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| Guidelines for malaria prevention in South East Asia |
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Written by Helen Marshall, pharmacist
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The risk of malaria
transmission varies greatly in South East Asia, with low
risk in many areas; but falciparum malaria that is resistant
to many drugs prevalent in some hilly, forested areas
along international borders. Malaria tends to be absent
from major cities and tourist resorts in this area of the world.
The risk is low in most of Thailand, and visitors
to most tourist areas, including Bangkok, Chang Ri and the coastal holiday resorts of
Pattaya, Phuket and Koh Samui do not need to take
antimalarials. However, people travelling to these areas
should still be aware of the risk of malaria, and should
seek medical advice if they develop a fever while in these
areas, or up to a year after leaving.
On the
Thai borders with Cambodia, Laos and Myanmar (formerly Burma)
malaria is resistant to many drugs, including mefloquine,
so people who work or spend substantial periods of time in
this area should take regular doxycycline or possibly
Malarone. Overland travellers who go backpacking in
northern Thailand near the Myanmar border have a low but
significant risk of contracting malaria. If you are
travelling in this area you should take either doxycycline
or Malarone, or take all possible precautions against
being bitten. The non-drug approach may be more appropriate
for people only spending a short time near the border,
however if you do take this approach, remember to seek
immediate medical attention if any fever
occurs.
The malaria risk is low in
peninsula Malaysia and Sarawak and avoiding mosquito bites
is enough prevention, except for jungle areas where
chloroquine plus proguanil is recommended. In Sabah there is
a high risk of malaria and mefloquine or doxycycline or
Malarone is recommended.
In
Indonesia the recommended preventive medicines are proguanil
plus chloroquine, except in Lombok and Irian
Jaya, where there is a higher risk requiring mefloquine or
doxycycline or Malarone. This also applies to East Timor. There is a relatively low risk in
Bali and medicines are not specifically needed,
but travellers should be aware of the potential
risk.
There is little or no risk in
most of China and preventive medicines are not needed.
However, those going to remote areas off the tourist route
should seek specialist advice or take chloroquine.
Falciparum malaria is only found in South Yunnan and in
Hainan province, where mefloquine or doxycycline or
Malarone are recommended.
Chloroquine-resistant Plasmodium
vivax strains of malaria are becoming prevalent
in parts of South East Asia.
|
Risk | Country |
Preferable
regimen | Alternative regimen |
| Risk great, mefloquine
resistance prevalent | Cambodia (western
provinces)
Thailand (borders with Cambodia, Laos and Myanmar, except very low risk in Chang Ri and Kwai Bridge, see below)
Myanmar (eastern Shan State) | Doxycycline OR
Malarone | . |
| Risk substantial, drug resistance
common | Cambodia (except
no risk in Phnom Penh and great risk in western provinces)
China (only in Yunnan and
Hainan; chloroquine recommended in other
remote areas of China; see also very low risk below)
East
Timor
Irian Jaya [West Papua]
Laos (except no risk in
Vientiane)
Lombok
Malaysia (Sabah; see also very low risk and variable risk below)
Myanmar (formerly
Burma; see also great risk above)
Vietnam (except very low risk in
cities and some areas, see below) | Mefloquine OR doxycycline OR
Malarone | . |
| Risk variable, some chloroquine
resistance | Indonesia
(except Bali and cities, which are very low
risk, and Irian Jaya [West Papua] and Lombok, which are substantial risk)
Philippines (rural areas
below 600m; no risk in cities, Cebu, Bohol and
Catanduanes)
Deep forests of peninsula
Malaysia and Sarawak (but substantial risk in Sabah, see above) | Chloroquine plus proguanil | Mefloquine OR Malarone |
| Risk very low,
but remember the possibility of malaria if you
have a fever | Bali
Brunei
China (main tourist
areas, but substantial risk in Yunnan and Hainan; chloroquine appropriate for other remote areas)
Hong Kong
Korea
(both North and South)
Malaysia (both East and West including Cameron Highlands, but substantial risk in Sabah [except Kota Kinabalu], and variable risk in deep forests, see above)
Singapore
Thailand (Bangkok and
main tourist centres, Chang Ri, Kwai Bridge, BUT regional risk exists, see great risk above)
Vietnam (cities, coast between Ho Chi Minh and Hanoi, and Mekong River until close to Cambodian border; substantial risk in other areas, see above) | 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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