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Guidelines for malaria prevention in Central and South America and the Caribbean

Written by Helen Marshall, Pharmacist

There is a high risk of contracting highly chloroquine-resistant falciparum malaria in the Amazon basin area of South America. The risk is chiefly in the area of Brazil that comprises the 'legal Amazon' (the Amazon region, Mato Grasso and Maranhão), but it also exists in adjacent parts of Colombia, Peru, Bolivia and Venezuala. Mefloquine or doxycycline or Malarone are the most suitable antimalarials for the entire Amazon basin and all malarious areas of Colombia.

The risk of malaria in areas of Brazil outside the Amazon basin is low enough that there are no preventive medicines recommended.

Other South American countries have variable risks, mainly of vivax malaria, but also of some chloroquine-resistant falciparum malaria. There is no malaria risk in Uruguay or Chile.

Central America has a risk of vivax malaria, but there is no chloroquine resistance so chloroquine can be recommended for these countries.

Malaria is not a risk in most of the Caribbean islands, but it is transmitted in Haiti and the Dominican Republic, where there is variable to low risk. Malaria in these areas is still sensitive to chloroquine, which is therefore recommended for prevention.

Risk	Country	Preferable regimen	Alternative regimen
Risk high, marked chloroquine resistance	Bolivia (Amazon basin area) Brazil ('legal Amazon' area, which includes the Amazon basin area, Mato Grosso and Maranhão only, elsewhere there is a very low risk with no preventive medicines necessary) Colombia (most areas below 800m) Ecuador (Esmereldas Province, see below for elsewhere) French Guiana Guyana (all interior regions) Peru (Amazon basin area) Surinam (except Paramaribo and coast) Venezuela (Amazon basin area, areas south of and including Orinoco river)	Mefloquine OR doxycycline OR Malarone	Chloroquine plus proguanil
Risk variable or high, chloroquine resistance present	Bolivia (rural areas below 2500m) Ecuador (areas below 1500m; no malaria in Galapagos Islands or Guayaquil, see above for Esmereldas Province) Panama (east of canal) Peru (rural areas east of the Andes and west of the Amazon basin area below 1500m; see above for Amazon basin area) Venezuala (north of Orinoco river; high risk south of and including Orinoco river and Amazon basin area, see above; Caracas free of malaria)	Chloroquine plus proguanil	Mefloquine OR doxycycline OR Malarone
Risk variable to low	Argentina (rural areas along northern borders only) Belize (rural areas except Belize district) Costa Rica (rural areas below 500m) Dominican Republic El Salvador (Santa Ana province in west) Guatemala (areas below 1500m) Haiti Honduras Mexico (states of Oaxaca and Chiapas) Nicaragua Panama (west of canal, but variable to high risk east of canal, see above) Paraguay (rural areas)	Chloroquine	Proguanil

Always see your pharmacist for more detailed information about the risks of malaria in each country you are visiting. Your pharmacist will be able to tell you which medicines are recommended.

Remember to tell your pharmacist:

if you are pregnant, planning a pregnancy or breastfeeding
if you suffer from any diseases or conditions
if you are taking any regular medications
if a child is travelling with you.

This information will help the pharmacist recommend the most appropriate regimen for you.

Remember to leave yourself enough time before you leave to obtain your medicines. All the malaria prevention medicines must be started before you travel. Mefloquine needs to be started two-and-a-half weeks before travel, chloroquine and proguanil should be started a week before, and Malarone and doxycycline one to two days before travelling.

Chloroquine (Avloclor or Nivaquine) and proguanil (Paludrine) can be bought from pharmacies, but may have to be ordered in if you are going for a long trip. Mefloquine (Lariam), doxycycline (eg Vibramycin) and Malarone all require a prescription from your doctor.

For these reasons always see your pharmacist at least three weeks before you plan to travel, to find out which (if any) medicines are recommended, when you need to start taking them, and whether you need a prescription to obtain them.

Remember to take your medicines regularly while you are away, and continue taking them for four further weeks after leaving the malarious area, with the exception of Malarone, which only needs to be continued for one week after leaving.

Always suspect malaria and seek urgent medical advice if you develop a fever or flu-like illness whilst you are away (even if you are taking preventive medicines) or up to a year after you return, in particular in the first three months.

Last updated 16.03.2007

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