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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†

Country
Areas of risk within country
Recommended regimens
Afghanistan All areas below 2000 m First-line agent*
Algeria One small focus in Ihrir Chloroquine in risk area
Angola All First-line agent*
Argentina Rural areas near Bolivian and Paraguay borders, lowlands of Salta and JuJuy provinces, and lowlands of Misiones and Corrientes Provinces Chloroquine
Armenia Risk limited to western border areas: Masis, Ararat, and Artashat regions in Ararat district. No risk in tourist areas. Chloroquine
Azerbaijan Rural lowlands with highest risk in areas between Kura and Arax rivers Chloroquine
Bangladesh All, except no risk in city of Dhaka First-line agent*
Belize Rural areas including resort areas, off shore islands, and forest preserves, except no risk in Belize City Chloroquine
     
Benin All First-line agent*
Bhutan Risk in southern belt of five districts: Chirang, Samchi, First-line agent*
  Samdrupjongkhar, Sarpang, and Shemgang  
Bolivia Rural areas < 2500 metres, risk in departments of Beni, First-line agent*
  Cochabamba, Chuquisaca, La Paz, Pando, Santa Cruz, and Tarija  
Botswana Northern part of country (north of 21o South) First-line agent*
Brazil Risk in Acre and Rondonia states, territories of Amapa and Roraima, and in rural areas of Amazonas, Maranhao, Mato Grosso, Para (except Belem City), and Tocantins. There is also transmission in urban areas, including large cities such as Porto Velho, Boa Vista, Macapa, Manaus, Santarem, and Maraba Note: No risk for travellers to coastal states from the horn to Uruguay border and Iguassu Falls. First-line agent*
Burkina Faso All First-line agent*
Burma:
see Myanmar		    
Burundi All First-line agent*
Cambodia All, except no risk in Phnom Penh. Malaria risk exists in Angkor Wat. First-line agent* (on western borders
- doxycycline or atovaquone/proguanil)
Cameroon All First-line agent*
Cape Verde Limited risk exists on Sao Tiago Island. First-line agent*
Central African Republic All First-line agent*
Chad All First-line agent*

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China Rural areas only in Anhui, Fujian, Guangdong, Guangxi, Guizhou, Hainan, Hubei, Hunan, Jiangsu, Jiangxi, Shandong, Shanghai, Sichuan, Xizang, Yunnan and Zhejiang provinces/autonomous regions. In provinces with risk, transmission only occurs during warm weather. Transmission occurs < 1500 metres from July to November north of 33o North, from May to December between33o North and 25o N and throughout the year below 25o North. Note: Travellers visiting cities and popular rural tourist routes, including Yangtze river cruises, are generally not at risk and require no prophylaxis. Chloroquine
First-line agent* for Hainin province,Yunnan province and Guangxi province
Colombia In general, rural areas only below 800 m, no risk in Bogota and vicinity First-line agent*
Comoros All First-line agent*
Congo All First-line agent*
Costa Rica Risk in the provinces of Alajuela, Limon, Guanacaste, and Heredia .No risk in Limon City. Chloroquine
Côte d'Ivoire (formerly Ivory Coast) All First-line agent*
Democratic Republicof Congo All First-line agent*
Djibouti All First-line agent*
Dominican Republic All rural areas. Highest risk in areas bordering Haiti. Travellers visiting resort areas are generally not at risk and require noprophylaxis. Chloroquine
East Timor All First-line agent*
Ecuador All areas less than 1500 metres (no risk in Guayaquil, Quito andvicinity, the central highland tourist areas or the Galapagos Islands) First-line agent*
Egypt Limited risk in El Faiyum area and part of Southern (upper) Egypt(no risk in main tourist areas including Nile cruises) None
El Salvador Rural areas of the departments of Santa Ana, Ahuachapan, and La Union. Chloroquine
Equatorial Guinea All First-line agent*
Eritrea All, except no risk in Asmara and above 2000 metres First-line agent*
Ethiopia All, except no risk in Addis Ababa and above 2000 metres First-line agent*
French Guiana All First-line agent*
Gabon All First-line agent*
Gambia All First-line agent*
Georgia Risk in the southeastern part of the country, in the districts of Lagodekhi, Sighnaghi, Dedophilistskaro, saraejo, Gardabani and Marneuli in the Kakheti and Kveno Kartli regions. No risk in Tbilisi. Chloroquine
Ghana All First-line agent*
Guatemala Rural areas only, except no risk in central highlands above1500 metres. No risk in Antigua or Lake Atitlan. Chloroquine
Guinea All First-line agent*

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Guinea-Bissau All First-line agent*
Guyana High risk in all of interior regions. Sporadic cases reported in the coastal region. First-line agent*
Haiti All Chloroquine
Honduras Rural areas only, including Roatan and other Bay Islands Chloroquine
Hong Kong S.A.R. (China) Urban areas: no risk, limited risk in extremely rural areas of S.A.R. None
India All areas below 2000 metres including Delhi and Bombay, except no transmission in parts of the states of Himachal Pradesh, Jammu, Kashmir, and Sikkim First-line agent*
Indonesia In general, rural areas only, except high risk in all areas of Irian Jaya (western half of island of New Guinea). No risk in cities of Java and Sumatra or resort areas in Java or Bali. Note: Transmission is largely confined to rural areas not visited by most tourists. Risk exists at the temple complex of Borobudur on Java. First-line agent*
Iran, Islamic Republic of Iraq Rural areas only in the provinces of Sistan-Baluchestan, the southern part of Kerman and Hormozgan All areas in northern region: Duhok, Erbil, Basrah, Tamim, Ninawa and Sulaimaniya province First-line agent*
Chloroquine
Ivory Coast: see Côte d'Ivoire    
Kenya All areas including game parks except low risk in city of Nairobi and above 2500 metres First-line agent*
Korea, Democratic People's Republic of (North) Limited malaria risk in some southern areas. No risk in Pyongyang. Chloroquine
Korea, Republic of (South) Risk limited to demilitarized zone and to rural areas in the northern parts of Kyonggi and Kangwon provinces along the demilitarized zone Chloroquine
Lao People's Democratic Republic All areas, except no risk in city of Vientiane First-line agent*
Liberia All First-line agent*
Madagascar All First-line agent*
Malawi All First-line agent*
Malaysia Risk limited to rural areas only. No risk in urban or coastal areas, no risk in Republic of Singapore. First-line agent*
 
Mali All First-line agent*
Mauritania All areas, except no risk in the northern areas of Dakhlet-Nouadhibou and Tiris-Zemour First-line agent*
Mauritius Rural areas only, except no risk in Rodrigues Island Chloroquine
Mayotte All First-line agent*
Mexico Rural areas including rural resort areas of the following states: Campeche, Chiapas, Chihauhua, Durango, Guerrero, Hidalgo, Jalisico (mountainous northern area only), Michoacan, Nayarit, Oaxaca, Quintana Roo, Sinaloa, Sonora and Veracrus. Risk also exists in area between24oN and 28oN latitiude and 106oW and 110oW longitude. No risk along U.S. border. No malaria risk along the Pacific and Gulf coasts. Chloroquine

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Morocco Very limited risk in rural areas of Khouribga province. The cities of Tangier, Rabat, Casablanca, Marrakech and Fes have no risk. None
Mozambique All First-line agent*
Myanmar (formerly Burma) Rural areas. Note: Travellers to Yangon (Rangoon) and Mandalay are not at risk and need no prophylaxis. First-line agent*
Doxycyline or atovaquone/ proguanil for borders with Thailand
Namibia Risk in the northern regions and in Omaheke and Otjozondjupa and along the Kavango and Kunene rivers First-line agent*
Nepal Rural areas in Terai District and hill districts below 1200 metres. No risk in Kathmandu and typical Himalayan treks. First-line agent*
New Hebrides:
see Vanuatu		    
Nicaragua Rural areas only, however risk occurs in the outskirts of Managua. Chloroquine
Niger All First-line agent*
Nigeria All First-line agent*
Oman Limited risk in remote areas of Musandam Province First-line agent*
Pakistan All areas below 2000 metres including cities First-line agent*
Panama Risk in rural areas of 3 provinces: Bocas del Toro, Darien and San Blas. No risk in the Canal Zone or in Panama City. Chloroquine in Bocas del Toro
First-line agent* in Darien, San Blas and San Blas Islands
Papua New Guinea All First-line agent*
Paraguay Risk in 3 departments: Alto Parana, Caaguazu, and Canendiyu Chloroquine
Peru Risk in all departments except Arequipa, Moquegua, Puno and Tacna. Note: no risk for travellers visiting only Lima and vicinity, coastal areas south of Lima, or the highland tourist areas (Cuzco, Machu Picchu, Lake Titicaca). First-line agent*
Philippines Rural areas only, except no risk in Manila and province of Bohol, Catanduanes and Cebu First-line agent*
Rwanda All First-line agent*
Sao Tome and Principe All First-line agent*
Saudi Arabia All areas in Western province, except no risk in the high altitude areas of Asir province (Yemen border), and the urban areas of Jeddah, Mecca, Medina and Taif First-line agent*
Senegal All First-line agent*
Sierra Leone All First-line agent*
Solomon Islands All First-line agent*
Somalia All First-line agent*
South Africa Risk in the low altitude areas of the Mpumalanga Province (including Kruger National Park), Northern Province and northeastern KwaZulu-Natal as far south as Tugelan River First-line agent*
Sri Lanka All rural areas except no risk in district of Colombo, Kalutara, and Nuwara Eliya. First-line agent*
Sudan All First-line agent*
Suriname Rural areas only, except no risk in Paramaribo district and coastal areas north of 5o North First-line agent*

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Swaziland All lowland areas First-line agent*
Syrian Arab Republic Rural areas only (May to October) especially along northern border. No risk in districts of Damascus, Deir-es-zor and Sweida. Chloroquine
Tajikistan Risk predominantly in southern border areas (Khatlon region); risk in some central (Dushanbe), western (Gorno-Badakhshan) and northern (Leninabad) areas. Chloroquine
Tanzania, All First-line agent*
United Republic of    
Thailand Malaria risk exists throughout the year in rural, especially forested and hilly, areas of the whole country, mainly towards the international borders (not visited by most travellers). There is no risk in cities and the main tourist resorts (e.g., Bangkok, Chiangmai, Chiang Rai, Pattaya, Phuket, and Ko Samui). Mefloquine resistance reported from areas on borders with Myanmar and Cambodia. Doxycycline or atovaquone/proguanil for overnight exposure in rural areas on border with Myanmar and Cambodia.
Togo All First-line agent*
Turkey Cukurova/Amikova areas and southeast Anatolia (May to October). No risk in main tourist areas in west and south-west or the Incirlik U.S. Air Force base. Chloroquine
Turkmenistan Risk in some villages from June to October in the Mary district Chloroquine
Uganda All First-line agent*
Vanuatu (formerly New Hebrides) All *First-line agent*
Venezuela Risk in the rural areas of the following states: Apure, Amazonas, Barinas, Bolivar, Sucre, Tachira, and Delta Amacuro. Risk in Angel Falls. First-line agent*
Viet Nam Rural areas only. No risk in Red Delta and coastal plain north of Nha Trang First-line agent*
Yemen All except no risk at elevations above 2000 metres. No risk in Sanas (2230 metres) First-line agent*
 
Zaire: see Democratic Republic of Congo    
Zambia All First-line agent*
Zimbabwe All (including Victoria Falls) except no risk in cities of Harare and Bulawayo First-line agent*

Countries not listed are considered free of malaria.
†Adapted from CDC Health Information for International Travel 2001 and WHO International Travel and Health 2003.
*First-line agent (for chloroquine-resistant area) = atovoquone/proguanil; doxycycline or mefloquine (alphabetical listing).

 

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Last Updated: 2004-06-28 Top
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