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Malaria Information and Prophylaxis, by Country [P]

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CountryAreas with MalariaEstimated relative risk of Malaria for US Travelers2Drug Resistance3Malaria Species4Recommended Chemoprophlaxis5Key Information Needed and Helpful Links to Assess Need for Prophylaxis for Select Countries
PakistanAll areas (including all cities) at altitudes below 2,500 m (8,202 ft)ModerateChloroquineP. vivax 70%
P. falciparum 30%
Atovaquone-proguanil, doxycycline, or mefloquine
PalauNoneNoneNot ApplicableNot ApplicableNot Applicable
PanamaTransmission occurs primarily in the provinces east of the Panama Canal and C. Ngobe Bugle.  Rare cases in the provinces of Bocas del Toro, Colon, and Veraguas.  None in the provinces of Cocle, Chiriqui, Herrera, Los Santos, San Miguelito, and the part of  Panama Province west of the canal. None in the city of Panama.LowChloroquine (east of the Panama Canal)P. vivax 99%
P. falciparum 1%

Provinces east of the Panama Canal: Atovaquone-proguanil, doxycycline, mefloquine, or primaquine7

C. Ngobe Bugle:
Atovaquone-proguanil, chloroquine, doxycycline, mefloquine, or primaquine7

Other areas with malaria: Mosquito avoidance only

Papua New GuineaPresent throughout country at altitudes below 2,000 m (6,562 ft)HighChloroquine (both P. falciparum and P. vivax)P. falciparum 65-80%
P. vivax 10-30%
remainder P. malariae and P. ovale
Atovaquone-proguanil, doxycycline, or mefloquine
ParaguayRare cases in the departments of Alto Paraná, Caaguazú, and Canendiyú.Very LowNoneP. vivax 95%
P. falciparum 5%
Mosquito avoidance only
PeruAll departments <2,000 m (6,561 ft), including the cities of Iquitos and Puerto Maldonado, and only the remote eastern regions of La Libertad and Lambayeque. None in the following areas: Lima province; the cities of Arequipa, Ica, Moquegua, Nazca, Puno, and Tacna; the highland tourist areas (Cuzco, Machu Picchu, and Lake Titicaca); and along the Pacific Coast.LowChloroquineP. vivax 85%
P. falciparum 15%
Atovaquone-proguanil, doxycycline, or mefloquine
PhilippinesPresent in rural areas below 600 m (1,969 ft) on islands of Basilan, Luzon, Mindanao, Mindoro, Palawan, Sulu (Jolo), and Tawi-Tawi. None in Manila and other urban areas.LowChloroquineP. falciparum 70-80%
P. vivax 20-30%
Atovaquone-proguanil, doxycycline, or mefloquine
Pitcairn Islands (U.K.)NoneNoneNot ApplicableNot ApplicableNot Applicable
PolandNoneNoneNot ApplicableNot ApplicableNot Applicable
PortugalNoneNoneNot ApplicableNot ApplicableNot Applicable
Puerto Rico (U.S.)NoneNoneNot ApplicableNot ApplicableNot Applicable
  1. 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.
  2. 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.
  3. Refers to P. falciparum malaria unless otherwise noted.
  4. Estimates of malaria species are based on best available data from multiple sources.
  5. 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.
  6. 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.
  7. 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.
 
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