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

This document was last updated 2020/10/01

Table of contents

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

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.		Atovaquone-proguanil, doxycycline or mefloquine.
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.
Belize	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.	*P. vivax* P. f.	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.	*P. f.* P. ovale P. vivax	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.		PPM.
	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.
Colombia	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.	*P. f.* P. vivax	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.
Ecuador	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.	*P. vivax* P. f.	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.
Eritrea	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.
Ethiopia	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.
French Guiana	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.
Guatemala	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.
Guyana	All other areas at elevations < 900 m. Risk is high in all parts of the interior. Year-round.	*P. f.* P. vivax	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.
Honduras	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.	P. f. *P. vivax*	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.
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.
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.
Kenya	All areas at elevations < 2500 m, except the city of Nairobi. Year-round.	*P. f.* P. vivax P. ovale	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.
Lao People's Democratic Republic (Laos)	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.	*P. f.* P. vivax P. malariae P. ovale	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.
Madagascar	Rare cases in the city of Antananarivo. Year-round.	*P. f.* P. vivax P. ovale	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.
Malaysia	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.
Mauritania	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.	*P. f.* P. malariae P. ovale P. vivax	Atovaquone-proguanil, doxycycline or mefloquine.
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.
Nicaragua	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.	*P. vivax* P. f	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.
Panama	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.	*P. vivax* P. f.	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
Peru	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
Philippines	Malaria risk exists year round in Palawan and Mindanao Islands.	*P. f.* P. vivax P. knowlesi	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.
South Africa	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.
Suriname	Tapanahony municipality in Sipaliwini Province. Year-round.	*P. f.* *P. vivax*	Atovaquone-proguanil, doxycycline or mefloquine.
Swaziland (Eswatini)	Limited/no transmission through most of the country.	*P. f.* P. vivax P. ovale	PPM.
Swaziland (Eswatini)	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.	*P. f.* P. vivax P. ovale	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.
Thailand	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.
Timor-Leste (East Timor)	Higher risk in Oecuse district.	*P. f.* *P. vivax* P. malariae P. ovale	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.	*P. f.* P. vivax P. malariae P. ovale	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.
	Low risk in Harare and Bulawayo and areas > 1200 m.		Atovaquone-proguanil, doxycycline or mefloquine.
	Year-round in the Zambezi Valley, including Victoria Falls. All other areas < 1200, transmission season is November-June.		Atovaquone-proguanil, doxycycline or mefloquine.
Abbreviations: FR, France; n/a, not applicable; NL, Netherlands; NZ, New Zealand; PPM, personal protective measures; UK, United Kingdom; US, United States.

References

World Health Organization. (‎2018)‎. World malaria report 2018. World Health Organization. http://www.who.int/iris/handle/10665/275867.
World Health Organization. (‎2018)‎. Targets and indicators for Health 2020. Version 4. http://www.euro.who.int/en/health-topics/health-policy/health-2020-the-european-policy-for-health-and-well-being/publications/2018/targets-and-indicators-for-health-2020.-version-4-2018.
Malaria Information and Prophylaxis, by Country. Centers for Disease Control and Prevention. CDC Yellow Book 2018: Health Information for International Travel. https://www.cdc.gov/malaria/travelers/country_table/a.html.
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. 2018
Santé publique France. Recommandations sanitaires pour les voyageurs, 2019 (à l'attention des professionnels de santé) // Health recommendations for travellers, 2019 (for health professionals).May 2019. https://afpa.org/content/uploads/2019/05/HCSP-Recommandations-sanitaires-voyageurs-2019.pdf.