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Appendix I: Malaria Risk and Recommended Chemoprophylaxis by Geographic AreaFootnote *

This document was last updated on February 9, 2016

Appendix I shows a country-by-country characterization of malaria transmission areas based on elevation, seasonality and epidemiologic data. Regional and/or city-specific information may also be provided. While relatively accurate in the shorter term, in some areas, risk may vary from year to year and season to season. In other countries where risk for malaria is present year-round in all areas, there is little variation that would affect malaria chemoprophylaxis recommendations from year to year. The Public Health Agency of Canada's Travel Health website (www.travelhealth.gc.ca) is available to keep travel health practitioners abreast of changes in risk.

In these guidelines, CATMAT has tried to balance the need for protection with the potential for adverse effects of chemoprophylaxis. For the most part, CATMAT guidelines are consistent with the World Health Organization's International Travel and Health report and the CDC's Yellow Book: Health Information for International Travel, but in some instances is reflective of European national recommendations Footnote 1-Footnote 10.

For certain countries, CATMAT now includes a duration-of-exposure component in its recommendations, expressed in the format: "Chloroquine for stays > 1 weeks; Chloroquine or PPM [personal protective measures] alone for stays of ≤ 1 weeks." The intent is to allow the travel health practitioner to be more flexible for those countries where malaria risk is particularly low. That is to say, practitioners may consider recommending PPM alone for stays equal to or shorter than the identified time period, but CATMAT continues to recommend chemoprophylaxis along with PPM for all longer stays. When no chemoprophylaxis has been used, urgent medical consultation should be sought in the event of a fever. The rationale for this decision is outlined in Chapter 2.

Malaria risk and recommended chemoprophylaxis by geographic area
Country Malaria transmission areasFootnote 1, Footnote 2, Footnote 6 Chemoprophylaxis recommended by CATMATTable 1 - Footnote *;Footnote 1-Footnote 8 SeasonFootnote 1-Footnote 2 Plasmodium falciparumFootnote 1, Footnote 2, Footnote 6 %
Table 1 - Footnote *
Chemoprophylaxis is recommended only in the risk areas identified during the transmission season identified. Chemoprophylaxis should always be used in conjunction with PPM.

Abbreviations: FR, France; n/a, not applicable; NL, Netherlands; NZ, New Zealand; PPM, personal protective measures; UK, United Kingdom; US, United States;

Note: PPM are outlined in Chapter 3: "Malaria Education for Travellers" and the CATMAT Statement on Personal Protective Measures to Prevent Arthropod Bites.
A
Countries: A B C D E F G H I J K L M N O P Q R S T U V W Y Z
Afghanistan All areas at elevations < 2000 m. Risk is considered lower in central Kabul where PPM can be considered as an alternative to chemoprophylaxis. Atovaquone-proguanil, doxycycline or mefloquine. May-Nov 10-20
Albania No malaria transmission. None. n/a n/a
Algeria Rare malaria cases in the South. None. n/a n/a
American Samoa No malaria transmission. None. n/a n/a
Andorra No malaria transmission. None. n/a n/a
Angola All areas. Atovaquone-proguanil, doxycycline or mefloquine. Year-round 90
Anguilla (UK) No malaria transmission. None. n/a n/a
Antigua and Barbuda No malaria transmission. None. n/a n/a
Argentina No malaria transmission. None. n/a n/a
Armenia No malaria transmission. None. n/a n/a
Aruba (NL) No malaria transmission. None. n/a n/a
Australia No malaria transmission. None. n/a n/a
Austria No malaria transmission. None. n/a n/a
Azerbaijan Areas at elevations < 1500 m in the rural lowlands mainly between the Kura and Arax rivers. No indigenous cases reported in 2013. No risk in Baku. Use PPM Jun-Oct 0
B
Countries: A B C D E F G H I J K L M N O P Q R S T U V W Y Z
Bahamas No malaria transmission. None. n/a n/a
Bahrain No malaria transmission. None. n/a n/a
Bangladesh No malaria transmission in the city of Dhaka. None. n/a n/a
Little or no risk in areas of the country not described below. PPM Year-round > 50
Low risk exists in the districts of Hobigonj, Kurigram, Moulvibazar,Mymensingh, Netrakona, Sherpur, Sunamgonj and Sylhet. Atovaquone-proguanil, doxycycline or mefloquine.
The risk is high in Chittagong Hill Tract districts (Bandarban, Rangamati and Khagrachari), Chittagong district and Cox Bazaar district.
Barbados No malaria transmission. None. n/a n/a
Belarus No malaria transmission. None. n/a n/a
Belgium No malaria transmission. None. n/a n/a
Belize No malaria transmission in Belize City and islands frequented by tourists. None. n/a n/a
Small foci of transmission, primarily in Stann Creek and Toledo. Rare locally transmitted cases in other districts. None; use PPM. Year-round 5
Benin All areas. Atovaquone-proguanil, doxycycline or mefloquine. Year-round 85
Bermuda (UK) No malaria transmission. None. n/a n/a
Bhutan Districts of Bumthang, Gaza, Paro, and Thimphu: no risk. None. n/a n/a
Rare seasonal cases in districts of Ha, Lhuentse, Monggar, Punakha, Trashigang, Trongsa, Tsirang, Yangtse, and Wangdue. PPM. May-September 50
All rural areas <1,700 m (5,577 ft) in districts of Chukha, Dagana, Pemagatshel, SamdrugJongkhar, Samtse, Sarpang, and Zhemgang. Atovaquone-proguanil, doxycycline or mefloquine. Year-round 50
Bolivia (Plurinational State of) No malaria transmission in areas at elevations > 2500m, including the city of La Paz. None. n/a n/a
All areas at elevations < 2500 m. The risk is predominantly due to P. vivax, with exceptions listed below. Atovaquone-proguanil, chloroquine, doxycycline or mefloquine. Year-round 6
Transmission of P. falciparum malaria occurs in the northern departments of Beni and Pando (especially in the localities of Guayaramerín and Riberalta) and in Santa Cruz. Atovaquone-proguanil,doxycycline or mefloquine.
Bosnia and Herzegovina No malaria transmission. None. n/a n/a
Botswana No malaria transmission in the cities of Francistown or Gaborone or in other areas not listed below. None. n/a n/a
Northern parts of the country: Bobirwa, Boteti, Chobe, Ngamiland, Okavango, Tutume districts/sub-districts. None in North East district. Atovaquone-proguanil, doxycycline or mefloquine. Predominantly Nov-Jun 90
Brazil In the states outside the administrative region of Amazonas the risk of malaria transmission is negligible or non-existent including Iguazu Falls; in the cities of Brasília, Recife, Rio de Janeiro, São Paulo, and Salvador. Risk is low in the less forested areas in southern Mato Grosso including most of the Pantanal. None; use PPM. Year-round 15
Malaria risk - P. vivax (84%), P. falciparum (15%), mixed infections (1%) - exists in most forested areas below 900 m within the nine states of the Amazon region (Acre, Amapá, Amazonas, Maranhão (western part), Mato Grosso (northern part), Pará (except Belém City), Rondônia, Roraima and Tocantins (western part)). Transmission intensity varies from one municipality to another, and is higher in jungle mining areas, in agricultural settlements, in indigenous areas and in some peripheral urban areas of Cruzeiro do Sul, Manaus and Pôrto Velho. Malaria also occurs on the periphery of large cities such as Boa Vista, Macapá, Maraba, Rio Branco and Santarém. Atovaquone-proguanil, doxycycline or mefloquine.
British Virgin Islands (UK) No malaria transmission. None. n/a n/a
Brunei Darussalam Human infection with P. knowlesi reported. None; use PPM. n/a n/a
Bulgaria No malaria transmission. None. n/a n/a
Burkina Faso All areas. Atovaquone-proguanil, doxycycline or mefloquine. Year-round 80
Burma (Myanmar) No malaria transmission at elevations > 1000 m or in urban areas. None. n/a n/a
Areas at elevations < 1000 m, except urban areas. Risk of transmission is higher in remote rural hilly and forested areas and some coastal areas of Rakhine State. There is risk in Bagan. Atovaquone-proguanil,doxycycline or mefloquine. Year-round 60
Mefloquine resistance reported in Kayin state and the eastern part of Shan state. Atovaquone-proguanil or doxycycline.
Burundi All areas. Atovaquone-proguanil, doxycycline or mefloquine. Year-round 86
C
Countries: A B C D E F G H I J K L M N O P Q R S T U V W Y Z
Cambodia No malaria transmission in the city of Phnom Penh and the area around Lake Tonlé Sap (Siem Reap). Negligible transmission in the tourist area of Angkor Wat and Siem Reap. None; use PPM. Year-round 86
Mefloquine resistance is reported in the western provinces of Banteay Meanchey, Battambang, Koh Kong, Odder Meanchey, Pailin, Kampot, PreahVihear, Pursat, and Siemreap bordering Thailand. Doxycycline or atovaquone-proguanil.
All other areas. Atovaquone-proguanil, doxycycline or mefloquine.
Cameroon All areas. Atovaquone-proguanil, doxycycline or mefloquine. Year-round 85
Canada No malaria transmission. None. n/a n/a
Cape Verde Limited cases in São Tiago (Santiago) Island. None; use PPM. Aug-Nov Primarily P. Falciparum
Cayman Islands (UK) No malaria transmission. None. n/a n/a
Central African Republic All areas. Atovaquone-proguanil, doxycycline or mefloquine. Year-round 85
Chad All areas. Atovaquone-proguanil,doxycycline or mefloquine. Year-round 85
Chile No malaria transmission. None. n/a n/a
China No malaria transmission in urban areas or northern China. No malaria risk above 1500 m. None. n/a n/a
Limited transmission in rural areas of Anhui, Hubei, Guangxi, and Motuo County in Tibet, including river cruises that pass through malaria-endemic parts of Anhui and Hubei. Use PPM Year-round 9
Along China-Burma (Myanmar) border in the western part of rural Yunnan Province. Atovaquone-proguanil, or doxycycline.
Other rural parts of Yunnan Province. Atovaquone-proguanil, doxycycline or mefloquine
Colombia No risk in areas at 1700 m or higher, in the cities of Baranquilla, Bogota, Cartagena and on the islands of San Andres and Providencia. None. n/a n/a
Risk is high in rural and jungle areas below 1700m. Risk exists on excursions on the Magdalena River south of Baranquilla, on the Pacific coast and east of the Cordillera Oriental. Risk is considered lower in northern rural areas. Atovaquone-proguanil, doxycycline or mefloquine. Year-round 35-40
Comoros All areas. Atovaquone-proguanil, doxycycline or mefloquine. Year-round Primarily P. falciparum
Congo All areas. Atovaquone-proguanil, doxycycline or mefloquine. Year-round 90
Congo, Democratic Republic of the (formerly Zaïre) All areas. Atovaquone-proguanil, doxycycline or mefloquine. Year-round 90
Cook Islands (NZ) No malaria transmission. None. n/a n/a
Costa Rica No malaria transmission. None. n/a n/a
Côte D'Ivoire (Ivory Coast) All areas. Atovaquone-proguanil, doxycycline or mefloquine. Year-round 85
Croatia No malaria transmission. None. n/a n/a
Cuba No malaria transmission. None. n/a n/a
Curaçao (NL) No malaria transmission. None. n/a n/a
Cyprus No malaria transmission. None. n/a n/a
CzechRepublic No malaria transmission. None. n/a n/a
D
Countries: A B C D E F G H I J K L M N O P Q R S T U V W Y Z
Denmark No malaria transmission. None. n/a n/a
Djibouti All areas. Atovaquone-proguanil, doxycycline or mefloquine. Year-round 90
Dominica No malaria transmission. None. n/a n/a
Dominican Republic Little to no malaria transmission in the resort areas of Romana and Samaná and the cities of Santo Domingo, Santiago, and Puerto Plata. None; use PPM. Year-round 100
Some cases in tourists have been reported in 2015 in the resort area of Punta Cana in La Altagracia province. Risk is considered higher during the rainy season (usually May to October). PPM, optionally chloroquine, atovaquone-proguanil, doxycycline or mefloquine; chloroquine, atovaquone-proguanil, doxycycline or mefloquine during outbreaks.
Rural areas, with the highest risk in the provinces of Dajabón, Elias Piña, and San Juan bordering Haiti. Chloroquine, atovaquone-proguanil, doxycycline or mefloquine.
E
Ecuador No malaria transmission at elevations > 1500 m, including Cuenca, Quito, and other cities and villages in the Andean highlands; in the city of Guayaquil or on the Galápagos Islands. None. n/a n/a
All other areas at elevations < 1500 m. Higher risk along the coast, in the north. Atovaquone-proguanil, doxycycline or mefloquine. Year-round 10
Egypt No malaria transmission. None. n/a n/a
El Salvador Rare cases along the Guatemalan border. None; use PPM. Year-round < 1
Equatorial Guinea All areas. Atovaquone-proguanil, doxycycline or mefloquine. Year-round 85
Eritrea No malaria transmission at elevations > 2200 m, including the city of Asmara. None. n/a n/a
All areas at elevations < 2200 m. Atovaquone-proguanil, doxycycline or mefloquine. Year-round 85
Estonia No malaria transmission. None. n/a n/a
Ethiopia No malaria transmission at elevations > 2200 m, including Addis Ababa. None. n/a n/a
All areas at elevations < 2200 m, including Axum (2139 m),Dire Dawa (1262 m), Harar (1848 m), and Nazret (1725 m). Atovaquone-proguanil, doxycycline or mefloquine. Year-round 60-70
F
Countries: A B C D E F G H I J K L M N O P Q R S T U V W Y Z
Fiji No malaria transmission. None. n/a n/a
Finland No malaria transmission. None. n/a n/a
France No malaria transmission. None. n/a n/a
French Guiana No malaria transmission in the city of Cayenne or on Devil's Island (Île du Diable). None. n/a n/a
All other areas. Risk along the coast is low but increases towards the interior. High risk of transmission in municipalities bordering Brazil and Suriname. PPM can be considered for coastal states Atovaquone-proguanil, doxycycline or mefloquine. Year-round < 50
French Polynesia No malaria transmission. None. n/a n/a
G
Gabon All areas. Atovaquone-proguanil, doxycycline or mefloquine. Year-round 90
Gambia All areas. Atovaquone-proguanil, doxycycline or mefloquine. Year-round ≥ 85
Georgia Limited risk in the eastern areas bordering Azerbaijan. The city of Tbilisi is risk-free. None; use PPM. June-Oct 0
Germany No malaria transmission. None. n/a n/a
Ghana All areas. Atovaquone-proguanil, doxycycline or mefloquine. Year-round 90
Gibraltar (UK) No malaria transmission. None. n/a n/a
Greece No malaria transmission. None. n/a n/a
Greenland (Denmark) No malaria transmission. None. n/a n/a
Grenada No malaria transmission. None. n/a n/a
Guadeloupe (FR) No malaria transmission. None. n/a n/a
Guam (US) No malaria transmission. None. n/a n/a
Guatemala No malaria transmission in urban areas or areas at elevations > 1500 m none in Guatemala City, Antigua, and Lake Atitlán. None. n/a n/a
Below 1500 m. There is high risk in the departments of Escuintla and Alta Verapaz and low risk in Baja Verapaz, Chiquimala, Izabal, Petén, Suchitepéquez and Zacapa. Chloroquine, atovaquone-proguanil, doxycycline or mefloquine. Year-round 3
Guinea All areas. Atovaquone-proguanil, doxycycline or mefloquine. Year-round 85
Guinea-Bissau All areas. Atovaquone-proguanil, doxycycline or mefloquine. Year-round 85
Guyana Rare cases in the cities of Amsterdam and Georgetown. Low risk along the coast of Guyana. PPM. Year-round 50
All other areas at elevations < 900 m. Risk is high in all parts of the interior. Atovaquone-proguanil, doxycycline or mefloquine.
H
Countries: A B C D E F G H I J K L M N O P Q R S T U V W Y Z
Haiti All areas. Chloroquine, atovaquone-proguanil, doxycycline or mefloquine. Year-round 99
Holy See (Vatican City) No malaria transmission. None. n/a n/a
Honduras No malaria transmission - in the cities of Tegucigalpa and San Pedro Sula.

Risk is low in higher mountainous areas in the west where PPM can be considered.
None. n/a n/a
Risk is high in departments of Colón and Gracias a Dios and moderate in Atlántida, El Paraiso, Olancho, and Yoro. P. falciparum transmission risk is high in Gracias a Dios. There is malaria risk on the island of Roatan. Chloroquine, atovaquone-proguanil, doxycycline or mefloquine. Year-round 20
Hong Kong (China) No malaria transmission. None. n/a n/a
Hungary No malaria transmission. None. n/a n/a
I
Iceland No malaria transmission. None. n/a n/a
India No malaria transmission at elevations > 2000 m in parts of the states of Himachal Pradesh, Jammu and Kashmir, and Sikkim. None. n/a n/a
Delhi PPM Year-round > 40
All other areas - including most urban areas such as Bombay (Mumbai).

Risk is lower in most of the southernmost regions of India.

Risk is low in central urban areas of Agra and Bangalore.
Atovaquone-proguanil, doxycycline or mefloquine.

PPM alone can be considered for stays of <1 week in central urban areas of Agra and Bangalore.

Year-round > 40
Indonesia No risk in cities of Jakarta and Ubud, resort areas of Bali and Java, and Gili Islands and the Thousand Islands (Pulau Seribu). None. n/a n/a
All areas of eastern Indonesia (provinces of Maluku, Maluku Utara, Nusa Tenggara Timur, Papua, and Papua Barat), including the town of Labuan Bajo and Komodo Islands in the Nusa Tenggara region. Rural areas of Kalimantan (Borneo), Nusa Tenggara Barat (includes the island of Lombok), Sulawesi, and Sumatra.Low transmission in rural areas of Java, including Pangandaran, Sukalumi, and Ujung Kulong. Atovaquone-proguanil, doxycycline or mefloquine. Year-round 66
Iran, Islamic Republic of Rural areas in the provinces of Hormozgan, Kerman (tropical part only), and Sistan-Baluchestan (southern part only). Atovaquone-proguanil, doxycycline, or mefloquine. Mar-Nov 12
All other areas. None. n/a n/a
Iraq No locally acquired cases reported since 2009. None. n/a n/a
Ireland No malaria transmission. None. n/a n/a
Israel No malaria transmission. None. n/a n/a
Italy No malaria transmission. None. n/a n/a
J
Countries: A B C D E F G H I J K L M N O P Q R S T U V W Y Z
Jamaica No malaria transmission. None. n/a n/a
Japan No malaria transmission. None. n/a n/a
Jordan No malaria transmission. None. n/a n/a
K
Kazakhstan No malaria transmission. None. n/a n/a
Kenya Little to no malaria transmission at elevations > 2500 m or in the city of Nairobi. None; use PPM. Year-round 85
All areas at elevations < 2500 m, except the city of Nairobi. Atovaquone-proguanil, doxycycline or mefloquine.
Kiribati No malaria transmission. None. n/a n/a
Korea, Democratic People's Republic of (North Korea) Limited risk in some southern areas. None; use PPM. Presumed to be March to Dec Presumed 0
Korea, Republic of (South Korea) Limited risk in the demilitarized zone (DMZ); rural areas in the northern parts of the provinces of Gyeonggi-do (Kyonggi) and Gangwon-do (Kangwon-do); and the northern part of the city of Incheon. None; use PPM. Mar-Dec 0
Kosovo No malaria transmission. None. n/a n/a
Kuwait No malaria transmission. None. n/a n/a
Kyrgyzstan No risk of transmission. None. Jun-Oct n/a
L
Lao People's Democratic Republic (Laos) No malaria transmission in the city of Vientiane. None. n/a n/a
Risk is low in the province of Bokeo away from the Burmese border, Huaphan and Oudomxay and the city of Luang Prabang. PPM. Year-round 65
Mefloquine resistance has been reported along the Loas-Burma (Myanmar) border in the provinces of Bokeo and Louang Namtha and along the Laos-Thailand boarder in the provinces of Champasak and Saravan, along the Laos-Cambodia border, and along the Laos-Vietnam border. Atovaquone-proguanil or doxycycline.
All other areas. Atovaquone-proguanil, doxycycline or mefloquine.
Latvia No malaria transmission. None. n/a n/a
Lebanon No malaria transmission. None. n/a n/a
Lesotho No malaria transmission. None. n/a n/a
Liberia All areas. Atovaquone-proguanil, doxycycline or mefloquine. Year-round 85
Libyan Arab Jamahiriya (Libya) No malaria transmission. None. n/a n/a
Liechtenstein No malaria transmission. None. n/a n/a
Lithuania No malaria transmission. None. n/a n/a
Luxembourg No malaria transmission. None. n/a n/a
M
Countries: A B C D E F G H I J K L M N O P Q R S T U V W Y Z
Macao (China) No malaria transmission. None. n/a n/a
Macedonia No malaria transmission. None. n/a n/a
Madagascar All areas. Risk is highest in coastal areas. Atovaquone-proguanil, doxycycline or mefloquine. Year-round 85
Rare cases in the city of Antananarivo. PPM measures only.
Malawi All areas. Atovaquone-proguanil, doxycycline or mefloquine. Year-round 90
Malaysia No malaria transmission in urban and coastal areas. None. n/a n/a
Transmission in Peninsular Malaysiais limited to areas in the rural interior. Atovaquone-proguanil, doxycycline or mefloquine. Year-round n/a
Risk in east Malaysian Borneo limited to deep hinterland in the states of Sabah and Sarawak.
Human P. knowlesi infection reported.
Maldives No malaria transmission. None. n/a n/a
Mali All areas. Atovaquone-proguanil, doxycycline or mefloquine. Year-round 85
Malta No malaria transmission. None. n/a n/a
Marshall Islands No malaria transmission. None. n/a n/a
Martinique (FR) No malaria transmission. None. n/a n/a
Mauritania No malaria transmission in the northern provinces of Dakhlet-Nouadhibou, and Tiris-Zemmour. None. n/a n/a
Present in southern provinces including Nouakchott. Atovaquone-proguanil, doxycycline or mefloquine. Year-round, except July-Oct in Adrar and Inchiri 85
Mauritius No malaria transmission. None. n/a n/a
Mayotte (FR) All areas. Atovaquone-proguanil, doxycycline or mefloquine. Year-round 40-50
Mexico Minimal or no malaria transmission in much of Mexico including major resort areas on the coasts, including the city of Acapulco or along the Mayan Riviera, including the cities of Cancún, Cozumel, and Playa del Carmen. None along the border with the United States. None. Year-round 0
Low malaria risk due almost exclusively to P. vivax exists intermittently throughout the year in some rural areas that are not often visited by tourists. Chiapas, Chihuahua, Durango, Nayarit, and Sinaloa. PPM.
Micronesia, Federated States of No malaria transmission. None. n/a n/a
Moldova, Republic of No malaria transmission. None. n/a n/a
Monaco No malaria transmission. None. n/a n/a
Mongolia No malaria transmission. None. n/a n/a
Montenegro No malaria transmission. None. n/a n/a
Montserrat (UK) No malaria transmission. None. n/a n/a
Morocco No malaria transmission. None. n/a n/a
Mozambique All areas. Atovaquone-proguanil, doxycycline or mefloquine. Year-round 90
N
Countries: A B C D E F G H I J K L M N O P Q R S T U V W Y Z
Namibia No malaria transmission in southern two-thirds of the country, including the city of Windhoek. None. n/a n/a
The regions of Caprivi; Kunene, including areas along the Kunene River and Kavango. Atovaquone-proguanil, doxycycline or mefloquine. Year-round 90
The regions of Ohangwena, Omaheke, Omusati, Oshana, Oshikoto, and Otjozondjupa, and Etosha National Park. Nov-June
Nauru No malaria transmission. None. n/a n/a
Nepal

CATMAT considers Kathmandu and typical Himalayan treks to be risk-free.

Areas other than those listed below: little or no risk.
None. n/a n/a
Malaria risk due predominantly to P. vivax exists throughout the year in rural areas of the 20 Terai districts bordering India, with occasional outbreaks of P. falciparum from July to October inclusive. Seasonal transmission of P. vivax takes place in 45 districts of the inner Terai and mid-hills. Atovaquone-proguanil, doxycycline or mefloquine. Year-round 15
Netherlands No malaria transmission. None. n/a n/a
New Caledonia (FR) No malaria transmission. None. n/a n/a
New Zealand No malaria transmission. None. n/a n/a
Nicaragua Little to no malaria transmission in departments not listed below. None; use PPM. Year-round 10
Departments of Chinandega, Jinotega, León, Managua, and Matagalpa, Región Autónoma Atlántico Norte (RAAN), and Región Autónoma Atlántico Sur (RAAS). Chloroquine, atovaquone-proguanil, doxycycline or mefloquine.
Niger All areas. Atovaquone-proguanil, doxycycline or mefloquine. Year-round 85
Nigeria All areas. Atovaquone-proguanil, doxycycline or mefloquine. Year-round 85
Niue (NZ) No malaria transmission. None. n/a n/a
Northern Mariana Islands (US) No malaria transmission. None. n/a n/a
Norway No malaria transmission. None. n/a n/a
O
Oman Sporadic transmission of P. falciparum and P. vivax may occur subsequent to international importations of parasites. In 2010, local outbreaks of P.falciparum and P.vivax were reported in North Sharqiya region. Local cases were also reported in 2011 and 2012. None. n/a n/a
P
Countries: A B C D E F G H I J K L M N O P Q R S T U V W Y Z
Pakistan Malaria risk - P. vivax and P. falciparum - exists throughout the year in the whole country below 2200 m, especially in rural areas from July to December inclusive.
Risk is lower in the north in winter.
Atovaquone-proguanil, doxycycline or mefloquine. Year-round 30
Palau No malaria transmission. None. n/a n/a
Panama Little to no malaria transmission in Panama City, the Canal zone, or regions not listed below. None; use PPM. Year-round 1
Provinces and indigenous territories (comarcas) along the Caribbean coast and the borders with Costa Rica:Bocas del Toro, Veraguas, Colón Chloroquine, atovaquone-proguanil, doxycycline or mefloquine for stays > 1 week; chloroquine, atovaquone-proguanil, doxycycline or mefloquine or PPM alone for stays of < 1 week.
Most transmission in provinces east of the Panama Canal toward the border with Colombia. P. falciparum resistance to chloroquine has been reported in Darién and Kuna Yala (San Blas). There is some risk in Ngäbe Buglé on the west side of the canal. Atovaquone-proguanil, doxycycline or mefloquine.
Papua New Guinea All areas at elevations < 1900 m. Atovaquone-proguanil, doxycycline or mefloquine. Year-round 65 - 80
Paraguay Little to no malaria transmission in departments not listed below. None. Year-round 5
Very low risk in the departments of Alto Paraná and Caaguazú. PPM.
Peru No malaria risk at elevations > 2000 m, including the highland tourist areas (Machu Picchu, Lake Titicaca, and the cities of Arequipa, Cuzco, Puno) or on the coast except in the north. The cities of Lima, Moquegua, Nazca, and Tacna have no risk. None. n/a n/a
All areas < 2000 m (except cities listed above). This includes the cities of Puerto Maldonado and Iquitos. Most P.falciparum cases occur in the region of Loreto. Atovaquone-proguanil, doxycycline or mefloquine. Year-round 15
Philippines Little to no malaria transmission in urban areas or on islands not listed below. None; use PPM. Year-round 70-80
Rural areas at elevations < 600 m on islands of Basilu, Luzon, Mindanao, Mindoro, Palawan, Sulu (Jolo) and Tawi-Tawi. Human cases of P. knowlesi reported on Palawan I. Atovaquone-proguanil, doxycycline or mefloquine.
Pitcairn Islands (UK) No malaria transmission. None. n/a n/a
Poland No malaria transmission. None. n/a n/a
Portugal No malaria transmission. None. n/a n/a
Puerto Rico (US) No malaria transmission. None. n/a n/a
Q
Qatar No malaria transmission. None. n/a n/a
R
Réunion (FR) No malaria transmission. None. n/a n/a
Romania No malaria transmission. None. n/a n/a
Russian Federation (Russia) No malaria transmission. None. n/a n/a
Rwanda All areas. Atovaquone-proguanil, doxycycline or mefloquine. Year-round 90
S
Countries: A B C D E F G H I J K L M N O P Q R S T U V W Y Z
Saint-Barthélemy (FR) No malaria transmission. None. n/a n/a
Saint Helena (UK) No malaria transmission. None. n/a n/a
Saint Kitts and Nevis No malaria transmission. None. n/a n/a
Saint Lucia No malaria transmission. None. n/a n/a
Saint Martin (FR) No malaria transmission. None. n/a n/a
Saint Pierre and Miquelon (FR) No malaria transmission. None. n/a n/a
Saint Vincent and the Grenadines No malaria transmission. None. n/a n/a
Samoa No malaria transmission. None. n/a n/a
San Marino No malaria transmission. None. n/a n/a
São Tomé and Príncipe All areas. Atovaquone-proguanil, doxycycline or mefloquine. Year-round 85
Saudi Arabia No malaria transmission in most of the country, in the cities of Mecca, Medina, Jeddah, Riyadh, or Ta'if; or in the high altitude areas of Asir province. None. n/a n/a
Local transmission reported only in villages on the border of Yemen (except in the high-altitude areas of Asir Province). Atovaquone-proguanil, doxycycline or mefloquine. Year-round (but mainly Sep-Jan) Predominantly P. falciparum
Senegal Malaria risk due predominantly to P. falciparum exists throughout the year in the whole country. There is less risk from January to June inclusive in the central western regions. Atovaquone-proguanil, doxycycline or mefloquine. Year-round > 85
Serbia No malaria transmission. None. n/a n/a
Seychelles No malaria transmission. None. n/a n/a
Sierra Leone All areas. Atovaquone-proguanil, doxycycline or mefloquine. Year-round 85
Singapore No malaria transmission. None. n/a n/a
Saint Maarten (NL) No malaria transmission. None. n/a n/a
Slovakia No malaria transmission. None. n/a n/a
Slovenia No malaria transmission. None. n/a n/a
Solomon Islands No malaria transmission on a few of the outlying islets in the east and south. None. n/a n/a
All other areas. Atovaquone-proguanil, doxycycline or mefloquine. Year-round 60
Somalia Malaria risk exists in the whole country. Risk is relatively low and seasonal in the north. It is higher in the central and southern parts of the country. Atovaquone-proguanil, doxycycline or mefloquine. Year-round 90
South Africa No malaria transmission in most of the country including the Garden Route and major cities. None. n/a n/a
Malaria risk due predominantly to P. falciparum exists throughout the year in the low-altitude areas of Mpumalanga Province (including the Kruger National Park), Limpopo Province and north-eastern KwaZulu-Natal. Atovaquone-proguanil, doxycycline or mefloquine. Year-round (risk is highest from Oct-May) 90
South Sudan All areas. Atovaquone-proguanil, doxycycline or mefloquine. Year-round 90
Spain No malaria transmission. None. n/a n/a
Sri Lanka Last locally transmitted case in October 2012. None. n/a n/a
Sudan, Republic of Malaria risk due exists throughout the year in the whole country. Risk is low and seasonal in the north. It is higher in the central and southern parts of the country. Malaria risk on the Red Sea coast is very limited.
Atovaquone-proguanil, doxycycline or mefloquine. Year-round (predomin-antly during wetter season in the north) 90
Suriname Little to no malaria transmission in the seven districts along the Atlantic Coast, including in the city of Paramaribo. None; use PPM. Year-round 40-70
Areas in the interior of the country. Risk of malaria transmission is highest along the eastern border with French Guiana and in gold mining areas. Atovaquone-proguanil, doxycycline or mefloquine.
Swaziland Present in eastern areas bordering Mozambique and South Africa, including all of Lubombo district and the eastern half of Hhohho, Manzini, and Shiselweni districts. Mbabane is risk-free. Atovaquone-proguanil, doxycycline or mefloquine. Year-round 90
Sweden No malaria transmission. None. n/a n/a
Switzerland No malaria transmission. None. n/a n/a
Syrian Arab Republic (Syria) No malaria transmission None. n/a n/a
T
Countries: A B C D E F G H I J K L M N O P Q R S T U V W Y Z
Tajikistan Rare indigenous case. PPM. Jun-Oct 10
Tanzania, United Republic of All areas at elevations < 1800 m. Atovaquone-proguanil, doxycycline or mefloquine. Year-round > 85
Thailand Few to rare cases in areas noted below. This includes the cities of Chiang Rai, Koh Phangan, Koh Samui, and Phuket. None in the islands of Krabi Province (Koh Phi Phi, Koh Yao Noi, Koh Yao Yai, and Ko Lanta), in Bangkok, Chiang Mai and Pattaya City. PPM, none where no malaria reported. n/a n/a
Malaria risk exists throughout the year in rural, especially forested and hilly, areas of the country, mainly towards the international borders, including the southernmost provinces. Included are the provinces of Kalasin, Plai Phraya district of Krabi, Nakhon Si Thammarat, Narathiwat, Pattani, Phang Nga (located to the north of Phuket, including Phang Nga city), Rayong, Sakon Nakhon, Songkhla, Surat Thani, and Yala. There is resistance to mefloquine. Atovaquone-proguanil or doxycycline. Year-round 50-75
Timor-Leste (East Timor) All areas. Atovaquone-proguanil, doxycycline or mefloquine. Year-round 50
Togo All areas. Atovaquone-proguanil, doxycycline or mefloquine. Year-round 85
Tokelau (NZ) No malaria transmission. None. n/a n/a
Tonga No malaria transmission. None. n/a n/a
Trinidad and Tobago No malaria transmission. None. n/a n/a
Tunisia No malaria transmission. None. n/a n/a
Turkey There is no malaria risk in the main tourist areas in the west and south-west of the country. None. n/a n/a
Limited malaria risk due exclusively to P. vivax exists in Mardin Province which borders Syria. Sporadic cases were reported in 2014. PPM. May-Oct Sporadically
Turkmenistan No malaria transmission. None. n/a n/a
Turks and Caicos Islands (UK) No malaria transmission. None. n/a n/a
Tuvalu No malaria transmission. None. n/a n/a
U
Uganda All areas. Atovaquone-proguanil, doxycycline or mefloquine. Year-round > 85
Ukraine No malaria transmission. None. n/a n/a
United Arab Emirates No malaria transmission. None. n/a n/a
United Kingdom No malaria transmission. None. n/a n/a
United States No malaria transmission. None. n/a n/a
US Virgin Islands No malaria transmission. None. n/a n/a
Uruguay No malaria transmission. None. n/a n/a
Uzbekistan No malaria transmission. None. June-Oct n/a
V
Countries: A B C D E F G H I J K L M N O P Q R S T U V W Y Z
Vanuatu All areas. Atovaquone-proguanil, doxycycline or mefloquine. Year-round 60
Venezuela, Bolivarian Republic of The cities of Caracas, La Asuncion, Maracaibo, parts of Margarita Island and other areas not noted below. None. n/a n/a
Few cases in the following states: Anzoategui, Apure excluding the municipality Pedro Camejo, Barinas, Guarico, Miranda, Monagas, Marcano municipality in Margarita Island of Nueva Esparta, Portuguesa, Tachira, and Zulia except as noted below. PPM. Year-round 25
The states of Amazonas, 1 municipality in Apure (Pedro Camejo), Bolivar including Angel Falls, Delta Amacuro, Monagas, Sucre, and 2 municipalities in Zulia (Jesus M.Semprum, Machiques de Perija). Atovaquone-proguanil, doxycycline or mefloquine.
Vietnam None in Da Nang, Haiphong, Hanoi, Ho Chi Minh City (Saigon), NhaTrang, Qui Nhon, and the Red River Delta.

Rare cases in the Mekong Delta. The common coastal itinerary between Ho Chi Minh City and Hanoi with overnights mainly in urban areas does not typically require chemoprophylaxis.
Use PPM. Year-round 50-90
Rural areas, excluding those listed above.

Risk in the town of Sapa in the hills to the northwest of Hanoi is lower; PPM can be considered for stays <1 week, particularly in the winter months.
Atovaquone-proguanil, doxycycline or mefloquine.
Mefloquine resistance reported in the southern part of the country in the provinces of Dac Lac, Gia Lai, Khanh Hoa, Kon Tum, Lam Dong, Ninh Thuan, Song Be, and Tay Ninh. Atovaquone-proguanil or doxycycline.
W
Countries: A B C D E F G H I J K L M N O P Q R S T U V W Y Z
West Bank and Gaza Strip No malaria transmission. None. n/a n/a
Western Sahara Malaria transmission very rare. None; use PPM. Unknown Unknown
Y
Yemen No malaria transmission at elevations > 2000 m, including in the city of Sana'a. None. n/a n/a
Very limited transmission on Socotra Island. None; use PPM. Year-round but main risk Sept-Feb 95
All areas at elevations < 2000 m. Atovaquone-proguanil, doxycycline or mefloquine.
Z
Zambia All areas. Atovaquone-proguanil, doxycycline or mefloquine. Year-round > 90
Zimbabwe Negligible malaria transmission in Harare and Bulawayo. None. Nov-Jun > 90
All other areas < 1200 m. Atovaquone-proguanil, doxycycline or mefloquine.
Malaria transmission occurs year-round in the Zambezi Valley, including at Victoria Falls. Year-round

Reference List

Footnote *
Geographic Areas as per WHO International Travel and Health
Footnote 1
Calleri G, Castelli F, El Hamad I, Gobbi F, Matteelli A, Napoletano G, et al. New Italian guidelines for malaria prophylaxis in travellers to endemic areas. Infection 2014 Feb;42(1):239-250.
Footnote 2
Caumes E, Caumes D. Recommandations sanitaires pour les voyageurs, 2015: Optimisme et vigilance. Les nouvelles recommandations pour la prévention du paludisme du voyageur [Health recommendations for travellers, 2015: Optimism and Vigilance. The New Recommendations for the Prevention of Traveller's Malaria]. 2015;21-22.
Footnote 3
Comite d'experts en medecine des voyages [Expert Committee in Travel Medicine]. Conseils medicaux aux voyageurs [Medical advice for travelers]. Available at: http://www.safetravel.ch/safetravel2/servlet/ch.ofac.wv.wv202j.pages.Wv202DestinationsCtrl?action=recherche. Accessed February 24, 2016.
Footnote 4
Deutsche Gesellschaft für Tropenmedizin und Internationale Gesundheit (DTG) [German Society for Tropical Medicine and International Health]. Empfehlungen zur Malariavorbeugung [Recommendations for malaria prevention]. 2015.
Footnote 5
Folkhälsomyndigheten [Public Health Agency]. Rekommendationer för malariaprofylax 2015 [Recommendations for malaria prophylaxis 2015]. 2015.
Footnote 6
Gershman MD, Jentes ES, Stoney RJ, Tan KR, Arguin PM, Steele SF. Chapter 3: Infectious Diseases Related to Travel: Yellow Fever & Malaria Information, by Country. Yellow Book. Atlanta, USA: Centers for Disease Control and Prevention; 2015.
Footnote 7
Health Protection Scotland. fitfortravel: Travel health information for people travelling abroad from the UK. Available at: http://www.fitfortravel.nhs.uk/destinations.aspx. Accessed February 24, 2016.
Footnote 8
Malaria Site. Malaria in India. 2015; Available at: http://www.malariasite.com/malaria-india/. Accessed February 24, 2016.
Footnote 9
PHE Advisory Committee for Malaria Prevention for UK Travellers (ACMP). Guidelines for malaria prevention in travellers from the UK 2015. 2015;2015337.
Footnote 10
World Health Organization. List of countries, territories and areas Yellow fever vaccination requirements and recommendations; malaria situation; and other vaccination requirements. 2015.