Malaria in the Dominican Republic

Updated: May 24, 2007

The Public Health Agency of Canada (PHAC) was recently notified of an additional laboratory confirmed case of malaria in a returning Canadian traveller from the Dominican Republic (DR).  PHAC continues to recommend that travelers use malaria prophylaxis (medication) and personal protective measures (e.g., repellants) against mosquito bites for all rural areas of the Dominican Republic and all areas in the province of La Altagracia [Map], including tourist resorts. Please refer to the recommendations section of this advisory for additional information.

The most recent case involved a Canadian traveller who bussed through rural areas of the province of La Altagracia during dusk – a time when the mosquito that transmits malaria is most active – and stayed in the province of La Romana at a resort that is located in a rural area. The traveller did not take antimalarial medication and did not use personal protective measures against mosquito bites. The person developed flu-like symptoms including fever on return to Canada, sought medical care, and was diagnosed with malaria due to Plasmodium falciparum.

PHAC closely monitors for reports of malaria in returning Canadian travellers and continues to collaborate with the Pan American Health Organization to monitor for and report any additional cases of malaria in travellers returning from the Dominican Republic.

About Malaria

Malaria is an acute flu-like illness caused by one of four species of parasite of the genus Plasmodium: Plasmodium falciparum, Plasmodium vivax, Plasmodium ovale and Plasmodium malariae.  Infection with P. falciparum malaria can be fatal. 

The disease is most commonly transmitted to humans through the bite of an infected mosquito, specifically the female Anopheles mosquito, a dusk-to-dawn biter.   

Malaria is endemic (i.e., constantly present) in most of sub-Saharan Africa; in large areas of the Middle East, South Asia, South East Asia, Oceania, Haiti, Central and South America; and in parts of Mexico, North Africa and the Dominican Republic.

For comprehensive information, please refer to the Public Health Agency of Canada's Disease Information Backgrounder on malaria.

Recommendations

Malaria occurs throughout the year in the Dominican Republic with the highest risk of transmission occurring in provinces bordering Haiti and in the province of La Altagracia.  Although resort areas are generally not considered risk areas, it is important to note that occasional transmission of malaria has occurred in international travellers. 

The Public Health Agency of Canada recommends malaria prophylaxis (medication) and the use of personal protective measures (e.g., repellants) against mosquito bites for all rural areas of the Dominican Republic and all areas in the province of La Altagracia, including tourist resorts (the tourist resort destinations of Punta Cana and Bavaro are located in the province of La Altagracia).

Note:  While chloroquine is the malaria drug of choice for the Dominican Republic, atovaquone / proguanil (Malarone ®), doxycycline and mefloquine are as effective as chloroquine and readily available.

How to prevent malaria infection

Two important measures can help you prevent malaria infection: avoiding mosquito bites and using effective anti-malarial medications.

1. Personal Protective Measures to Prevent Mosquito Bites
   
   Comprehensive information on mosquito-bite avoidance is detailed in CATMAT's “Statement on Personal Protective Measures to Prevent Arthropod Bites".

2. Antimalarial Medication (Prophylaxis)
   
   Antimalarial medications decrease the risk of developing symptomatic malaria. However, they do not provide 100% protection against the disease. Your individual need for antimalarial medications should be discussed with your physician or travel medicine professional several weeks before travel.
   
   If your physician or travel medicine clinic prescribes an antimalarial medication, it is important that you take it as directed in order to maximize the protective effect. Each drug has its own dosing regime that should be strictly followed. Because of the incubation period of the disease, these medications must be taken both before, during, and after travel.
   
   Travellers are reminded to complete their prescribed regimen of prophylaxis on their return. Except for atovaquone/proguanil which must be taken for one week after returning from a malaria-endemic area, chloroquine, doxycyline and mefloquine must be taken for four weeks after returning from a malaria-endemic area.

All travellers to an area where malaria occurs, regardless of whether or not they have taken malaria prophylaxis, must understand that any fever should be immediately followed up with a medical consultation to rule out malaria.

As a reminder...

The Public Health Agency of Canada routinely recommends that Canadian international travellers consult their personal physician or a travel clinic prior to international travel, regardless of destination, for an individual risk assessment to determine their individual health risks and their need for vaccination, preventative medication, and personal protective measures.

The Public Health Agency of Canada recommends, as well, that travellers who become sick or feel unwell on their return to Canada should seek a medical assessment with their personal physician.  Travellers should inform their physician, without being asked, that they have been travelling or living outside of Canada, and where they have been.

For additional information on malaria:

• Visit the Public Health Agency of Canada's Disease Information Backgrounder on Malaria.
• The Committee to Advise on Tropical Medicine and Travel (CATMAT) produces evidence based statements and guidelines. For maps of malaria-endemic areas and other information about malaria, visit CATMAT's Canadian recommendations for the prevention and treatment of malaria among international travellers as published in the Canada Communicable Disease Report - Supplement (Vol. 30, June 2004).
• Malaria – Frequently Asked Questions