ARCHIVED - Supplement: Canadian Recommendations for the Prevention and Treatment of Malaria Among International Travellers
Appendix I. Malaria Risk by Geographic Area in Countries with Endemic Malaria - 2009
Note: While relatively accurate in the shorter term, the risk areas, elevations and seasonality data cannot be interpreted as absolute; such data can change from year to year and season to season. For the major malaria-risk countries, where risk occurs in all areas and all year, there is expected to be little variation from year to year that would affect malaria chemoprophylaxis recommendations. However, in other areas, risk may vary; hence, it is recommended that travel health practitioners keep abreast of potential changes, e.g., by regular monitoring of the Public Health Agency of Canada's Travel Health website, the World Health Organization's International Travel and Health 2011 Edition and the US Centers for Disease Control and Prevention, Health Information for International Travel, 2012 Edition.
Key: CQ = chloroquine, MEF = mefloquine, DOXY = doxycyline, A/P = atovaquone/proguanil
| Country1 | Malarious Areas2 | Seasonality (inclusive)3 | % Plasmodium Falciparum (Pf)(4) | Chloroquineresistant Pf reported(2) | Chemoprophylaxis recommended by CATMAT |
|---|---|---|---|---|---|
| Afghanistan | All areas below 2,000 metres elevation | May-Nov | 10 | yes | MEF, DOXY, A/P |
| Algeria | One small focus in the Sahara region in Ihrir (Illizi Department) | Not reported; assumed to be Jan-Dec | < 1 | no | Risk is very limited; therefore, prophylaxis is not recommended |
| Angola | All areas | Jan-Dec | 90 | yes | MEF, DOXY, A/P |
| Argentina | Rural areas of Salta and Jujuy provinces (along the Bolivian border) and Misiones and Corrientes provinces (along the border of Paraguay) | Oct-May(3) | 0 | no | CQ |
| Armenia | Limited to the Ararat Valley in the Ararat and Artashat region; greatest risk in Masis district | Jun-Oct | 0 | no | CQ |
| Azerbaijan | Rural lowlands near Kura and Arax rivers in the provinces of Agcabadi, Barda, Beylaqan, Bilasuvar, Calilabad, Fuzuli, Imisli, Kurdamir, Nakhichivan, Sabirabad, Saatli and Zardab | Jun-Oct | 0 | no | CQ |
| Bahamas | Intermittantly rare cases reported in Greater Exuma Island | Jan-Dec (4) | no | Risk is very limited; therefore, prophylaxis is not recommended | |
| Bangladesh | All areas, except no risk in city of Dhaka | Jan-Dec | 44 | yes | MEF, DOXY, A/P |
| Belize | All areas, except no risk in Belize City | Jan-Dec (3) | 14 | no | CQ |
| Benin | All areas | Jan-Dec | 87 | yes | MEF, DOXY, A/P |
| Bhutan | The 5 southern belt districts of: Chirang, Samchi, Samdrup Jongkhar, Sarpang and Shemgang at elevations less than 1,700 metres2 | Jan-Dec | 41 | yes | MEF, DOXY, A/P |
| Bolivia | The following departments: Beni, Chuquisaca, Cochabamba, La Paz, Pando, Santa Cruz and Tarija. No risk in city of La Paz or at elevations greater than 2,500 metres | Jan-Dec | 51 | yes | MEF, DOXY, A/P |
| Botswana | North of 22°S in the northern provinces of Central, Chobe, Ghanzi, Ngamiland and including safaris to the Okavango Delta area. No risk in the city of Gaborone | Nov-Jun | 95 | yes | MEF, DOXY, A/P |
| Brazil | States of Acre, Rondônia, Amapá, Amazonas, Roraima and Tocantins. Parts of states of Maranhaõ (western part), Mato Grosso (northern part), and Pará (except Belem City). Transmission also occurs in urban areas, including large cities such as Porto Velho, Boa Vista, Macapa, Manaus, Santarem and Maraba, where transmission occurs on the urban periphery. Risk at elevations up to 900 metres | Jan-Dec (3) | 25 | yes | MEF, DOXY, A/P |
| Burkina Faso | All areas | Jan-Dec | >85 | yes | MEF, DOXY, A/P |
| Burundi | All areas | Jan-Dec | >85 | yes | MEF, DOXY, A/P |
| Cambodia | Throughout the country, including risk in the temple complex at Angkor Wat. No risk in Phnom Penh and around Lake Tonle Sap | Jan-Dec | 90 | Yes (also mefloquine resistance reported in western provinces bordering Thailand) | DOXY, A/P in the provinces of Preah Vihear, Siemreap, Oddar, Meanchey, Banteay Meanchey, Battambang, Pailin, Koh Kong, and Pursat bordering Thailand. All other areas MEF, DOXY, A/P |
| Cameroon | All areas | Jan-Dec | > 85 | yes | MEF, DOXY, A/P |
| Cape Verde | Limited to Saõ Tiago Island | Aug-Nov | Not reported | yes | MEF, DOXY, A/P |
| Central African Republic | All areas | Jan-Dec | > 85 | yes | MEF, DOXY, A/P |
| Chad | All areas | Jan-Dec | > 85 | yes | MEF, DOXY, A/P |
| China | Rural areas only of the following provinces: (at elevations of 1,500 metres and below) Hainan, Yunnan, Fuijan, Guangdong, Guangxi, Guizhou, Sichuan, Tibet (in the Zangbo River valley only), Anhui, Hubei, Hunan, Jiangsu, Jiangxi, and Shandong | North of 33º N, Jul-Nov; between 25º N and 33º N, May-Dec; south of 25º N, Jan-Dec (2) | 9 | yes (in Hainan and Yunan) | DOXY, AP along China-Burma border in the western part of Yunnan province and MEF, DOXY, A/P in Hainan and other parts of Yunnan province (NOTE: travellers to cities and popular tourist areas, including Yangtze River cruises, are not at risk and do not need to take chemoprophylaxis) |
| Colombia | All rural/jungle areas below 1,600m; no risk in Bogotá and vicinity | Jan-Dec | 38 | yes (in Amazonia, Pacifico, and Uraba-Bujo Cauca) | MEF, DOXY, A/P |
| Comoros | All areas | Jan-Dec | 88 | yes | MEF, DOXY, A/P |
| Congo | All areas | Jan-Dec | 90 | yes | MEF, DOXY, A/P |
| Congo, Democratic Republic of the (formerly Zaire) | All areas | Jan-Dec | 93 | yes | MEF, DOXY, A/P |
| Costa Rica | In Alajuela, Limón, Guanacaste and Heredia provinces; no risk in Limón city (Puerto Limon) | Jan-Dec | < 1 | no | CQ |
| Côte D'Ivoire (Ivory Coast) | All areas | Jan-Dec | 88 | yes | MEF, DOXY, A/P |
| Djibouti | All areas | Jan-Dec | 98 | yes | MEF, DOXY, A/P |
| Dominican Republic | Rural, with highest risk in provinces bordering Haiti; in addition, risk in all areas of La Altagracia Province, including resort areas | Jan-Dec | 99 | no | CQ |
| Ecuador | All areas 1,500 metres elevation and below; no risk in the cities of Guayaquil and Quito, the central highland tourist areas, and the Galápagos Islands | Jan-Dec | 15 | yes | MEF, DOXY, A/P |
| Egypt | Very limited risk in El Faiyûm area only; no risk in tourist areas, including Nile River cruises | Jun-Oct | < 1 | no | None (risk is very limited; therefore, prophylaxis is not recommended) |
| El Salvador | Rural areas of Santa Ana, Ahuachapán and La Unión departments; no risk in the city of San Salvador | Jan-Dec (3) | <1 | no | CQ |
| Equatorial Guinea | All areas | Jan-Dec | >85 | yes | MEF, DOXY, A/P |
| Eritrea | All areas 2,200 m elevation and below; no risk in Asmara | Jan-Dec | 85 | yes | MEF, DOXY, A/P |
| Ethiopia | All areas 2,000 m elevation and below; no risk in Addis Ababa | Jan-Dec | >85 | yes | MEF, DOXY, A/P |
| French Guiana | All areas except no risk on Devil's Island (Ile du Diable) and the other coastal islands | Jan-Dec | 45 | yes | MEF, DOXY, A/P |
| Gabon | All areas | Jan-Dec | 95 | yes | MEF, DOXY, A/P |
| Gambia | All areas | Jan-Dec | >85 | yes | MEF, DOXY, A/P |
| Georgia | In southeastern part of the country near Azerbaijan border and Kura River and in the districts of Gardabanis, Marneulis and Sighnaghis in the Kakheti and Kveno Kartli regions; no risk in Tbilisi | Jul-Oct | 0 | no | CQ |
| Ghana | All areas | Jan-Dec | >85 | yes | MEF, DOXY, A/P |
| Guatemala | Rural areas at 1,500 metres elevation and below; no risk in Guatemala City, Antigua or Lake Atitlán | Jan-Dec | 5 | no | CQ |
| Guinea | All areas | Jan-Dec | 92 | yes | MEF, DOXY, A/P |
| Guinea- Bissau | All areas | Jan-Dec | 90 | yes | MEF, DOXY, A/P |
| Guyana | All rural areas at 900 metres elevation and below | Jan-Dec | 50 | yes | MEF, DOXY, A/P |
| Haiti | All areas | Jan-Dec | 100 | no | CQ |
| Honduras | Throughout the country at altitudes below 1,000 m (< 3,281 ft) and in Roatán and other Bay Island; risk exists in the outskirts of Tegucigalpa and San Pedro Sula | Jan-Dec(3) | 3 | no | CQ |
| India | All areas throughout country, except no risk in areas above 2,000 meters in Himachal Pradesh, Jammu, kashmir and Sikkim; in urban areas below 2,000 m, including Delhi and Mumbai (Bombay) | Jan-Dec | 45 | yes | MEF, DOXY, A/P |
| Indonesia | Rural Sumatra, Sulawesi, Kalimantan and Nusa Tenggara Barat (no risk in urban areas); in all areas of eastern Indonesia (provinces of Papua Indonesia, Irian Jaya Barat, Nusa Tenggara Timur, Maluku, and Maluku Utara); no risk in Jakarta, resort areas of Bali and the island of Java, except for the Menoreh Hills in central Java | Jan-Dec | 66 | yes | MEF, DOXY, A/P |
| Iran | Rural areas of Sistan- Baluchestan, the southern tropical part of Kerman, and Hormozgan province; in Ardebil and East Azerbijan provinces north of the Zagros mountains | Mar-Nov in areas of Kerman (tropical part), Hormozgan and southern Sistan- Baluchestan; summer months in Ardebil and East Azerbijan provinces north of the Zagros mountains | 41 | yes | MEF, DOXY, A/P |
| Iraq | Basrah province and below 1,500 metres in provinces of Duhok, Erbil, Ninawa, Sulaimaninya and Ta'mim ; no risk in Baghdad, Tikrit and Ramadi | May-Nov | 0 | no | CQ |
| Jamaica | Very limited risk, in Kingston | Jan-Dec (4) | unreported | no | CQ |
| Kenya | All areas (including game parks) below 2,500 metres elevation; no risk in Nairobi | Jan-Dec | >85 | yes | |
| Korea, Democratic People's Republic of (North Korea) | Limited risk in some southern areas | Not reported; assumed to be Jan-Dec | 0 | no | CQ |
| Korea, Republic of (South Korea) | Limited to Demilitarized Zone (DMZ) and to rural areas in the northern parts of Kyonggi and Kangwon Provinces | Not reported; assumed to be Jan-Dec | 0 | no | CQ |
| Kyrgyzstan | Some southern and western parts of the country, mainly in the provinces of Batken, Osh, and Jalal-Abad in the areas bordering Tajikistan and Uzbekistan; also in the capital city Bishkek. | Jun-Oct | 0 | no | CQ |
| Lao People's Democratic Republic (Laos) | All, except no risk in city of Vientiane | Jan-Dec | 97 | yes | DOXY, A/P in the provinces of Bokèo and Louang Namtha along the Laos-Burma border and along the Laos- Thailand border in the province of Saravane and Champassack. All other areas MEF, DOXY, A/P |
| Liberia | All areas | Jan-Dec | 90 | yes | MEF, DOXY, A/P |
| Madagascar | All areas | Jan-Dec | >85 | yes | MEF, DOXY, A/P |
| Malawi | All areas | Jan-Dec | 90 | yes | MEF, DOXY, A/P |
| Malaysia | Rural areas, particularly in the forested, hilly and underdeveloped interior areas; no risk in urban and coastal areas. Note: no risk in Republic of Singapore. | Jan-Dec (3) | 65 | MEF, DOXY, A/P | |
| Mali | All areas | Jan-Dec | >85 | yes | MEF, DOXY, A/P |
| Mauritania | All, except no risk Dakhlet-Nouadhibou and Tiris- Zemmour region | Jan-Dec in all areas except Jul-Oct in Adrar and Inchiri | >85 | likely | MEF, DOXY, A/P |
| Mauritius | Rural areas only; no risk on Rodrigues Island | Jan-Dec (3) | 0 | no | CQ |
| Mayotte (French Territorial Collectivity) | All areas | Jan-Dec | Not reported | yes | MEF, DOXY, A/P |
| Mexico | Limited to areas infrequently visited by travellers, including small foci along the Guatemala and Belize borders in the states of Chiapas, Quintana Roo and Tabasco; rural areas in the states of Nayarit, Oaxaca, Sinaloa; and in an area between 24° N and 28° N latitude, and 106° W and 110° W longitude, which lies in parts of Sonora, Chihuahua, and Durango. No malaria risk exists along the United States-Mexico border. No malaria risk exists in the major resorts along the Pacific and Gulf coasts | Jan-Dec | 1 | no | CQ (risk is very limited; therefore, prophylaxis is not recommended for most travellers to Mexico. Travellers should use personal protection measures such as insect repellents for malaria prevention. Chemoprophylaxis is recommended for the rare traveller going to the risk areas) |
| Morocco (including Western Sahara) | Rural areas of Chefchaouen province; no risk in Tangier, Rabat, Casablanca, Marrakech and Fès | May-Oct | <1 | no | None (risk is very limited; therefore, prophylaxis is not recommended) |
| Mozambique | All areas | Jan-Dec | 95 | yes | MEF, DOXY, A/P |
| Myanmar (formerly Burma) | Rural areas throughout the country below 1,000 metres elevation; no risk in cities of Rangoon (Yangon) and Mandalay | Jan-Dec | 85 | yes | DOXY, A/P in the provinces of Shan, Kayah, Kachin, Kayin, and Tanintharyi. MEF, DOXY, A/P in all other areas |
| Namibia | The provinces of Kunene, Ohangwena, Okavango, Omaheke, Omusati, Oshana, Oshikoto, Otjozondjupa and the Caprivi Strip | Nov-Jun in: Oshana, Oshikoto, Omusati, Omaheke, Ohangwena and Otjozondjupa. Jan-Dec along the Kunene river and in Kavango and Caprivi regions. | 90 | yes | MEF, DOXY, A/P |
| Nepal | Risk below 1,200 metres in rural areas in the Tarai and Hill districts bordering India and in the areas of the inner Tarai valley areas of Udaypur Sindhupalchowk, Makwanpur, Chitwan and Dang; no risk in Kathmandu or on typical Himalayan treks | Jan-Dec | 12 | yes | MEF, DOXY, A/P |
| Nicaragua | Rural areas in outskirts of Managua | Jan-Dec | 10 | no | CQ |
| Niger | All areas | Jan-Dec | >85 | yes | MEF, DOXY, A/P |
| Nigeria | All areas | Jan-Dec | >85 | yes | MEF, DOXY, A/P |
| Oman | Limited risk in remote areas of Musandam Province | Jan-Dec (3) | 90 | yes | None (risk is very limited; therefore, prophylaxis is not recommended) |
| Pakistan | All areas, including all cities below 2,000 metres elevation. | Jan-Dec | 46 | yes | MEF, DOXY, A/P |
| Panama | Rural areas of Bocas Del Toro, Darién, San Blas provinces and San Blas Islands; no risk in Panama City or in the former Canal Zone | Jan-Dec | 13 | yes | CQ in Bocas Del Tora; MEF, DOXY, A/P in Darién and San Blas |
| Papua New Guinea | All areas below 1,800 metres | Jan-Dec | 82 | yes | MEF, DOXY, A/P |
| Paraguay | The departments of Alto Paraná, Caaguazú, and Canendiyú | Oct-May (3) | 4 | no | CQ |
| Peru | Below 2,000 metres in all departments except Arequipa, Moquegua, Puno and Tacna; risk in Puerto Maldonado | Jan-Dec | 15 | yes | MEF, DOXY, A/P (NOTE: travellers who will visit only Lima and its vicinity, coastal areas south of Lima or the highland tourist areas [Cuzco, Machu Picchu and Lake Titicaca] are not at risk and need no prophylaxis) |
| Philippines | All areas below 600 metres elevation, except no risk in Bohol Island, Borocay Island, Catanduanes Island and Cebu Island. No risk is considered to exist in Manila or other urban areas. | Jan-Dec | 74 | yes (for P. Falciparum) | MEF, DOXY, A/P |
| Rwanda | All areas | Jan-Dec | 90 | yes | MEF, DOXY, A/P |
| Sao Tome and Principe | All areas | Jan-Dec | >85 | yes | MEF, DOXY, A/P |
| Saudi Arabia | Al Bahah, Al Madinah, Asir (excluding the highaltitude areas above 2,000 m), Jizan, Makkah, Najran and Tabuk province. No risk in urban areas of Jeddah, Mecca, Medina and Ta'if | Jan-Dec | 88 | yes | MEF, DOXY, A/P |
| Senegal | All areas | Jan-Dec | >85 | yes | MEF, DOXY, A/P |
| Sierra Leone | All areas | Jan-Dec | >85 | yes | MEF, DOXY, A/P |
| Solomon Islands | All areas except for the southern province of Rennell and Bellona, the eastern province of Temotu, and the outer islands of Tikopia, Anuta and Fatutaka | Jan-Dec | 62 | yes | MEF, DOXY, A/P |
| Somalia | All areas | Jan-Dec | 95 | yes | MEF, DOXY, A/P |
| South Africa | The low altitude areas of the Mpumalanga Province, Northern Province Limpopo and northeastern KwaZulu-Natal as far south as the Tugela (Thukela) River; also, risk in Kruger National Park | Jan-Dec | 99 | yes | MEF, DOXY, A/P |
| Sri Lanka | All areas, except no risk in the districts of Colombo, Galle, Kalutara and Nuwara Eliya | Jan-Dec | 12 | yes | MEF, DOXY, A/P |
| Sudan | All areas | Jan-Dec | 90 | yes | MEF, DOXY, A/P |
| Suriname | All areas, except no risk in the Paramaribo and coastal districts of Nickerie, Coronie, Saramacca, Wanica, Commewijne and Marowijne north of 5° N | Jan-Dec | 81 | yes (also: mefloquine reistance reported | MEF, DOXY, A/P |
| Swaziland | The northern and eastern lowland areas bordering Mozambique in the Lubombo district, particularly around the villages/towns of Big Bend, Mhlume, Simunye and Tshaneni | Jan-Dec | 99 | yes | MEF, DOXY, A/P |
| Syrian Arab Republic (Syria) | Along the northern border in El Hassaka province | May-Oct | 0 | no | CQ |
| Tajikistan | All areas below 2,500 elevation, particularly along the southern border in Khatlon Oblast; central (Dushanbe), western (Gorno- Badakhshan), and northern (Leninabad) areas | Jun-Dec | 9 | yes | MEF, DOXY, A/P |
| Tanzania | All areas below 1,800 metres | Jan-Dec | >85 | yes | MEF, DOXY, A/P |
| Thailand | In rural areas that border Cambodia, Laos and Myanmar (Burma); risk in Koh Phangan. No risk in cities and no risk in major tourist resorts. No risk in Bangkok, Chiang Mai, Chiang Rai, Pattaya, Phuket Island and Ko Samui | Jan-Dec | 56 | yes (also: mefloquine resistance reported from areas near the borders with Cambodia and Myanmar) | DOXY, A/P |
| Timor Leste (East Timor) | All areas | Jan-Dec | Predominates2 | yes | MEF, DOXY, A/P |
| Togo | All areas | Jan-Dec | >85 | yes | MEF, DOXY, A/P |
| Turkey | The provinces of Adana, Adryaman, Batman, Bingol, Bitlis, Diyarbakar, Elazig, Gaziantep, Hakkari, Hatay, Icel, Kahraman Maras, Kilis, Mardin, Mus, Osmaniyeh, , Sanliurfa, Siirt, Sirnak and Van; no risk on the Incirlik U.S. Air Force base and on typical cruise itineraries | May-Oct | 0 | no | CQ |
| Turkmenistan | Southeast Mary Region and in the flood plains between the Murgab and Tedzhen Rivers | Jun-Oct | 0 | no | CQ |
| Uganda | All areas | Jan-Dec | >85 | yes | MEF, DOXY, A/P |
| Uzbekistan | Sporadic cases reported in Uzunskiy, Sariassiskiy and Shurchinskiy districts (Surkhanda-Rinskaya Region) | Typically May-Oct (4) | 0 | no | CQ |
| Vanuatu | All areas | Jan-Dec | 62 | yes | MEF, DOXY, A/P |
| Venezuela | Rural areas of the following states: Apure, Amazonas, Barinas, Bolivar, Sucre, Tachira and Delta Amacuro; risk in Angel Falls | Jan-Dec | 10 | yes | MEF, DOXY, A/P |
| Viet Nam | Rural areas, except no risk in the Red River Delta and the coastal plain north of Nha Trang.; no risk in Hanoi, Ho Chi Minh City (Saigon), Da Nang, Nha Trang, Qui Nhon and Haiphong | Jan-Dec(3) | 72 | yes (also: mefloquine resistance reported) | DOXY, A/P in the southern part of the country in the provinces of Tay Ninh, Song Be, Lam Dong, Ninh Thuan, Khanh Hoa, Dac Lac, Gia Lai and Kon Tum. All other areas MEF, DOXY, A/P. |
| Yemen | All areas below 2,000 metres; no risk in Sana'a | Jan-Dec | 95 | yes | MEF, DOXY, A/P |
| Zambia | All areas | Jan-Dec | 90 | yes | MEF, DOXY, A/P |
| Zimbabwe | All areas, except no risk in cities of Harare and Bulawayo | 97 | yes | MEF, DOXY, A/P |
References
- from World Health Organization's International Travel and Health 2011 Edition (last accessed: 23 April 2009)
- from US Centers for Disease Control and Prevention, Health Information for International Travel, 2007-2008 (last accessed: 13 April 2009)
- from the World Malaria Risk Chart (PDF) , International Association for Medical Assistance to Travellers at (last accessed: 13 April 2009)
- from sources other than WHO
- from sources other than IAMAT
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