colombia	Risk is high in rural and jungle areas below 1700m. Risk exists on excursions on the Magdalena River south of Baranquilla, on the Pacific coast and east of the Cordillera Oriental. Risk is considered lower in northern rural areas.	Atovaquone-proguanil, doxycycline or mefloquine.^{Footnote ‡}	Year-round	35-40
Comoros	All areas.	Atovaquone-proguanil, doxycycline or mefloquine.^{Footnote ‡}	Year-round	Primarily P. falciparum
Congo	All areas.	Atovaquone-proguanil, doxycycline or mefloquine.^{Footnote ‡}	Year-round	90
Congo, Democratic Republic of the (formerly Zaïre)	All areas.	Atovaquone-proguanil, doxycycline or mefloquine.^{Footnote ‡}	Year-round	90
Cook Islands (NZ)	No malaria transmission.	None.	n/a	n/a
Costa Rica	Limited local transmission or potential for transmission in Matina Canton in Limón Province, Sarapiquí Canton in Heredia Province, Pital District in San Carlos Canton in Alajuela Province and Puerto Jiménez district of Golfito Canton and Sierpe district of Osa Canton both in Puntarenas Province.	None; PPM recommended for areas where cases reported.	n/a	n/a
Côte D'Ivoire (Ivory Coast)	All areas.	Atovaquone-proguanil, doxycycline or mefloquine.^{Footnote ‡}	Year-round	85
Croatia	No malaria transmission.	None.	n/a	n/a
Cuba	No malaria transmission.	None.	n/a	n/a
Curaçao (NL)	No malaria transmission.	None.	n/a	n/a
Cyprus	Some cases in tourists visiting Esentepe, in the northern part of the country have been reported in 2017. Local transmission is presumed to be occurring in that region.	None; use PPM.	n/a	n/a
CzechRepublic	No malaria transmission.	None.	n/a	n/a
D
Countries: A B C D E F G H I J K L M N O P Q R S T U V W Y Z
Denmark	No malaria transmission.	None.	n/a	n/a
Djibouti	All areas.	Atovaquone-proguanil, doxycycline or mefloquine.^{Footnote ‡}	Year-round	90
Dominica	No malaria transmission.	None.	n/a	n/a
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.	PPM.	Year-round	100
	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 to October).	PPM, plus optionally chloroquine, atovaquone-proguanil, doxycycline or mefloquine ^{Footnote ‡}.
	Rural areas, with the highest risk in the provinces of Dajabón, Elias Piña, and San Juan bordering Haiti.	PPM, plus chloroquine, atovaquone-proguanil, doxycycline or mefloquine.^{Footnote ‡}
E
Ecuador	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.	None.	n/a	n/a
Ecuador	All other areas at elevations < 1500 m. Higher risk along the coast, in the north.	Atovaquone-proguanil, doxycycline or mefloquine.^{Footnote ‡}	Year-round	10
Egypt	No malaria transmission.	None.	n/a	n/a
El Salvador	Rare cases along the Guatemalan border.	None; use PPM.	Year-round	< 1
Equatorial Guinea	All areas.	Atovaquone-proguanil, doxycycline or mefloquine.^{Footnote ‡}	Year-round	85
Eritrea	No malaria transmission at elevations > 2200 m, including the city of Asmara.	None.	n/a	n/a
Eritrea	All areas at elevations < 2200 m.	Atovaquone-proguanil, doxycycline or mefloquine.^{Footnote ‡}	Year-round	85
Estonia	No malaria transmission.	None.	n/a	n/a
Ethiopia	No malaria transmission at elevations > 2200 m, including Addis Ababa.	None.	n/a	n/a
Ethiopia	All areas at elevations < 2200 m, including Axum (2139 m),Dire Dawa (1262 m), Harar (1848 m), and Nazret (1725 m).	Atovaquone-proguanil, doxycycline or mefloquine.^{Footnote ‡}	Year-round	60-70
F
Countries: A B C D E F G H I J K L M N O P Q R S T U V W Y Z
Fiji	No malaria transmission.	None.	n/a	n/a
Finland	No malaria transmission.	None.	n/a	n/a
France	No malaria transmission.	None.	n/a	n/a
French Guiana	No malaria transmission in the city of Cayenne or on Devil's Island (Île du Diable).	None.	n/a	n/a
French Guiana	All other areas. Risk along the coast is low but increases towards the interior. High risk of transmission in municipalities bordering Brazil and Suriname.	PPM can be considered for coastal states Atovaquone-proguanil, doxycycline or mefloquine.^{Footnote ‡}	Year-round	< 50
French Polynesia	No malaria transmission.	None.	n/a	n/a
G
Gabon	All areas.	Atovaquone-proguanil, doxycycline or mefloquine.^{Footnote ‡}	Year-round	90
Gambia	All areas.	Atovaquone-proguanil, doxycycline or mefloquine.^{Footnote ‡}	Year-round	≥ 85
Georgia	Limited risk in the eastern areas bordering Azerbaijan. The city of Tbilisi is risk-free.	None; use PPM.	June-Oct	0
Germany	No malaria transmission.	None.	n/a	n/a
Ghana	All areas.	Atovaquone-proguanil, doxycycline or mefloquine.^{Footnote ‡}	Year-round	90
Gibraltar (UK)	No malaria transmission.	None.	n/a	n/a
Greece	Limited local transmission in western and central Greece.	None; PPM recommended for areas where cases reported.	n/a	n/a
Greenland (Denmark)	No malaria transmission.	None.	n/a	n/a
Grenada	No malaria transmission.	None.	n/a	n/a
Guadeloupe (FR)	No malaria transmission.	None.	n/a	n/a
Guam (US)	No malaria transmission.	None.	n/a	n/a
Guatemala	No malaria transmission in urban areas or areas at elevations > 1500 m none in Guatemala City, Antigua, and Lake Atitlán.	None.	n/a	n/a
Guatemala	Below 1500 m. There is high risk in the departments of Escuintla and Alta Verapaz and low risk in Baja Verapaz, Chiquimala, Izabal, Petén, Suchitepéquez and Zacapa.	Chloroquine, atovaquone-proguanil, doxycycline or mefloquine.^{Footnote ‡}	Year-round	3
Guinea	All areas.	Atovaquone-proguanil, doxycycline or mefloquine.^{Footnote ‡}	Year-round	85
Guinea-Bissau	All areas.	Atovaquone-proguanil, doxycycline or mefloquine.^{Footnote ‡}	Year-round	85
Guyana	Rare cases in the cities of Amsterdam and Georgetown. Low risk along the coast of Guyana.	PPM.	Year-round	50
Guyana	All other areas at elevations < 900 m. Risk is high in all parts of the interior.	Atovaquone-proguanil, doxycycline or mefloquine.^{Footnote ‡}	Year-round	50
H
Countries: A B C D E F G H I J K L M N O P Q R S T U V W Y Z
Haiti	All areas.	Chloroquine, atovaquone-proguanil, doxycycline or mefloquine.^{Footnote ‡}	Year-round	99
Holy See (Vatican City)	No malaria transmission.	None.	n/a	n/a
Honduras	No malaria transmission - in the cities of Tegucigalpa and San Pedro Sula. Risk is low in higher mountainous areas in the west where PPM can be considered.	None.	n/a	n/a
Honduras	Risk is high in departments of Colón and Gracias a Dios and moderate in Atlántida, El Paraiso, Olancho, and Yoro. P. falciparum transmission risk is high in Gracias a Dios. There is malaria risk on the island of Roatan.	Chloroquine, atovaquone-proguanil, doxycycline or mefloquine.^{Footnote ‡}	Year-round	20
Hong Kong (China)	No malaria transmission.	None.	n/a	n/a
Hungary	No malaria transmission.	None.	n/a	n/a
I
Iceland	No malaria transmission.	None.	n/a	n/a
India	No malaria transmission at elevations > 2000 m in parts of the states of Himachal Pradesh, Jammu and Kashmir, and Sikkim.	None.	n/a	n/a
	Delhi	PPM	Year-round	> 40
	All other areas - including most urban areas such as Bombay (Mumbai). Risk is lower in most of the southernmost regions of India. Risk is low in central urban areas of Agra and Bangalore.	Atovaquone-proguanil, doxycycline or mefloquine.^{Footnote ‡} PPM alone can be considered for stays of <1 week in central urban areas of Agra and Bangalore.	Year-round	> 40
Indonesia	No risk in cities of Jakarta and Ubud, resort areas of Bali and Java, and Gili Islands and the Thousand Islands (Pulau Seribu).	None.	n/a	n/a
Indonesia	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.^{Footnote ‡}	Year-round	66
Iran, Islamic Republic of	Rural areas in the provinces of Hormozgan, Kerman (tropical part only), and Sistan-Baluchestan (southern part only).	Atovaquone-proguanil, doxycycline, or mefloquine.^{Footnote ‡}	Mar-Nov	12
Iran, Islamic Republic of	All other areas.	None.	n/a	n/a
Iraq	No malaria transmission.	None.	n/a	n/a
Ireland	No malaria transmission.	None.	n/a	n/a
Israel	No malaria transmission.	None.	n/a	n/a
Italy	No malaria transmission.	None.	n/a	n/a
J
Countries: A B C D E F G H I J K L M N O P Q R S T U V W Y Z
Jamaica	No malaria transmission.	None.	n/a	n/a
Japan	No malaria transmission.	None.	n/a	n/a
Jordan	No malaria transmission.	None.	n/a	n/a
K
Kazakhstan	No malaria transmission.	None.	n/a	n/a
Kenya	Little to no malaria transmission at elevations > 2500 m or in the city of Nairobi.	None; use PPM.	Year-round	85
Kenya	All areas at elevations < 2500 m, except the city of Nairobi.	Atovaquone-proguanil, doxycycline or mefloquine.^{Footnote ‡}	Year-round	85
Kiribati	No malaria transmission.	None.	n/a	n/a
Korea, Democratic People's Republic of (North Korea)	Limited risk in some southern areas.	None; use PPM.	Presumed to be March to Dec	Presumed 0
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.	None; use PPM.	Mar-Dec	0
Kosovo	No malaria transmission.	None.	n/a	n/a
Kuwait	No malaria transmission.	None.	n/a	n/a
Kyrgyzstan	No risk of transmission.	None.	n/a	n/a
L
Lao People's Democratic Republic (Laos)	No malaria transmission in the city of Vientiane.	None.	n/a	n/a
	Risk is low in the province of Bokeo away from the Burmese border, Huaphan and Oudomxay and the city of Luang Prabang.	PPM.	Year-round	65
	Mefloquine resistance has been reported along the Loas-Burma (Myanmar) border in the provinces of Bokeo and Louang Namtha and along the Laos-Thailand boarder in the provinces of Champasak and Saravan, along the Laos-Cambodia border, and along the Laos-Vietnam border.	Atovaquone-proguanil or doxycycline.
	All other areas.	Atovaquone-proguanil, doxycycline or mefloquine.^{Footnote ‡}
Latvia	No malaria transmission.	None.	n/a	n/a
Lebanon	No malaria transmission.	None.	n/a	n/a
Lesotho	No malaria transmission.	None.	n/a	n/a
Liberia	All areas.	Atovaquone-proguanil, doxycycline or mefloquine.^{Footnote ‡}	Year-round	85
Libyan Arab Jamahiriya (Libya)	No malaria transmission.	None.	n/a	n/a
Liechtenstein	No malaria transmission.	None.	n/a	n/a
Lithuania	No malaria transmission.	None.	n/a	n/a
Luxembourg	No malaria transmission.	None.	n/a	n/a
M
Countries: A B C D E F G H I J K L M N O P Q R S T U V W Y Z
Macao (China)	No malaria transmission.	None.	n/a	n/a
Macedonia	No malaria transmission.	None.	n/a	n/a
Madagascar	All areas. Risk is highest in coastal areas.	Atovaquone-proguanil, doxycycline or mefloquine.^{Footnote ‡}	Year-round	85
Madagascar	Rare cases in the city of Antananarivo.	PPM measures only.	Year-round	85
Malawi	All areas.	Atovaquone-proguanil, doxycycline or mefloquine.^{Footnote ‡}	Year-round	90
Malaysia	No malaria transmission in urban and coastal areas.	None.	n/a	n/a
	Transmission in Peninsular Malaysiais limited to areas in the rural interior.	Atovaquone-proguanil, doxycycline or mefloquine.^{Footnote ‡}	Year-round	n/a
	Risk in east Malaysian Borneo limited to deep hinterland in the states of Sabah and Sarawak.
	Human P. knowlesi infection reported.
Maldives	No malaria transmission.	None.	n/a	n/a
Mali	All areas.	Atovaquone-proguanil, doxycycline or mefloquine.^{Footnote ‡}	Year-round	85
Malta	No malaria transmission.	None.	n/a	n/a
Marshall Islands	No malaria transmission.	None.	n/a	n/a
Martinique (FR)	No malaria transmission.	None.	n/a	n/a
Mauritania	No malaria transmission in the northern provinces of Dakhlet-Nouadhibou, and Tiris-Zemmour.	None.	n/a	n/a
Mauritania	Present in southern provinces including Nouakchott.	Atovaquone-proguanil, doxycycline or mefloquine.^{Footnote ‡}	Year-round, except July-Oct in Adrar and Inchiri	85
Mauritius	No malaria transmission.	None.	n/a	n/a
Mayotte (FR)	All areas.	Atovaquone-proguanil, doxycycline or mefloquine.^{Footnote ‡}	Year-round	40-50
Mexico	Minimal or no malaria transmission in much of Mexico including major resort areas on the coasts, including the city of Acapulco or along the Mayan Riviera, including the cities of Cancún, Cozumel, and Playa del Carmen. None along the border with the United States.	None.	Year-round	0
Mexico	Low malaria risk due almost exclusively to P. vivax exists intermittently throughout the year in some rural areas that are not often visited by tourists. Chiapas, Chihuahua, Durango, Nayarit, and Sinaloa.	PPM.	Year-round	0
Micronesia, Federated States of	No malaria transmission.	None.	n/a	n/a
Moldova, Republic of	No malaria transmission.	None.	n/a	n/a
Monaco	No malaria transmission.	None.	n/a	n/a
Mongolia	No malaria transmission.	None.	n/a	n/a
Montenegro	No malaria transmission.	None.	n/a	n/a
Montserrat (UK)	No malaria transmission.	None.	n/a	n/a
Morocco	No malaria transmission.	None.	n/a	n/a
Mozambique	All areas.	Atovaquone-proguanil, doxycycline or mefloquine.^{Footnote ‡}	Year-round	90
N
Countries: A B C D E F G H I J K L M N O P Q R S T U V W Y Z
Namibia	No malaria transmission in southern two-thirds of the country, including the city of Windhoek.	None.	n/a	n/a
	The regions of Caprivi; Kunene, including areas along the Kunene River and Kavango.	Atovaquone-proguanil, doxycycline or mefloquine.^{Footnote ‡}	Year-round	90
	The regions of Ohangwena, Omaheke, Omusati, Oshana, Oshikoto, and Otjozondjupa, and Etosha National Park.		Nov-June	90
Nauru	No malaria transmission.	None.	n/a	n/a
Nepal	CATMAT considers Kathmandu and typical Himalayan treks to be risk-free. Areas other than those listed below: little or no risk.	None.	n/a	n/a
Nepal	Malaria risk due predominantly to P. vivax exists throughout the year in rural areas of the 20 Terai districts bordering India, with occasional outbreaks of P. falciparum from July to October inclusive. Seasonal transmission of P. vivax takes place in 45 districts of the inner Terai and mid-hills.	Atovaquone-proguanil, doxycycline or mefloquine.^{Footnote ‡}	Year-round	15
Netherlands	No malaria transmission.	None.	n/a	n/a
New Caledonia (FR)	No malaria transmission.	None.	n/a	n/a
New Zealand	No malaria transmission.	None.	n/a	n/a
Nicaragua	Little to no malaria transmission in departments not listed below.	None; use PPM.	Year-round	10
Nicaragua	Departments of Chinandega, Jinotega, León, Managua, and Matagalpa, Región Autónoma Atlántico Norte (RAAN), and Región Autónoma Atlántico Sur (RAAS).	Chloroquine, atovaquone-proguanil, doxycycline or mefloquine.^{Footnote ‡}	Year-round	10
Niger	All areas.	Atovaquone-proguanil, doxycycline or mefloquine.^{Footnote ‡}	Year-round	85
Nigeria	All areas.	Atovaquone-proguanil, doxycycline or mefloquine.^{Footnote ‡}	Year-round	85
Niue (NZ)	No malaria transmission.	None.	n/a	n/a
Northern Mariana Islands (US)	No malaria transmission.	None.	n/a	n/a
Norway	No malaria transmission.	None.	n/a	n/a
O
Oman	Sporadic transmission of P. falciparum and P. vivax may occur subsequent to international importations of parasites. In 2010, local outbreaks of P.falciparum and P.vivax were reported in North Sharqiya region. Local cases were also reported in 2011 and 2012.	None.	n/a	n/a
P
Countries: A B C D E F G H I J K L M N O P Q R S T U V W Y Z
Pakistan	Malaria risk - P. vivax and P. falciparum - exists throughout the year in the whole country below 2200 m, especially in rural areas from July to December inclusive. Risk is lower in the north in winter.	Atovaquone-proguanil, doxycycline or mefloquine.^{Footnote ‡}	Year-round	30
Palau	No malaria transmission.	None.	n/a	n/a
Panama	Little to no malaria transmission in Panama City, the Canal zone, or regions not listed below.	None; use PPM.	Year-round	1
	Provinces and indigenous territories (comarcas) along the Caribbean coast and the borders with Costa Rica:Bocas del Toro, Veraguas, Colón	Chloroquine, atovaquone-proguanil, doxycycline or mefloquine^{Footnote ‡} for stays > 1 week; chloroquine, atovaquone-proguanil, doxycycline or mefloquine^{Footnote ‡} or PPM alone for stays of < 1 week.
	Most transmission in provinces east of the Panama Canal toward the border with Colombia. P. falciparum 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.	Atovaquone-proguanil, doxycycline or mefloquine.^{Footnote ‡}
Papua New Guinea	All areas at elevations < 1900 m.	Atovaquone-proguanil, doxycycline or mefloquine.^{Footnote ‡}	Year-round	65 - 80
Paraguay	No malaria transmission.	None.	n/a	n/a
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 on the coast except in the north. The cities of Lima, Moquegua, Nazca, and Tacna have no risk.	None.	n/a	n/a
Peru	All areas < 2000 m (except cities listed above). This includes the cities of Puerto Maldonado and Iquitos. Most P.falciparum cases occur in the region of Loreto.	Atovaquone-proguanil, doxycycline or mefloquine.^{Footnote ‡}	Year-round	15
Philippines	Little to no malaria transmission in urban areas or on islands not listed below.	None; use PPM.	Year-round	70-80
Philippines	Rural areas at elevations < 600 m on islands of Basilu, Luzon, Mindanao, Mindoro, Palawan, Sulu (Jolo) and Tawi-Tawi. Human cases of P. knowlesi reported on Palawan I.	Atovaquone-proguanil, doxycycline or mefloquine.^{Footnote ‡}	Year-round	70-80
Pitcairn Islands (UK)	No malaria transmission.	None.	n/a	n/a
Poland	No malaria transmission.	None.	n/a	n/a
Portugal	No malaria transmission.	None.	n/a	n/a
Puerto Rico (US)	No malaria transmission.	None.	n/a	n/a
Q
Qatar	No malaria transmission.	None.	n/a	n/a
R
Réunion (FR)	No malaria transmission.	None.	n/a	n/a
Romania	No malaria transmission.	None.	n/a	n/a
Russian Federation (Russia)	No malaria transmission.	None.	n/a	n/a
Rwanda	All areas.	Atovaquone-proguanil, doxycycline or mefloquine.^{Footnote ‡}	Year-round	90
S
Countries: A B C D E F G H I J K L M N O P Q R S T U V W Y Z
Saint-Barthélemy (FR)	No malaria transmission.	None.	n/a	n/a
Saint Helena (UK)	No malaria transmission.	None.	n/a	n/a
Saint Kitts and Nevis	No malaria transmission.	None.	n/a	n/a
Saint Lucia	No malaria transmission.	None.	n/a	n/a
Saint Martin (FR)	No malaria transmission.	None.	n/a	n/a
Saint Pierre and Miquelon (FR)	No malaria transmission.	None.	n/a	n/a
Saint Vincent and the Grenadines	No malaria transmission.	None.	n/a	n/a
Samoa	No malaria transmission.	None.	n/a	n/a
San Marino	No malaria transmission.	None.	n/a	n/a
São Tomé and Príncipe	All areas.	Atovaquone-proguanil, doxycycline or mefloquine.^{Footnote ‡}	Year-round	85
Saudi Arabia	No malaria transmission in most of the country, in the cities of Mecca, Medina, Jeddah, Riyadh, or Ta'if; or in the high altitude areas of Asir province.	None.	n/a	n/a
Saudi Arabia	Local transmission reported only in villages on the border of Yemen (except in the high-altitude areas of Asir Province).	Atovaquone-proguanil, doxycycline or mefloquine.^{Footnote ‡}	Year-round (but mainly Sep-Jan)	Predominantly P. falciparum
Senegal	Malaria risk due predominantly to P. falciparum exists throughout the year in the whole country. There is less risk from January to June inclusive in the central western regions.	Atovaquone-proguanil, doxycycline or mefloquine.^{Footnote ‡}	Year-round	> 85
Serbia	No malaria transmission.	None.	n/a	n/a
Seychelles	No malaria transmission.	None.	n/a	n/a
Sierra Leone	All areas.	Atovaquone-proguanil, doxycycline or mefloquine.^{Footnote ‡}	Year-round	85
Singapore	No malaria transmission.	None.	n/a	n/a
Saint Maarten (NL)	No malaria transmission.	None.	n/a	n/a
Slovakia	No malaria transmission.	None.	n/a	n/a
Slovenia	No malaria transmission.	None.	n/a	n/a
Solomon Islands	No malaria transmission on a few of the outlying islets in the east and south.	None.	n/a	n/a
Solomon Islands	All other areas.	Atovaquone-proguanil, doxycycline or mefloquine.^{Footnote ‡}	Year-round	60
Somalia	Malaria risk exists in the whole country. Risk is relatively low and seasonal in the north. It is higher in the central and southern parts of the country.	Atovaquone-proguanil, doxycycline or mefloquine.^{Footnote ‡}	Year-round	90
South Africa	No malaria transmission in most of the country including the Garden Route and major cities.	None.	n/a	n/a
South Africa	Malaria risk due predominantly to P. falciparum exists throughout the year in the low-altitude areas of Mpumalanga Province (including the Kruger National Park), in Limpopo Province and in north-eastern KwaZulu-Natal.	Atovaquone-proguanil, doxycycline or mefloquine.^{Footnote ‡}	Year-round (risk is highest from Oct-May)	90
South Sudan	All areas.	Atovaquone-proguanil, doxycycline or mefloquine.^{Footnote ‡}	Year-round	90
Spain	No malaria transmission.	None.	n/a	n/a
Sri Lanka	No malaria transmission.	None.	n/a	n/a
Sudan, Republic of	Malaria risk due exists throughout the year in the whole country. Risk is low and seasonal in the north. It is higher in the central and southern parts of the country. Malaria risk on the Red Sea coast is very limited.	Atovaquone-proguanil, doxycycline or mefloquine.^{Footnote ‡}	Year-round (predomin-antly during wetter season in the north)	90
Suriname	Little to no malaria transmission in the seven districts along the Atlantic Coast, including in the city of Paramaribo.	None; use PPM.	Year-round	40-70
Suriname	Areas in the interior of the country. Risk of malaria transmission is highest along the eastern border with French Guiana and in gold mining areas.	Atovaquone-proguanil, doxycycline or mefloquine.^{Footnote ‡}	Year-round	40-70
Swaziland	Present in eastern areas bordering Mozambique and South Africa, including all of Lubombo district and the eastern half of Hhohho, Manzini, and Shiselweni districts. Mbabane is risk-free.	Atovaquone-proguanil, doxycycline or mefloquine.^{Footnote ‡}	Year-round	90
Sweden	No malaria transmission.	None.	n/a	n/a
Switzerland	No malaria transmission.	None.	n/a	n/a
Syrian Arab Republic (Syria)	No malaria transmission	None.	n/a	n/a
T
Countries: A B C D E F G H I J K L M N O P Q R S T U V W Y Z
Tajikistan	Rare indigenous case.	PPM.	Jun-Oct	10
Tanzania, United Republic of	All areas at elevations < 1800 m.	Atovaquone-proguanil, doxycycline or mefloquine.^{Footnote ‡}	Year-round	> 85
Thailand	Few to rare cases in areas noted below. This includes the cities of Chiang 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), in Bangkok, Chiang Mai and Pattaya City.	PPM, none where no malaria reported.	n/a	n/a
Thailand	Malaria risk exists throughout the year in rural, especially forested and hilly, areas of the country, mainly towards the international borders, including the southernmost provinces. Included are the provinces of Kalasin, Plai Phraya district of Krabi, Nakhon Si Thammarat, Narathiwat, Pattani, Phang Nga (located to the north of Phuket, including Phang Nga city), Rayong, Sakon Nakhon, Songkhla, Surat Thani, and Yala. There is resistance to mefloquine.	Atovaquone-proguanil or doxycycline.	Year-round	50-75
Timor-Leste (East Timor)	All areas.	Atovaquone-proguanil, doxycycline or mefloquine.^{Footnote ‡}	Year-round	50
Togo	All areas.	Atovaquone-proguanil, doxycycline or mefloquine.^{Footnote ‡}	Year-round	85
Tokelau (NZ)	No malaria transmission.	None.	n/a	n/a
Tonga	No malaria transmission.	None.	n/a	n/a
Trinidad and Tobago	No malaria transmission.	None.	n/a	n/a
Tunisia	No malaria transmission.	None.	n/a	n/a
Turkey	There is no malaria risk in the main tourist areas in the west and south-west of the country.	None.	n/a	n/a
Turkey	Limited malaria risk due exclusively to P. vivax exists in Mardin Province which borders Syria. Sporadic cases were reported in 2014.	PPM.	May-Oct	Sporadically
Turkmenistan	No malaria transmission.	None.	n/a	n/a
Turks and Caicos Islands (UK)	No malaria transmission.	None.	n/a	n/a
Tuvalu	No malaria transmission.	None.	n/a	n/a
U
Uganda	All areas.	Atovaquone-proguanil, doxycycline or mefloquine.^{Footnote ‡}	Year-round	> 85
Ukraine	No malaria transmission.	None.	n/a	n/a
United Arab Emirates	No malaria transmission.	None.	n/a	n/a
United Kingdom	No malaria transmission.	None.	n/a	n/a
United States	No malaria transmission.	None.	n/a	n/a
US Virgin Islands	No malaria transmission.	None.	n/a	n/a
Uruguay	No malaria transmission.	None.	n/a	n/a
Uzbekistan	No malaria transmission.	None.	n/a	n/a
V
Countries: A B C D E F G H I J K L M N O P Q R S T U V W Y Z
Vanuatu	All areas.	Atovaquone-proguanil, doxycycline or mefloquine.^{Footnote ‡}	Year-round	60
Venezuela, Bolivarian Republic of	All areas. The number of cases of malaria and the areas affected are expanding rapidly in Venuzuela.	Atovaquone-proguanil, doxycycline or mefloquine^{Footnote ‡}.	Year-round	25 (6% mixed infections of P.vivax and P.falciparum)
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.	Use PPM.	Year-round	50-90
	Rural areas, excluding those listed above. Risk in the town of Sapa in the hills to the northwest of Hanoi is lower; PPM can be considered for stays <1 week, particularly in the winter months.	Atovaquone-proguanil, doxycycline or mefloquine.^{Footnote ‡}
	Mefloquine resistance reported in the southern part of the country in the provinces of Dac Lac, Gia Lai, Khanh Hoa, Kon Tum, Lam Dong, Ninh Thuan, Song Be, and Tay Ninh.	Atovaquone-proguanil or doxycycline.
W
Countries: A B C D E F G H I J K L M N O P Q R S T U V W Y Z
West Bank and Gaza Strip	No malaria transmission.	None.	n/a	n/a
Western Sahara	Malaria transmission very rare.	None; use PPM.	Unknown	Unknown
Y
Yemen	No malaria transmission at elevations > 2000 m, including in the city of Sana'a.	None.	n/a	n/a
	Very limited transmission on Socotra Island.	None; use PPM.	Year-round but main risk Sept-Feb	95
	All areas at elevations < 2000 m.	Atovaquone-proguanil, doxycycline or mefloquine.^{Footnote ‡}	Year-round but main risk Sept-Feb	95
Z
Zambia	All areas.	Atovaquone-proguanil, doxycycline or mefloquine.^{Footnote ‡}	Year-round	> 90
Zimbabwe	Negligible malaria transmission in Harare and Bulawayo.	None.	Nov-Jun	> 90
	All other areas < 1200 m.	Atovaquone-proguanil, doxycycline or mefloquine.^{Footnote ‡}	Nov-Jun
	Malaria transmission occurs year-round in the Zambezi Valley, including at Victoria Falls.		Year-round

Reference List

Footnote 1

Calleri G, Castelli F, El Hamad I, Gobbi F, Matteelli A, Napoletano G, et al. New Italian guidelines for malaria prophylaxis in travellers to endemic areas. Infection 2014 Feb;42(1):239-250.

Return to footnote1 Referrer

Footnote 2

Caumes E, Caumes D. Recommandations sanitaires pour les voyageurs, 2015: Optimisme et vigilance. Les nouvelles recommandations pour la prévention du paludisme du voyageur [Health recommendations for travellers, 2015: Optimism and Vigilance. The New Recommendations for the Prevention of Traveller's Malaria]. 2015;21-22.

Return to footnote2 Referrer

Footnote 3

Comite d'experts en medecine des voyages [Expert Committee in Travel Medicine]. Conseils medicaux aux voyageurs [Medical advice for travelers]. Available at: http://www.safetravel.ch/safetravel2/servlet/ch.ofac.wv.wv202j.pages.Wv202DestinationsCtrl?action=recherche. Accessed February 24, 2016.

Return to footnote3 Referrer

Footnote 4

Deutsche Gesellschaft für Tropenmedizin und Internationale Gesundheit (DTG) [German Society for Tropical Medicine and International Health]. Empfehlungen zur Malariavorbeugung [Recommendations for malaria prevention]. 2015.

Return to footnote4 Referrer

Footnote 5

Folkhälsomyndigheten [Public Health Agency]. Rekommendationer för malariaprofylax 2015 [Recommendations for malaria prophylaxis 2015]. 2015.

Return to footnote5 Referrer

Footnote 6

Gershman MD, Jentes ES, Stoney RJ, Tan KR, Arguin PM, Steele SF. Chapter 3: Infectious Diseases Related to Travel: Yellow Fever & Malaria Information, by Country. Yellow Book. Atlanta, USA: Centers for Disease Control and Prevention; 2015.

Return to footnote6 Referrer

Footnote 7

Health Protection Scotland. fitfortravel: Travel health information for people travelling abroad from the UK. Available at: http://www.fitfortravel.nhs.uk/destinations.aspx. Accessed February 24, 2016.

Return to footnote7 Referrer

Footnote 8

Malaria Site. Malaria in India. 2015; Available at: http://www.malariasite.com/malaria-india/. Accessed February 24, 2016.

Return to footnote8 Referrer

Footnote 9

PHE Advisory Committee for Malaria Prevention for UK Travellers (ACMP). Guidelines for malaria prevention in travellers from the UK 2015. 2015;2015337.

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Footnote 10

World Health Organization. International travel and health. List of countries, territories and areas Yellow fever vaccination requirements and recommendations; malaria situation; and other vaccination requirements. 2015.

Return to footnote10 Referrer

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Appendix 1: Malaria Risk and Recommended Chemoprophylaxis by Geographic Area

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