Malaria Information and Prophylaxis, by Country1 [P]
|Country||Areas with Malaria||Estimated relative risk of Malaria for US Travelers2||Drug Resistance3||Malaria Species4||Recommended Chemoprophlaxis5||Helpful links for Select Countries|
|Pakistan||All areas (including all cities) at altitudes below 2,500 m (8,202 ft)||Moderate||Chloroquine||P. falciparum 70%
P. vivax 30%
|Atovaquone/ proguanil, doxycycline, or mefloquine|
|Palau||None||None||Not Applicable||Not Applicable||Not Applicable|
|Panama||Majority of transmission in provinces east of the Panama Canal towards the border with Colombia (provinces of Panama east of the canal and Darien). Transmission also in provinces of Veraguas, Chiriqui, C. Ngobe Buble, Cocle, and Kuna Yala. None in urban areas of Panama City or in the former Canal Zone.||Low||Chloroquine (east of the Panama Canal)||P. vivax 99
P. falciparum 1%
|Provinces east of the Panama Canal: Atovaquone/proguanil, doxycycline, mefloquine, or primaquine7
Other areas with malaria: Mosquito avoidance
|Provinces in Panama
To determine if a city is within a certain province
|Papua New Guinea||Present throughout country at altitudes below 1,800 m (5,906 ft)||High||Chloroquine (both P. falciparum and P. vivax)||P. falciparum 65-80%
P. vivax 10-30%
P. malariae and P. ovale remainder
|Atovaquone/ proguanil, doxycycline, or mefloquine||Altitude information for Papua New Guinea|
|Paraguay||Present in the departments of Alto Paranvá, Caaguazú, and Canendiyú||Very Low||None||P. vivax 95%
P. falciparum 5%
|Atovaquone/ proguanil, chloroquine, doxycycline, mefloquine, or primaquine7||To determine if a city is within a certain department
Departments of Paraguay
|Peru||All departments below 2,000 m (6, 561 ft) including cities of Puerto Maldonado and Iquitos, except none in cities of Lima (and coast south of Lima), Ica, and Nazca.
None in the highland tourist areas (Cuzco, Machu Picchu, and Lake Titicaca) and southern cities of Arequipa, Moquegua, Puno, and Tacna.
|Low||Chloroquine||P. vivax 70%
P. falciparum 30%
P. malariae <1%
|Atovaquone/proguanil, doxycycline, or mefloquine|
|Philippines||Present in rural areas below 600 m (1,969 ft) on islands of Luzon, Mindanao, Mindoro, and Palawan. None in urban areas.||Low||Chloroquine||P. falciparum 70-80%
P. vivax 20-30%
|Atovaquone/ proguanil, doxycycline, or mefloquine||Altitude information and to determine if city is within a certain island
|Pitcairn Islands (U.K.)||None||None||Not Applicable||Not Applicable||Not Applicable|
|Poland||None||None||Not Applicable||Not Applicable||Not Applicable|
|Portugal||None||None||Not Applicable||Not Applicable||Not Applicable|
|Puerto Rico (U.S.)||None||None||Not Applicable||Not Applicable||Not Applicable|
- The information presented herein was accurate at the time of publication; however, factors that can change rapidly and from year to year, such as local weather conditions, mosquito vector density, and prevalence of infection, can markedly affect local malaria transmission patterns. Updated information may be found on the CDC Travelers' Health website at www.cdc.gov/travel.
- This estimate of risk is based on numbers of cases of malaria reported in US travelers and the estimated volume of travel to these countries. In some instances the risk may be low because the actual intensity of transmission is low in that country. In other instances, significant malaria transmission may occur only in small focal areas of the country where US travelers seldom go. Thus even though the risk for the average traveler to that country may be low, the risk for the rare traveler going to the areas with higher transmission intensity will of course be higher. For some countries that are rarely visited by US travelers, there is insufficient information to make a risk estimate.
- Refers to P. falciparum malaria unless otherwise noted.
- Estimates of malaria species are based on best available data from multiple sources.
- Several medications are available for chemoprophylaxis. When deciding which drug to use, consider specific itinerary, length of trip, cost of drug, previous adverse reactions to antimalarials, drug allergies, and current medical history. All travelers should seek medical attention in the event of fever during or after return from travel to areas with malaria.
- This risk estimate is based largely on cases occurring in US military personnel who travel for extended periods of time with unique itineraries that likely do not reflect the risk for the average US traveler.
- Primaquine can cause hemolytic anemia in persons with glucose-6-phosphate dehydrogenase (G6PD) deficiency. Patients must be screened for G6PD deficiency prior to starting primaquine.