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*

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*

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

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*

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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