Malaria Risk by Country - non TCM Malaria info

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Malaria is always a serious disease and may be a

deadly illness. If you become ill with a fever or

flu-like illness either while traveling in a

malaria-risk area or after you return home (for up to

1 year), you should seek immediate medical attention

and should tell the physician your travel history.

 

Malaria Risk by Country

 

Afghanistan: risk in all areas at altitudes lower than

2000 meters (6,561 feet) if the travel is during the

months of April through December.

Bangladesh: All areas, except city of Dhaka.

Bhutan: Risk in the southern belt of five districts:

Chirang, Samchi, Samdrupjongkhar, Sarpang, and

Shemgang.

India: All areas lower than 2,000 meters (6,561 feet),

including cities. Some parts of the states of Himachal

Pradesh, Jammu, Kashmir, and Sikkim, in the far

northern part of the country, are the only areas with

elevations higher than 2000 meters (6,561 feet). The

cities of Delhi and Bombay are risk areas.

Maldives: No risk.

Nepal: Rural areas in the Terai and Hill Districts.

Risk at altitudes lower than 1,200 meters (3,937

feet). Pakistan: All areas, including the cities, at

altitudes lower than 2,000 meters (6,562 feet).

Sri Lanka: Risk in all areas, except no risk in the

districts of Colombo, Kalutara, and Nuwara Eliya.

 

Prevention

 

All travelers to malaria-risk areas in the Indian

Subcontinent, including infants, children, and former

residents of the Indian Subcontinent, should take one

of the following antimalarial drugs (listed

alphabetically):

 

* atovaquone/proguanil,

* doxycycline,

* mefloquine,

* primaquine (in special circumstances; see below)

 

NOTE: Chloroquine is NOT an effective antimalarial

drug in the Indian Subcontinent and should not be

taken to prevent malaria in this region.

 

Atovaquone/proguanil (brand name: Malarone™)

 

Atovaquone/proguanil is a fixed combination of two

drugs, atovaquone and proguanil. In the United States,

it is available as the brand name, Malarone™.

 

Directions for Use

 

* The adult dosage is 1 adult tablet (250mg

atovaquone/100mg proguanil) once a day.

* Take the first dose of atovaquone/proguanil 1 to

2 days before travel to the malaria-risk area.

* Take atovaquone/proguanil once a day during

travel in the malaria-risk area.

* Take atovaquone/proguanil once a day for 7 days

after leaving the malaria-risk area.

* Take the dose at the same time each day with

food or milk.

 

Atovaquone/proguanil Side Effects and Warnings

The most common side effects reported by travelers

taking atovaquone/proguanil are abdominal pain,

nausea, vomiting, and headache. Most travelers taking

atovaquone/proguanil do not have side effects serious

enough to stop taking the drug. Other antimalarial

drugs are available if you cannot tolerate

atovaquone/proguanil; see your health care provider.

 

Contraindications

The following travelers should NOT take

atovaquone/proguanil (other antimalarial drugs are

available; see your health care provider):

 

* children weighing less than 11 kilograms (25

pounds);

* pregnant women;

* women breast-feeding infants weighing less than

11 kilograms (25 pounds);

* patients with severe renal impairment;

* patients allergic to atovaquone or proguanil.

 

Doxycycline (many brand names and generics are

available)

 

Doxycycline is related to the antibiotic tetracycline.

 

Directions for Use

 

* The adult dosage is 100 mg once a day.

* Take the first dose of doxycycline 1 or 2 days

before arrival in the malaria-risk area.

* Take doxycycline once a day, at the same time

each day, while in the malaria-risk area.

* Take doxycycline once a day for 4 weeks after

leaving the malaria-risk area.

 

Doxycycline Side Effects and Warnings

The most common side effects reported by travelers

taking doxycycline include sun sensitivity (sunburning

faster than normal). To prevent sunburn, avoid midday

sun, wear a high SPF sunblock, wear long-sleeved

shirts, long pants, and a hat. Doxycycline may cause

nausea and stomach pain. Always take the drug on a

full stomach with a full glass of liquid. Do not lie

down for 1 hour after taking the drug to prevent

reflux of the drug (backing up into the esophagus).

 

Women who use doxycycline may develop a vaginal yeast

infection. You may either take an over-the-counter

yeast medication or have a prescription pill from your

health care provider for use if vaginal itching or

discharge develops.

 

Most travelers taking doxycycline do not have side

effects serious enough to stop taking the drug. (Other

antimalarial drugs are available if you cannot

tolerate doxycycline; see your health care provider.)

 

Contraindications

The following travelers should NOT take doxycycline

(other antimalarial drugs are available; see your

health care provider):

 

* pregnant women;

* children under the age of 8 years;

* persons allergic to doxycycline or other

tetracyclines.

 

Mefloquine (brand name: Lariam™ and generic)

 

Directions for Use

 

* The adult dosage is 250 mg salt (one tablet)

once a week.

* Take the first dose of mefloquine 1 week before

arrival in the malaria-risk area.

* Take mefloquine once a week, on the same day

each week, while in the malaria-risk area.

* Take mefloquine once a week for 4 weeks after

leaving the malaria-risk area.

* Mefloquine should be taken on a full stomach,

for example, after a meal.

 

Mefloquine Side Effects and Warnings

The most common side effects reported by travelers

taking mefloquine include headache, nausea, dizziness,

difficulty sleeping, anxiety, vivid dreams, and visual

disturbances.

 

Mefloquine has rarely been reported to cause serious

side effects, such as seizures, depression, and

psychosis. These serious side effects are more

frequent with the higher doses used to treat malaria;

fewer occurred at the weekly doses used to prevent

malaria. Most travelers taking mefloquine do not have

side effects serious enough to stop taking the drug.

(Other antimalarial drugs are available if you cannot

tolerate mefloquine; see your health care provider.)

 

Contraindications

Some travelers should NOT take mefloquine (other

antimalarial drugs are available; see your health care

provider):

 

* persons with active depression or a recent

history of depression;

* persons with a history of psychosis, generalized

anxiety disorder, schizophrenia, or other major

psychiatric disorder;

* persons with a history of seizures (does not

include the typical seizure caused by high fever in

childhood);

* persons allergic to mefloquine;

* Mefloquine is not recommended for persons with

cardiac conduction abnormalities (irregular

heartbeat).

 

Primaquine (primary prophylaxis)

 

In certain circumstances when other antimalarial drugs

cannot be used and in consultation with malaria

experts, primaquine may be used to prevent malaria

while the traveler is in the malaria-risk area

(primary prophylaxis).

 

Directions for Use

 

Note: Travelers must be tested for G6PD deficiency

(glucose-6-phosphate dehydrogenase) and have a

documented G6PD level in the normal range before

primaquine use.

Primaquine can cause a fatal hemolysis (bursting of

the red blood cells) in G6PD deficient persons.

 

* The adult dosage is 52.6mg salt (30mg base

primaquine)/once a day.

* Take the drug 1-2 days before travel to the

malaria-risk area.

* Take the drug once a day, at the same time each

day, while in the malaria-risk area.

* Take the drug 7 days after leaving the

malaria-risk area.

 

Primaquine Side Effects

The most common side effects reported by travelers

taking primaquine include abdominal cramps, nausea,

and vomiting.

 

Contraindications

Some travelers should not take primaquine (other

antimalarial drugs are available; see your health care

provider):

 

* persons with G6PD deficiency;

* pregnant women (the fetus may be G6PD deficient,

even if the mother is in the normal range);

* women breast-feeding infants unless the infant

has a documented normal G6PD level;

* persons allergic to primaquine.

 

 

I am only one; but still I am one.

I cannot do everything, but still I can do something;

I will not refuse to do the something I can do.

- Helen Keller

 

 

 

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