Travel Information

Malaria, a common and life-threatening disease, is a risk in tropical and subtropical areas of over 100 countries. An estimated 30,000 international travelers fall ill with the disease annually. Fever occurring in a traveller one week or more after entering a malaria risk area, and up to 3 months after departure, is a medical emergency that should be investigated urgently. Prompt diagnosis and correct treatment of malaria can mean the difference between life and death.

The ABCD’s of Malaria Protection

A: Awareness—Be aware of the Risk, the Incubation Period, and the Main Symptoms of malaria.
B: Bites—Avoid being bitten by mosquitos—especially between dusk and dawn.
C: Chemoprophylaxis—Take antimalarial drugs (chemoprophylaxis) to suppress infection where appropriate. (More information on antimalarial drugs).
D: Diagnosis—Immediately seek diagnosis and treatment if a fever develops one week or more after entering an area where there is malaria risk, and up to 3 months after departure.

Malaria in travellers can usually be prevented. All travellers to malarious regions should follow the ABCD principles listed above.

This information is intended for travelers who reside in the United States. Travelers from other countries may find this information helpful; however, because malaria prevention recommendations and the availability of antimalarial drugs vary, travelers from other countries should consult health care providers in their respective countries.

Countries with Malaria Risk

Travelers to sub-Saharan Africa have the greatest risk of both getting malaria and dying from their infection. However, all travelers to countries with malaria risk may get this potentially deadly disease.

Malaria is transmitted in

large areas of Central and South America
the island of Hispaniola (includes Haiti and the Dominican Republic)
Africa
Asia (including the Indian subcontinent, Southeast Asia and the Middle East)
Eastern Europe
and the South Pacific

What Determines Your Individual Risk

If you are traveling outside of the United States, Canada, and Western Europe, you may be at risk for malaria. All visitors to malaria risk areas are at risk of getting malaria; however, many factors determine the risk to an individual traveler. Even in the same locale, these factors can vary widely over time. From year to year, conditions such as amount of rainfall, the number of mosquitoes, and the number of infected persons in the area will change and may produce a different level of risk than previously seen.

Factors that determine a traveler’s risk include:

Unaware of malaria risk areas
Many U.S. travelers, their healthcare providers, and tour companies may be unaware that their travel itinerary includes malaria risk areas.
Amount of malaria in the area to be visited
Most malaria transmission occurs in rural areas, although malaria occurs in urban areas in many countries. Low altitudes with warm temperatures allow for larger populations of infective mosquitoes. Transmission is generally higher in Africa south of the Sahara than in most other areas of the world; in 2002, 73% of imported malaria cases among U.S. and foreign civilians occurred in persons who traveled to Africa.
Time of the year
Seasons with more rainfall and higher temperatures will have more malaria transmission than colder, drier seasons. However, in most tropical and semi-tropical countries, transmission may occur even during cooler months or periods of less rainfall.
Type (species) of malaria parasite present in the area
While all species of malaria parasites can make a person feel very ill, Plasmodium falciparum causes severe, potentially fatal malaria. Persons who travel to areas where P. falciparum malaria is present should be extra careful to take their antimalarial drug and to prevent mosquito bites.
Nighttime exposure to mosquito bites
Because the mosquito that transmits malaria bites at night, travelers who are frequently out of doors between dusk and dawn will be at greater risk for malaria.
Preventive measures taken by travelers
Individual measures, such as taking an effective antimalarial drug and preventing mosquito bites, are the most important factors in minimizing risk. While other risk factors may be difficult to change or avoid, travelers can greatly reduce their risk of malaria by following recommended travel precautions.
Immunity or lack of immunity to malaria
Because malaria was eliminated from the United States in the late 1940s, most residents have never developed resistance (immunity) to the disease. Malaria infection in a non-immune person can quickly result in a severe and life-threatening illness.

In addition, many healthcare providers and laboratories in the United States rarely see cases of malaria and may be unfamiliar with the diagnosis and treatment of the disease, and this can delay effective treatment.

How to Protect Yourself

Know the Facts About Malaria

Every year, millions of United States residents travel to countries where malaria is present; about 800 cases of malaria are diagnosed in these returning travelers each year. From 1985-2002, 78 U.S. travelers died from malaria.

Persons who are traveling to malaria risk areas can almost always prevent this potentially deadly disease if they correctly take an effective antimalarial drug and follow measures to prevent mosquito bites.

Know the Symptoms

Despite these protective measures, travelers may become infected with malaria. Malaria symptoms can include:

fever
chills
headache
flu-like symptoms
muscle aches
fatigue
low blood cell counts (anemia)
yellowing of the skin and whites of the eye (jaundice)

If not promptly treated, infection with Plasmodium falciparum, the most harmful malaria parasite, may cause coma, kidney failure, and death.

When Symptoms Appear, Seek Immediate Medical Attention
Malaria is always a serious disease and may be a deadly illness. Travelers who become ill with a fever or flu-like illness either while traveling in a malaria-risk area or after returning home (for up to 1 year) should seek immediate medical attention and should tell the physician their travel history.

Additional Information Resources:

The CDC Travelers’ Health website provides information on protecting the health of international travelers, including detailed country-specific malaria prevention information plus recommendations for vaccinations (there is no malaria vaccine), food and water precautions, and safety information.
Preventing Malaria in Travelers ((PDF brochure, Size: 280 KB/8 pages

Counterfeit (“fake”) Drugs

In some countries (including those with malaria risk), drugs may be sold that are counterfeit (“fake”) or substandard (not made according to United States standards). Such drugs may not be effective. Purchase your antimalarial drugs before traveling overseas!

Source: World Health Organization (WHO); Centers for Disease Control (CDC)

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