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| Guidelines for malaria prevention in North Africa, the Middle East and Central Asia |
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Written by Helen Marshall, pharmacist
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The risk of malaria is very
low in areas of North Africa and the Middle East that are
most visited by tourists. For many of these areas, the
best advice is to avoid mosquito bites, using measures such
as mosquito repellents. Remember the remote possibility of
malaria if you have a fever within a year of returning
from these areas. This applies to all of North Africa
(except for the El Faiyum area of Egypt, south-west of
Cairo) and to Turkish tourist areas as far east as
Antalya.
Chloroquine is recommended to
prevent vivax malaria eastwards along the coast from
Antalya to the Syrian border, and inland in South East
Turkey. Chloroquine is also recommended in parts of Syria,
Iraq and the former USSR.
Falciparum malaria, which is often resistant to
chloroquine, occurs in some Emirates, parts of Saudi
Arabia, Yemen, Iran, Afghanistan and parts of Oman (except
Muscat, which is malaria free). Chloroquine plus proguanil
is the recommended regimen for these areas.
|
Risk | Country |
Preferable
regimen |
Alternative regimen |
| Risk variable,
chloroquine resistance present | Afghanistan (below 2000m,
May-November)
Iran
(rural south-east provinces, March-November)
Oman (remote rural areas only)
Saudi Arabia (south-west and rural areas of western region; no risk in Mecca, Medina, Jeddah, or high-altitude areas of Asir Province)
Tajikstan (June-October)
Yemen
(no risk in Sana'a) | Chloroquine plus
proguanil | Doxycycline |
| Risk low | Armenia (June-October).
Azerbaijan
(southern border areas,
June-September)
Egypt (El Faiyum only,
June-October)
Iran (northern border with Azerbaijan, May–October, variable risk in rural south-east)
Iraq (rural north,
May-November)
Kyrgystan (south-west, May-October)
Syria (north border,
May-October)
Turkey (plain
around Adana and east of there, border with Syria,
March-November)
Turkmenistan
(south-east only, June-October) | Chloroquine | Proguanil |
| Risk very low |
Algeria
Egypt (but low risk in El Faiyum)
Georgia (south-east, July-October)
Kyrgystan (but low risk in south-west)
Libya
Morocco (rural areas)
Turkey
(most tourist areas, but low risk in Adana and border with Syria)
Uzbekistan (extreme south-east only) | Avoid mosquito bites | . |
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:
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if you are pregnant,
planning a pregnancy or breastfeeding
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if you suffer from any diseases or
conditions
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if you are taking any
regular medications
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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.
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Last updated 16.03.2007
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