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Appendix I. Malaria Risk by Geographic Area in Countries with Endemic Malaria - 2009

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Note: While relatively accurate in the shorter term, the risk areas, elevations and seasonality data cannot be interpreted as absolute; such data can change from year to year and season to season. For the major malaria-risk countries, where risk occurs in all areas and all year, there is expected to be little variation from year to year that would affect malaria chemoprophylaxis recommendations. However, in other areas, risk may vary; hence, it is recommended that travel health practitioners keep abreast of potential changes, e.g., by regular monitoring of the Public Health Agency of Canada's Travel Health website, the World Health Organization's International Travel and Health 2011 Edition External Link and the US Centers for Disease Control and Prevention, Health Information for International Travel, 2012 Edition External Link.

Key: CQ = chloroquine, MEF = mefloquine, DOXY = doxycyline, A/P = atovaquone/proguanil

Malaria Risk by Geographic Area in Countries with Endemic Malaria
Country1 Malarious Areas2 Seasonality (inclusive)3 % Plasmodium Falciparum (Pf)(4) Chloroquineresistant Pf reported(2) Chemoprophylaxis recommended by CATMAT
Afghanistan All areas below 2,000 metres elevation May-Nov 10 yes MEF, DOXY, A/P
Algeria One small focus in the Sahara region in Ihrir (Illizi Department) Not reported; assumed to be Jan-Dec < 1 no Risk is very limited; therefore, prophylaxis is not recommended
Angola All areas Jan-Dec 90 yes MEF, DOXY, A/P
Argentina Rural areas of Salta and Jujuy provinces (along the Bolivian border) and Misiones and Corrientes provinces (along the border of Paraguay) Oct-May(3) 0 no CQ
Armenia Limited to the Ararat Valley in the Ararat and Artashat region; greatest risk in Masis district Jun-Oct 0 no CQ
Azerbaijan Rural lowlands near Kura and Arax rivers in the provinces of Agcabadi, Barda, Beylaqan, Bilasuvar, Calilabad, Fuzuli, Imisli, Kurdamir, Nakhichivan, Sabirabad, Saatli and Zardab Jun-Oct 0 no CQ
Bahamas Intermittantly rare cases reported in Greater Exuma Island Jan-Dec (4)   no Risk is very limited; therefore, prophylaxis is not recommended
Bangladesh All areas, except no risk in city of Dhaka Jan-Dec 44 yes MEF, DOXY, A/P
Belize All areas, except no risk in Belize City Jan-Dec (3) 14 no CQ
Benin All areas Jan-Dec 87 yes MEF, DOXY, A/P
Bhutan The 5 southern belt districts of: Chirang, Samchi, Samdrup Jongkhar, Sarpang and Shemgang at elevations less than 1,700 metres2 Jan-Dec 41 yes MEF, DOXY, A/P
Bolivia The following departments: Beni, Chuquisaca, Cochabamba, La Paz, Pando, Santa Cruz and Tarija. No risk in city of La Paz or at elevations greater than 2,500 metres Jan-Dec 51 yes MEF, DOXY, A/P
Botswana North of 22°S in the northern provinces of Central, Chobe, Ghanzi, Ngamiland and including safaris to the Okavango Delta area. No risk in the city of Gaborone Nov-Jun 95 yes MEF, DOXY, A/P
Brazil States of Acre, Rondônia, Amapá, Amazonas, Roraima and Tocantins. Parts of states of Maranhaõ (western part), Mato Grosso (northern part), and Pará (except Belem City). Transmission also occurs in urban areas, including large cities such as Porto Velho, Boa Vista, Macapa, Manaus, Santarem and Maraba, where transmission occurs on the urban periphery. Risk at elevations up to 900 metres Jan-Dec (3) 25 yes MEF, DOXY, A/P
Burkina Faso All areas Jan-Dec >85 yes MEF, DOXY, A/P
Burundi All areas Jan-Dec >85 yes MEF, DOXY, A/P
Cambodia Throughout the country, including risk in the temple complex at Angkor Wat. No risk in Phnom Penh and around Lake Tonle Sap Jan-Dec 90 Yes (also mefloquine resistance reported in western provinces bordering Thailand) DOXY, A/P in the provinces of Preah Vihear, Siemreap, Oddar, Meanchey, Banteay Meanchey, Battambang, Pailin, Koh Kong, and Pursat bordering Thailand. All other areas MEF, DOXY, A/P
Cameroon All areas Jan-Dec > 85 yes MEF, DOXY, A/P
Cape Verde Limited to Saõ Tiago Island Aug-Nov Not reported yes MEF, DOXY, A/P
Central African Republic All areas Jan-Dec > 85 yes MEF, DOXY, A/P
Chad All areas Jan-Dec > 85 yes MEF, DOXY, A/P
China Rural areas only of the following provinces: (at elevations of 1,500 metres and below) Hainan, Yunnan, Fuijan, Guangdong, Guangxi, Guizhou, Sichuan, Tibet (in the Zangbo River valley only), Anhui, Hubei, Hunan, Jiangsu, Jiangxi, and Shandong North of 33º N, Jul-Nov; between 25º N and 33º N, May-Dec; south of 25º N, Jan-Dec (2) 9 yes (in Hainan and Yunan) DOXY, AP along China-Burma border in the western part of Yunnan province and MEF, DOXY, A/P in Hainan and other parts of Yunnan province (NOTE: travellers to cities and popular tourist areas, including Yangtze River cruises, are not at risk and do not need to take chemoprophylaxis)
Colombia All rural/jungle areas below 1,600m; no risk in Bogotá and vicinity Jan-Dec 38 yes (in Amazonia, Pacifico, and Uraba-Bujo Cauca) MEF, DOXY, A/P
Comoros All areas Jan-Dec 88 yes MEF, DOXY, A/P
Congo All areas Jan-Dec 90 yes MEF, DOXY, A/P
Congo, Democratic Republic of the (formerly Zaire) All areas Jan-Dec 93 yes MEF, DOXY, A/P
Costa Rica In Alajuela, Limón, Guanacaste and Heredia provinces; no risk in Limón city (Puerto Limon) Jan-Dec < 1 no CQ
Côte D'Ivoire (Ivory Coast) All areas Jan-Dec 88 yes MEF, DOXY, A/P
Djibouti All areas Jan-Dec 98 yes MEF, DOXY, A/P
Dominican Republic Rural, with highest risk in provinces bordering Haiti; in addition, risk in all areas of La Altagracia Province, including resort areas Jan-Dec 99 no CQ
Ecuador All areas 1,500 metres elevation and below; no risk in the cities of Guayaquil and Quito, the central highland tourist areas, and the Galápagos Islands Jan-Dec 15 yes MEF, DOXY, A/P
Egypt Very limited risk in El Faiyûm area only; no risk in tourist areas, including Nile River cruises Jun-Oct < 1 no None (risk is very limited; therefore, prophylaxis is not recommended)
El Salvador Rural areas of Santa Ana, Ahuachapán and La Unión departments; no risk in the city of San Salvador Jan-Dec (3) <1 no CQ
Equatorial Guinea All areas Jan-Dec >85 yes MEF, DOXY, A/P
Eritrea All areas 2,200 m elevation and below; no risk in Asmara Jan-Dec 85 yes MEF, DOXY, A/P
Ethiopia All areas 2,000 m elevation and below; no risk in Addis Ababa Jan-Dec >85 yes MEF, DOXY, A/P
French Guiana All areas except no risk on Devil's Island (Ile du Diable) and the other coastal islands Jan-Dec 45 yes MEF, DOXY, A/P
Gabon All areas Jan-Dec 95 yes MEF, DOXY, A/P
Gambia All areas Jan-Dec >85 yes MEF, DOXY, A/P
Georgia In southeastern part of the country near Azerbaijan border and Kura River and in the districts of Gardabanis, Marneulis and Sighnaghis in the Kakheti and Kveno Kartli regions; no risk in Tbilisi Jul-Oct 0 no CQ
Ghana All areas Jan-Dec >85 yes MEF, DOXY, A/P
Guatemala Rural areas at 1,500 metres elevation and below; no risk in Guatemala City, Antigua or Lake Atitlán Jan-Dec 5 no CQ
Guinea All areas Jan-Dec 92 yes MEF, DOXY, A/P
Guinea- Bissau All areas Jan-Dec 90 yes MEF, DOXY, A/P
Guyana All rural areas at 900 metres elevation and below Jan-Dec 50 yes MEF, DOXY, A/P
Haiti All areas Jan-Dec 100 no CQ
Honduras Throughout the country at altitudes below 1,000 m (< 3,281 ft) and in Roatán and other Bay Island; risk exists in the outskirts of Tegucigalpa and San Pedro Sula Jan-Dec(3) 3 no CQ
India All areas throughout country, except no risk in areas above 2,000 meters in Himachal Pradesh, Jammu, kashmir and Sikkim; in urban areas below 2,000 m, including Delhi and Mumbai (Bombay) Jan-Dec 45 yes MEF, DOXY, A/P
Indonesia Rural Sumatra, Sulawesi, Kalimantan and Nusa Tenggara Barat (no risk in urban areas); in all areas of eastern Indonesia (provinces of Papua Indonesia, Irian Jaya Barat, Nusa Tenggara Timur, Maluku, and Maluku Utara); no risk in Jakarta, resort areas of Bali and the island of Java, except for the Menoreh Hills in central Java Jan-Dec 66 yes MEF, DOXY, A/P
Iran Rural areas of Sistan- Baluchestan, the southern tropical part of Kerman, and Hormozgan province; in Ardebil and East Azerbijan provinces north of the Zagros mountains Mar-Nov in areas of Kerman (tropical part), Hormozgan and southern Sistan- Baluchestan; summer months in Ardebil and East Azerbijan provinces north of the Zagros mountains 41 yes MEF, DOXY, A/P
Iraq Basrah province and below 1,500 metres in provinces of Duhok, Erbil, Ninawa, Sulaimaninya and Ta'mim ; no risk in Baghdad, Tikrit and Ramadi May-Nov 0 no CQ
Jamaica Very limited risk, in Kingston Jan-Dec (4) unreported no CQ
Kenya All areas (including game parks) below 2,500 metres elevation; no risk in Nairobi Jan-Dec >85 yes  
Korea, Democratic People's Republic of (North Korea) Limited risk in some southern areas Not reported; assumed to be Jan-Dec 0 no CQ
Korea, Republic of (South Korea) Limited to Demilitarized Zone (DMZ) and to rural areas in the northern parts of Kyonggi and Kangwon Provinces Not reported; assumed to be Jan-Dec 0 no CQ
Kyrgyzstan Some southern and western parts of the country, mainly in the provinces of Batken, Osh, and Jalal-Abad in the areas bordering Tajikistan and Uzbekistan; also in the capital city Bishkek. Jun-Oct 0 no CQ
Lao People's Democratic Republic (Laos) All, except no risk in city of Vientiane Jan-Dec 97 yes DOXY, A/P in the provinces of Bokèo and Louang Namtha along the Laos-Burma border and along the Laos- Thailand border in the province of Saravane and Champassack. All other areas MEF, DOXY, A/P
Liberia All areas Jan-Dec 90 yes MEF, DOXY, A/P
Madagascar All areas Jan-Dec >85 yes MEF, DOXY, A/P
Malawi All areas Jan-Dec 90 yes MEF, DOXY, A/P
Malaysia Rural areas, particularly in the forested, hilly and underdeveloped interior areas; no risk in urban and coastal areas. Note: no risk in Republic of Singapore. Jan-Dec (3) 65   MEF, DOXY, A/P
Mali All areas Jan-Dec >85 yes MEF, DOXY, A/P
Mauritania All, except no risk Dakhlet-Nouadhibou and Tiris- Zemmour region Jan-Dec in all areas except Jul-Oct in Adrar and Inchiri >85 likely MEF, DOXY, A/P
Mauritius Rural areas only; no risk on Rodrigues Island Jan-Dec (3) 0 no CQ
Mayotte (French Territorial Collectivity) All areas Jan-Dec Not reported yes MEF, DOXY, A/P
Mexico Limited to areas infrequently visited by travellers, including small foci along the Guatemala and Belize borders in the states of Chiapas, Quintana Roo and Tabasco; rural areas in the states of Nayarit, Oaxaca, Sinaloa; and in an area between 24° N and 28° N latitude, and 106° W and 110° W longitude, which lies in parts of Sonora, Chihuahua, and Durango. No malaria risk exists along the United States-Mexico border. No malaria risk exists in the major resorts along the Pacific and Gulf coasts Jan-Dec 1 no CQ (risk is very limited; therefore, prophylaxis is not recommended for most travellers to Mexico. Travellers should use personal protection measures such as insect repellents for malaria prevention. Chemoprophylaxis is recommended for the rare traveller going to the risk areas)
Morocco (including Western Sahara) Rural areas of Chefchaouen province; no risk in Tangier, Rabat, Casablanca, Marrakech and Fès May-Oct <1 no None (risk is very limited; therefore, prophylaxis is not recommended)
Mozambique All areas Jan-Dec 95 yes MEF, DOXY, A/P
Myanmar (formerly Burma) Rural areas throughout the country below 1,000 metres elevation; no risk in cities of Rangoon (Yangon) and Mandalay Jan-Dec 85 yes DOXY, A/P in the provinces of Shan, Kayah, Kachin, Kayin, and Tanintharyi. MEF, DOXY, A/P in all other areas
Namibia The provinces of Kunene, Ohangwena, Okavango, Omaheke, Omusati, Oshana, Oshikoto, Otjozondjupa and the Caprivi Strip Nov-Jun in: Oshana, Oshikoto, Omusati, Omaheke, Ohangwena and Otjozondjupa. Jan-Dec along the Kunene river and in Kavango and Caprivi regions. 90 yes MEF, DOXY, A/P
Nepal Risk below 1,200 metres in rural areas in the Tarai and Hill districts bordering India and in the areas of the inner Tarai valley areas of Udaypur Sindhupalchowk, Makwanpur, Chitwan and Dang; no risk in Kathmandu or on typical Himalayan treks Jan-Dec 12 yes MEF, DOXY, A/P
Nicaragua Rural areas in outskirts of Managua Jan-Dec 10 no CQ
Niger All areas Jan-Dec >85 yes MEF, DOXY, A/P
Nigeria All areas Jan-Dec >85 yes MEF, DOXY, A/P
Oman Limited risk in remote areas of Musandam Province Jan-Dec (3) 90 yes None (risk is very limited; therefore, prophylaxis is not recommended)
Pakistan All areas, including all cities below 2,000 metres elevation. Jan-Dec 46 yes MEF, DOXY, A/P
Panama Rural areas of Bocas Del Toro, Darién, San Blas provinces and San Blas Islands; no risk in Panama City or in the former Canal Zone Jan-Dec 13 yes CQ in Bocas Del Tora; MEF, DOXY, A/P in Darién and San Blas
Papua New Guinea All areas below 1,800 metres Jan-Dec 82 yes MEF, DOXY, A/P
Paraguay The departments of Alto Paraná, Caaguazú, and Canendiyú Oct-May (3) 4 no CQ
Peru Below 2,000 metres in all departments except Arequipa, Moquegua, Puno and Tacna; risk in Puerto Maldonado Jan-Dec 15 yes MEF, DOXY, A/P (NOTE: travellers who will visit only Lima and its vicinity, coastal areas south of Lima or the highland tourist areas [Cuzco, Machu Picchu and Lake Titicaca] are not at risk and need no prophylaxis)
Philippines All areas below 600 metres elevation, except no risk in Bohol Island, Borocay Island, Catanduanes Island and Cebu Island. No risk is considered to exist in Manila or other urban areas. Jan-Dec 74 yes (for P. Falciparum) MEF, DOXY, A/P
Rwanda All areas Jan-Dec 90 yes MEF, DOXY, A/P
Sao Tome and Principe All areas Jan-Dec >85 yes MEF, DOXY, A/P
Saudi Arabia Al Bahah, Al Madinah, Asir (excluding the highaltitude areas above 2,000 m), Jizan, Makkah, Najran and Tabuk province. No risk in urban areas of Jeddah, Mecca, Medina and Ta'if Jan-Dec 88 yes MEF, DOXY, A/P
Senegal All areas Jan-Dec >85 yes MEF, DOXY, A/P
Sierra Leone All areas Jan-Dec >85 yes MEF, DOXY, A/P
Solomon Islands All areas except for the southern province of Rennell and Bellona, the eastern province of Temotu, and the outer islands of Tikopia, Anuta and Fatutaka Jan-Dec 62 yes MEF, DOXY, A/P
Somalia All areas Jan-Dec 95 yes MEF, DOXY, A/P
South Africa The low altitude areas of the Mpumalanga Province, Northern Province Limpopo and northeastern KwaZulu-Natal as far south as the Tugela (Thukela) River; also, risk in Kruger National Park Jan-Dec 99 yes MEF, DOXY, A/P
Sri Lanka All areas, except no risk in the districts of Colombo, Galle, Kalutara and Nuwara Eliya Jan-Dec 12 yes MEF, DOXY, A/P
Sudan All areas Jan-Dec 90 yes MEF, DOXY, A/P
Suriname All areas, except no risk in the Paramaribo and coastal districts of Nickerie, Coronie, Saramacca, Wanica, Commewijne and Marowijne north of 5° N Jan-Dec 81 yes (also: mefloquine reistance reported MEF, DOXY, A/P
Swaziland The northern and eastern lowland areas bordering Mozambique in the Lubombo district, particularly around the villages/towns of Big Bend, Mhlume, Simunye and Tshaneni Jan-Dec 99 yes MEF, DOXY, A/P
Syrian Arab Republic (Syria) Along the northern border in El Hassaka province May-Oct 0 no CQ
Tajikistan All areas below 2,500 elevation, particularly along the southern border in Khatlon Oblast; central (Dushanbe), western (Gorno- Badakhshan), and northern (Leninabad) areas Jun-Dec 9 yes MEF, DOXY, A/P
Tanzania All areas below 1,800 metres Jan-Dec >85 yes MEF, DOXY, A/P
Thailand In rural areas that border Cambodia, Laos and Myanmar (Burma); risk in Koh Phangan. No risk in cities and no risk in major tourist resorts. No risk in Bangkok, Chiang Mai, Chiang Rai, Pattaya, Phuket Island and Ko Samui Jan-Dec 56 yes (also: mefloquine resistance reported from areas near the borders with Cambodia and Myanmar) DOXY, A/P
Timor Leste (East Timor) All areas Jan-Dec Predominates2 yes MEF, DOXY, A/P
Togo All areas Jan-Dec >85 yes MEF, DOXY, A/P
Turkey The provinces of Adana, Adryaman, Batman, Bingol, Bitlis, Diyarbakar, Elazig, Gaziantep, Hakkari, Hatay, Icel, Kahraman Maras, Kilis, Mardin, Mus, Osmaniyeh, , Sanliurfa, Siirt, Sirnak and Van; no risk on the Incirlik U.S. Air Force base and on typical cruise itineraries May-Oct 0 no CQ
Turkmenistan Southeast Mary Region and in the flood plains between the Murgab and Tedzhen Rivers Jun-Oct 0 no CQ
Uganda All areas Jan-Dec >85 yes MEF, DOXY, A/P
Uzbekistan Sporadic cases reported in Uzunskiy, Sariassiskiy and Shurchinskiy districts (Surkhanda-Rinskaya Region) Typically May-Oct (4) 0 no CQ
Vanuatu All areas Jan-Dec 62 yes MEF, DOXY, A/P
Venezuela Rural areas of the following states: Apure, Amazonas, Barinas, Bolivar, Sucre, Tachira and Delta Amacuro; risk in Angel Falls Jan-Dec 10 yes MEF, DOXY, A/P
Viet Nam Rural areas, except no risk in the Red River Delta and the coastal plain north of Nha Trang.; no risk in Hanoi, Ho Chi Minh City (Saigon), Da Nang, Nha Trang, Qui Nhon and Haiphong Jan-Dec(3) 72 yes (also: mefloquine resistance reported) DOXY, A/P in the southern part of the country in the provinces of Tay Ninh, Song Be, Lam Dong, Ninh Thuan, Khanh Hoa, Dac Lac, Gia Lai and Kon Tum. All other areas MEF, DOXY, A/P.
Yemen All areas below 2,000 metres; no risk in Sana'a Jan-Dec 95 yes MEF, DOXY, A/P
Zambia All areas Jan-Dec 90 yes MEF, DOXY, A/P
Zimbabwe All areas, except no risk in cities of Harare and Bulawayo   97 yes MEF, DOXY, A/P

References

  1. from World Health Organization's International Travel and Health 2011 Edition External Link (last accessed: 23 April 2009)
  2. from US Centers for Disease Control and Prevention, Health Information for International Travel, 2007-2008 (last accessed: 13 April 2009)
  3. from the World Malaria Risk Chart (PDF) External Link, International Association for Medical Assistance to Travellers at (last accessed: 13 April 2009)
  4. from sources other than WHO
  5. from sources other than IAMAT

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