Malaria in Africa: Risk, Resistance and Prophylaxis
| Country | Malaria Risk | Species | Drug Resistance | Prophylaxis |
|---|---|---|---|---|
| Algeria | Small focus in Ihrir (Illizi Department); Sporadic P. vivax and imported P. falciparum | Sporadic P. vivax and imported P. falciparum | Sporadic cases | Avoid mosquitoes |
| Angola | All areas | Mainly P. falciparum (92%); P. ovale and P. malariae also occur | Resistance to chloroquine and Sulfa-Pyrimeth | Atovaquone/proguanil or doxycycline or mefloquine |
| Benin | All areas | Mainly P. falciparum; P.n malariae also | Multi-drug resistant P. falciparum | Atovaquone/proguanil or doxycycline or mefloquine |
| Botswana | Northern districts of Central, Chobe, Ngamiland, North East, and Okavango | Mainly P. falciparum | Chloroquine resistance | Atovaquone/proguanil or doxycycline or mefloquine |
| Burkina Fasso | All areas | P. falciparum in >95%; P. malariae, P. ovale known | Resistance not common | Atovaquone/proguanil or doxycycline or mefloquine |
| Burundi | All areas | Mostly P. falciparum; P.n malariae in Rusizi valley | Chloroquine resistance known | Atovaquone/proguanil or doxycycline or mefloquine |
| Cameroon | All areas | Mainly P. falciparum; P. malariae and P. ovale also | Multi drug resistance | Atovaquone/proguanil or doxycycline or mefloquine |
| Canary Islands | No malaria | No malaria | No malaria | None |
| Cape Verde | All areas; seasonal | Only P. falciparum; imported P. malariae and P. ovale | No resistance | Avoid mosquitoes |
| Central African Republic | All areas | P. falciparum; imported P. malariae | ?Multi drug resistance | Atovaquone/proguanil or doxycycline or mefloquine |
| Chad | Mainly southern parts and bordering Sudan | P. falciparum | Chloroquine resistance | Atovaquone/proguanil or doxycycline or mefloquine |
| Comoros Island | All areas | P. falciparum | ?Multi drug resistance | Atovaquone/proguanil or doxycycline or mefloquine |
| Congo | All areas | P. falciparum | ?Multi drug resistance | Atovaquone/proguanil or doxycycline or mefloquine |
| Cote d'Ivoire | All areas | P. falciparum | Chloroquine resistance | Atovaquone/proguanil or doxycycline or mefloquine |
| Democratic Republic of Congo (Zaire) | All areas | P. falciparum | Chloroquine resistance | Atovaquone/proguanil or doxycycline or mefloquine |
| Djibouti | All areas | Almost all due to P. falciparum; P. vivax in Balbala area | Chloroquine resistance | Atovaquone/proguanil or doxycycline or mefloquine |
| Egypt | Free from malaria except in El Fayoum Oasis area | P. vivax | Not known | None |
| Equatorial Guinea | All areas | Mostly P. falciparum; a few cases of P. malariae and P. vivax | Chloroquine resistance | Atovaquone/proguanil or doxycycline or mefloquine |
| Eritrea | All areas | P. falciparum (90%) and P. vivax (10%) | Chloroquine resistance | Atovaquone/proguanil or doxycycline or mefloquine |
| Ethiopia | All areas except border areas with Somalia and Djibouti and the city of Addis Ababa | Mostly P. falciparum; a few cases of P. malariae and P. vivax | Chloroquine resistance | Atovaquone/proguanil or doxycycline or mefloquine |
| Gabon | All areas | Mostly P. falciparum; a few cases of P. malariae and P. ovale | Multi drug resistance | Atovaquone/proguanil or doxycycline or mefloquine |
| Gambia | All areas | P. falciparum | ?Multi drug resistance | Atovaquone/proguanil or doxycycline or mefloquine |
| Ghana | All areas | P. falciparum | ?Multi drug resistance | Atovaquone/proguanil or doxycycline or mefloquine |
| Guinea | All areas | P. falciparum | Chloroquine resistance | Atovaquone/proguanil or doxycycline or mefloquine |
| Guinea Bissau | All areas | P. falciparum (90%); a few cases of P. malariae and P. ovale (10%) | Chloroquine resistance | Atovaquone/proguanil or doxycycline or mefloquine |
| Kenya | All areas at altitudes lower than 2,500 meters; no risk in Nairobi | P. falciparum | ?Multi drug resistance | Atovaquone/proguanil or doxycycline or mefloquine |
| Lesotho | No malaria | No malaria | No malaria | None |
| Liberia | All areas | P. falciparum (82%), P. malariae (39%) and P. ovale (9%) | Resistance to chloroquine and Sulfa-Pyrimeth | Atovaquone/proguanil or doxycycline or mefloquine |
| Libya | No malaria | No malaria | None | |
| Madagascar | All areas | P. falciparum | ?Multi drug resistance | Atovaquone/proguanil or doxycycline or mefloquine |
| Malawi | All areas | P. falciparum | ?Multi drug resistance | Atovaquone/proguanil or doxycycline or mefloquine |
| Mali | All areas | P. falciparum (95%); P. ovale and P. malariae (5%) | ?Multi drug resistance | Atovaquone/proguanil or doxycycline or mefloquine |
| Mauritania | All areas | Mostly P. falciparum; a few cases of P. malariae and P. vivax | Chloroquine resistance | Atovaquone/proguanil or doxycycline or mefloquine |
| Mauritius | Rural areas only; no risk on Rodrigues Island | Mostly P. falciparum | Resistance to chloroquine and Sulfa-Pyrimeth | Atovaquone/proguanil or doxycycline or mefloquine |
| Mayotte | All areas | Only P. falciparum | ?Multi drug resistance | Atovaquone/proguanil or doxycycline or mefloquine |
| Morocco | Limited risk in rural areas of Khouribga Province | P. vivax | No resistance | None |
| Mozambique | All areas | P. falciparum | ?Multi drug resistance | Atovaquone/proguanil or doxycycline or mefloquine |
| Namibia | Only northern parts- provinces of Kunene, Ohangwena, Okavango, Caprivi, Omaheke, Omusati, Oshana, Oshikoto, and Otjozondjupa. | P. falciparum | Chloroquine resistance | Atovaquone/proguanil or doxycycline or mefloquine |
| Niger | All areas | P. falciparum | Chloroquine resistance | Atovaquone/proguanil or doxycycline or mefloquine |
| Nigeria | All areas | P. falciparum | ?Multi drug resistance | Atovaquone/proguanil or doxycycline or mefloquine |
| Reunion | No malaria | No malaria | No malaria | None |
| Rwanda | All areas | P. falciparum | Multi drug resistance | Atovaquone/proguanil or doxycycline or mefloquine |
| Sao Tome and Principe | All areas | Mostly P. falciparum; P. malariae, P. ovale and P. vivax also reported | Multi drug resistance | Atovaquone/proguanil or doxycycline or mefloquine |
| Senegal | All areas | Mostly P. falciparum; a few cases due to P. malariae and P. ovale | Multi drug resistance | Atovaquone/proguanil or doxycycline or mefloquine |
| Seychelles | No malaria | No malaria | No malaria | None |
| Sierra Leone | All areas | Mostly P. falciparum | Multi drug resistance | Atovaquone/proguanil or doxycycline orn mefloquine |
| Somalia | All areas | Mostly P. falciparum (90%); also P. malariae and P. vivax | Chloroquine resistance | Atovaquone/proguanil or doxycycline or mefloquine |
| South Africa | Areas with risk: Low altitude areas of the Mpumalanga Province, Northern Province, and northeastern KwaZulu-Natal as far south as the Tugela River, Kruger National Park. | Mostly P. falciparum (96%); P. ovale (4%) | Resistance to chloroquine and Sulfa-Pyrimeth | Atovaquone/proguanil or doxycycline or mefloquine |
| St. Helena | No malaria | No malaria | No malaria | None |
| Sudan | All areas | P. falciparum (>85%); P. vivax, P. ovale and P. malariae cause the rest | Multi drug resistance | Atovaquone/proguanil or doxycycline or mefloquine |
| Swaziland | Risk in all lowlands | P. falciparum | Chloroquine resistance | Atovaquone/proguanil or doxycycline or mefloquine |
| Tanzania | All areas at altitudes lower than 1,800 meters | Mostly P. falciparum | ?Multi drug resistance | Atovaquone/proguanil or doxycycline or mefloquine |
| Togo | All areas | Mostly P. falciparum (90%); also P. malariae and P. ovale | Multi drug resistance | Atovaquone/proguanil or doxycycline or mefloquine |
| Tunisia | Only imported cases | Mostly P. falciparum | No resistance | None |
| Uganda | All areas | Mostly P. falciparum | Multi drug resistance | Atovaquone/proguanil or doxycycline or mefloquine |
| Zambia | All areas | Mostly P. falciparum | Multi drug resistance | Atovaquone/proguanil or doxycycline or mefloquine |
| Zimbabwe | All areas except the cities of Harare and Bulawayo | Mostly P. falciparum | Multi drug resistance | Atovaquone/proguanil or doxycycline or mefloquine |
Malaria in Asia: Risk, Resistance and Prophylaxis
| Country | Malaria Risk | Species | Drug Resistance | Prophylaxis |
|---|---|---|---|---|
| Afghanistan | Risk in all areas at altitudes lower than 2000 meters from April to December | P. vivax and P.falciparum | Chloroquine-resistant P. falciparum | Chloroquine +proguanil; atovaquone/proguanil, doxycycline, mefloquine |
| Bahrain | No malaria | No malaria | No Risk | |
| Bangladesh | All areas except city of Dhaka | P. vivax and P.falciparum | P. falciparum resistant to chloroquine and Pyrimethamine/Sulfa | Atovaquone/proguanil or doxycycline or mefloquine |
| Bhutan | Risk in the southern belt of five districts: Chirang, Samchi, Samdrupjongkhar, Sarpang, and Shemgang. | P. vivax and P.falciparum | P. falciparum resistant ton chloroquine and Pyrimethamine/Sulfa | Atovaquone/proguanil, doxycycline, mefloquine |
| Brunei Darussalam | No risk | No malaria | No risk | |
| Burma (Myanmar) | Rural only. No risk in cities of Yangon and Mandalay (Throughout the year in Karen State; March to December in Chin, Kachin, Kayah, Mon, Rakhine and Shan states, Pegu Division, and Hlegu, Hmawbi, and Taikkyi townships of Yangon Division; April to December in the rural areas of Tenasserim Division; May to December in Irrawaddy Division and the rural areas of Mandalay Division; June to November in the rural areas of Magwe Division, and in Sagaing Division) | Predominantly due to P. falciparum; alson P. vivax | P. falciparum resistant ton chloroquine and Pyrimethamine/Sulfa; Mefloquine resistance reported in the eastern part ofn Shan State | Atovaquone/proguanil, doxycycline, mefloquine (not in eastern part of Shan State) |
| Cambodia | All areas including Angkor Wat temple complex; no risk in Phnom Penh and around Lake Tonle Sap | Predominantly due to P. falciparum; also P.vivax | Multi drug resistance P. falciparum: Resistance to chloroquine and pyrimeth/sulfadoxine; resistance to mefloquine reported in western provinces near the Thai border | Atovaquone/proguanil, doxycycline, mefloquine (not in western provinces) |
| China | Risk in rural areas of Hainan, Yunnan, Fuijan, Guangdong, Guangxi, Guizhou, Sichuan, Tibet (in the Zangbo River Valley only), Anhui, Hubei, Hunan, Jiangsu, Jiangxi, Shandong, Shanghai and Zhejiang provinces. Transmission during warm weather (North of 33 N: July to November; between 33 N to 25 N: May to December; south of 25 N: year-round); No malaria risk in urban areas nor in the densely populated plain areas. | P. falciparum as well as P.vivax | Multidrug-resistant P.falciparum in Hainan and Yunnan provinces | No need unless planning to stay in remote rural areas; Travelers to rural areas of the Hainan and Yunnan provinces should take atovaquone/proguanil or doxycycline or mefloquine; chloroquine would suffice for other areas |
| China - Hong Kong | No risk in urban areas; limited risk in extremely rural areas | P. falciparum as well as P. vivax | No resistance | Chloroquine in remote rural areas |
| China - Macao | No risk | No malaria | No risk | |
| Cyprus | No risk | No malaria | No risk | |
| East Timor | All areas | Predominantly P. falciparum | P. falciparum resistant ton chloroquine and Pyrimetha/Sulfa | Atovaquone/proguanil, doxycycline, mefloquine |
| India | All areas lower than 2,000 meters (thatn excludes some parts of the states of Himachal Pradesh, Jammu, Kashmir, and Sikkim) | P. vivax (80%); P. falciparum (20%) | P. falciparum, resistant to chloroquine all over, resistant to Sulfa/pyrimethamione in north eastern states | Atovaquone/proguanil, doxycycline, mefloquine |
| Indonesia | All areas including Irian Jaya, temple complex of Borobudur on Java and rural areas of remainder of the islands. No risk in Jakarta Municipality, big cities and resorts in Java, Sumatra and Bali | P. falciparum and P. vivax | P. falciparum resistant ton chloroquine and Pyrimetha/Sulfa; P. vivax resistant to chloroquine | Atovaquone/proguanil or doxycycline or mefloquine |
| Iran | P. vivax in some areas north of the Zagros mountains and in western and south-western regions during the summer months; P. falciparum in rural areas of Sistan-Baluchestan, Kerman (southern tropical part) and Hormozgan Provinces during March to November | P. falciparum and P. vivax | P. falciparum resistant to chloroquine and Sulfa-Pyrimeth | Chloroquine in P. vivax risk areas; chloroquine + proguanil in P. falciparum risk areas |
| Iraq | Areas in the north below 1500 m - Provinces of Duhok, Erbil, Ninawa, Sulaimaniya, Tamim, and Basrah | Only P. vivax | No chloroquine resistance | Chloroquine only |
| Israel | Free from malaria | No malaria | No malaria | |
| Japan | No risk | No malaria | No risk | |
| Jordan | No risk | No malaria | No risk | |
| Korea, DPR (North) | Limited risk in some southern areas | Only P. vivax | No resistance | Limited risk |
| Korea, Republic (South) | Risk limited to Demilitarized Zone and to rural areas in the northern parts of Kyonggi Do and Gangwon Do Provinces | Only P. vivax | No resistance | Limited risk |
| Kuwait | No risk | No malaria | No risk | |
| Lao People's Democratic Republicn (Laos) | All areas exceptu00a0the city of Vientiane | Mostly P. falciparum | Chloroquine resistance | Atovaquone/proguanil or doxycycline or mefloquine |
| Lebanon | No risk | No malaria | No risk | |
| Malaysia | Risk limited to rural areas; no risk in urban and coastal areas | P. falciparum; some cases of P. knowlesi | Resistance to chloroquine and Sulfa-Pyrimeth | Atovaquone/proguanil or doxycycline or mefloquine |
| Maldives | No risk | No malaria | No risk | |
| Mongolia | No risk | No malaria | No risk | |
| Nepal | Rural areas in the Terai and Hill Districts of Bara, Dhanukha, Kapilvastu, Mahotari, Parsa, Rautahat, Rupendehi and Sarlahi, and especially along the Indian border; at altitudes lower than 1,200 meters; no risk in Kathmandu and typical Himalayan treks | Predominantly due to P. vivax, also P. falciparum | P. falciparum resistant to chloroquine and Sulfa-Pyrimeth | Atovaquone/proguanil or doxycycline or mefloquine |
| Oman | Limited risk in remote areas of Musandam Province; no cases since 2001 | P. falciparum | Chloroquine resistance | Limited risk; no need |
| Pakistan | All areas, including the cities, at altitudes lower than 2,000 meters | P. falciparum (~60%), P. vivax (~40%) | Resistance to chloroquine and Sulfa-Pyrimeth | Atovaquone/proguanil or doxycycline or mefloquine |
| Philippines | Throughout the year in areas below 600 m, rural areas and Subic Bay; no risk in the provinces of Aklan, Bilaran, Bohol, Capiz Catanduanes, Cebu, Guimaras, Iloilo, Leyte, Masbate, northern Samar, Sequijor and metropolitan Manila as well as urban areas or in the plains | Predominantly P. falciparum; Also P. vivax | P. falciparum resistant to chloroquine and Sulfa-Pyrimeth | Atovaquone/proguanil or doxycycline or mefloquine |
| Qatar | No risk | None | No malaria | No risk |
| Saudi Arabia | Throughout the year in most of the Southern Region - Jizan province (except in the high-altitude areas of Asir Province) and in certain rural areas of the Western Region; no risk in cities of Jeddah, Mecca, Medina and Taif. | Predominantly P. falciparum | Chloroquine resistance | Chloroquine+Proguanil or Atovaquone/proguanil or doxycycline or mefloquine |
| Singapore | No risk | None | No malaria | No risk |
| Sri Lanka | Risk in all areas except the districts of Colombo, Galle Kalutara, and Nuwara Eliya | P. vivax (87%), P. falciparum (13%) | Resistance to chloroquine and Sulfa-Pyrimeth | Chloroquine+Proguanil or Atovaquone/proguanil or doxycycline or mefloquine |
| Syrian Arab Republic | Limited risk from May to October in foci along the northern border, especially in the north-eastern part of the country (in El Hassaka province) | Only P. vivax | No resistance | Only Chloroquine for areas with risk |
| Taiwan | No risk | None | No malaria | No risk |
| Thailand | Limited risk throughout the year in rural, especially forested and hilly areas of the whole country, mainly towards the international borders with Cambodia, Laos, and Burma. No risk in cities and major tourist resorts like Bangkok, Chiangmai, Pattaya, Phuket, Samui | P. vivax and P. falciparum; some cases of P. knowlesi | P. falciparum resistant to chloroquine and Sulfa-Pyrimeth; resistance to mefloquine and to quinine near the borders with Cambodia and Myanmar. | Atovaquone/proguanil or doxycycline or mefloquine; doxycycline for areas near Cambodia and Myanmar borders |
| Turkey | Risk from May to October in the south-eastern parts and in Amikova and Cukurova Plain. No risk in the main tourist areas in the west and south-west of the country | Only P. vivax | No resistance | Only Chloroquine |
| United Arab Emirates | No risk | None | No malaria | No risk |
| Vietnam | All areas except urban centres, the Red River delta, and the coastal plain areas of central Viet Nam. High-risk areas are the provinces of Dak Lak, Gia Lai and Kon Tum, Ca Mau, Bac Lieu, and Tay Ninh; no risk in Hanoi, Ho Chi Minh City, Da Nang, Nha Trang, Qui Nhon and Haiphong | Predominantly P. falciparum; some cases of P. knowlesi | Resistance to chloroquine and Sulfa-Pyrimeth | Atovaquone/proguanil or doxycycline or mefloquine |
| Yemen | All areas at altitudes lower than 2,000 meters; no risk in Sana'a | Predominantly P. falciparum | Chloroquine resistance | Chloroquine+Proguanil |
Malaria in South East Asia Region: South and South eastern Asia (SEA region) harbours most cases of malaria in the Asian continent. An estimated 1,216 million people or 70% of the total population of SEA Region are at risk of malaria. Out of which around 29% population at moderate to high risk of malaria, 71% are at low risk of malaria where as remaining 30% of population free from malaria (See Table). About 96% of the population of moderate to high risk of malaria in SEA Region are living in Bangladesh, India, Indonesia, Myanmar and Thailand and contributing more than 95% of confirmed malaria cases and deaths. During 2000-2009, in SEA Region, malaria confirmed cases of malaria ranged between 2.16 -2.83 millions and malaria deaths between 3188 – 6978. The proportion of P. falciparum was between 44 – 60%.
During 2009 total 2.7 million confirmed malaria cases (Microscopically and RDT) and 3188 malaria deaths were reported in the Region where as estimated malaria cases were around 26 -36 million and malaria deaths between 42300 – 77300. The P. faciparum proportion remained around 60.5% (including RDT positives). The highest number laboratory confirmed cases were reported from India (1,563,344) followed by Indonesia (544,470) and Myanmar (414,008) where as the lowest number of cases was reported from Sri Lanka (558) followed by Bhutan(972) and Nepal(3,335). Among the population living in malarious areas, infants, young children and pregnant women have been identified as higher malaria risk group. Other group of people which constitute higher malaria risk are mobile population particularly those engaged in forest-related economy, gem-mining, fishing, industrial and road construction work. In some countries, ethnic minorities, refugees, displaced persons tourists and pilgrims also constitute high risk group.[4]
Malaria situation in forest and forest related areas remains serious problem due to highly efficient vectors, multiple-vector transmission, prolonged transmission season, and drug-resistant P. falciparum malaria combined with large scale and uncontrolled population movement. Forest related malaria constitutes about 40% of total malaria cases of total malaria cases and about 60% of the total P. falciparum cases in the Region. As forests are becoming increasingly accessible due to the exploitation of their natural resources, very often such population movements result in epidemics of malaria in such areas.[4]
Several cases of P. knowlesi, acquired from macaque monkeys, have been reported from countries such as Malaysia, Thailand, Viet Nam, Myanmar, and Phillippines.[5-9]
Malaria in Australia and Oceania: Risk, Resistance, Prophylaxis
| Country | Malaria Risk | Species | Drug Resistance | Prophylaxis |
|---|---|---|---|---|
| Australia | No malaria | No malaria | No malaria | No risk |
| Cook Island | No malaria | No malaria | No malaria | No risk |
| Fiji | No malaria | No malaria | No malaria | No risk |
| French Polynesia (Society Islands [Tahiti, Moorea, Bora-Bora], Marquesas Islands [Nuku Hiva, Hiva Oa, Ua Huka], and Austral Islands [Tubuai, Rurutu, Rimatara, Rapa]) | No malaria | No malaria | No malaria | No risk |
| Kiribati (Tarawa, Tabuaeran [Fanning Island], Kiritimati [Christmas Island], and Banaba [Ocean Island]) | No malaria | No malaria | No malaria | No risk |
| Marshall Islands | No malaria | No malaria | No malaria | No risk |
| Micronesia (Yap Islands, Pohnpei, Chuuk, Kosrae) | No malaria | No malaria | No malaria | No risk |
| Nauru | No malaria | No malaria | No malaria | No risk |
| New Caledonia | No malaria | No malaria | No malaria | No risk |
| New Zealand | No malaria | No malaria | No malaria | No risk |
| Niue | No malaria | No malaria | No malaria | No risk |
| Northern Mariana Islands (Saipan, Tinian, Rota Island) | No malaria | No malaria | No malaria | No risk |
| Palau | No malaria | No malaria | No malaria | No risk |
| Papua New Guinea | Risk in all areas lower than 1800 meters | Predominantly P. falciparum; also P. vivax | P. falciparum resistant to chloroquine and Sulfa-Pyrimeth; P. vivax resistant to chloroquine | Atovaquone/proguanil or doxycycline or mefloquine |
| Pitcairn | No malaria | No malaria | No malaria | No risk |
| Samoa | No malaria | No malaria | No malaria | No risk |
| Solomon Islands | Risk in 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 | Predominantly P. falciparum | P. falciparum resistant to chloroquine and pyrimeth/sulfadoxine | Atovaquone/proguanil or doxycycline or mefloquine |
| Tokelau | No malaria | No malaria | No malaria | No risk |
| Tonga | No malaria | No malaria | No malaria | No risk |
| Tuvalu | No malaria | No malaria | No malaria | No risk |
| U.S. Trust Territory of the Pacific Islands (Guam, American Samoa, Johnston Atoll, Wake Island, Midway Islands) | No malaria | No malaria | No malaria | No risk |
| Vanuatu | Risk in all areas. | Predominantly P. falciparum; also P. vivax | P. falciparum resistant to chloroquine and Sulfa-Pyrimeth; P. vivax resistant to chloroquine | Atovaquone/proguanil or doxycycline or mefloquine |
| Wallis and Futuna | No malaria | No malaria | No malaria | No risk |
Malaria in North America: Risk, Resistance, Prophylaxis
| Country | Malaria Risk | Species | Drug Resistance | Prophylaxis |
|---|---|---|---|---|
| Anguilla | No malaria | No malaria | No malaria | No risk |
| Antigua & Barbuda | No malaria | No malaria | No malaria | No risk |
| Bahamas | No malaria | No malaria | No malaria | No risk |
| Barbados | No malaria | No malaria | No malaria | No risk |
| Belize | All districts, but risk is highest in the southern region. | Almost exclusively P.vivax | No resistance | Chloroquine |
| Bermuda | No malaria | No malaria | No malaria | No risk |
| Canada | No malaria | No malaria | No malaria | No risk |
| Cayman Islands | No malaria | No malaria | No malaria | No risk |
| Costa Rica | Moderate risk throughout the year in the cantons of Los Chiles (Alajuela Province) and Matina and Talamanca (Limon Province); lower risk in cantons in the provinces of Alajuela, Guanacaste and Heredia, and in other cantons in Limon Province; negligible or no risk in the other cantons. | Almost exclusively P.vivax | No resistance | Chloroquine |
| Cuba | No malaria | No malaria | No malaria | No malaria |
| Dominica | No malaria | No malaria | No malaria | No malaria |
| Dominican Republic | Low risk throughout the year in rural areas of the western provinces (Castanuelas, Hondo Valle and Pepillo Salcedo) | Only P.falciparum | No resistance | Chloroquine |
| El Salvador | Very low risk throughout the year in Santa Ana, Ahuachapan and La Union Provinces, in rural areas of migratory influence from Guatemala. | Only P.vivax | No resistance | Chloroquine |
| Grenada | No malaria | No malaria | No malaria | No malaria |
| Guadeloupe and St. Martin Island | No malaria | No malaria | No malaria | No malaria |
| Guatemala | Risk throughout the year below 1500 m; high risk in Alta Verapaz, Baja Verapaz, Peten and San Marcos, and moderate risk in Escuintla, Huehuetenango, Izabal, Quiche, Retalhuleu, Suchitepequez and Zacapa. | Predominantly P.vivax | No resistance | Chloroquine |
| Haiti | Throughout the year in forest areas in Chantal, Gros Morne, Hinche, Jacmel and Maissade. | Only P. falciparum | No resistance | Chloroquine |
| Honduras | High risk throughout the year; low risk inn San Pedro Sula and the city of Tegucigalpa. P. falciparum risk is the highest in Sanitary Region VI, including Islas de la Bahia. | Predominantly due to P.vivax; also P.falciparum | No resistance | No resistance |
| Jamaica | No malaria | No malaria | No malaria | No malaria |
| Martinique | No malaria | No malaria | No malaria | No malaria |
| Mexico | Throughout the year in some rural areas - high risk in the states of Chiapas, Quintana Roo, Sinaloa and Tabasco; moderate risk in the states of Chihuahua, Durango, Nayarit, Oaxaca and Sonora; and low risk in Campeche, Guerrero, Michoacan and Jalisco. | Almost exclusively P.vivax | No resistance | Chloroquine |
| Montserrat | No malaria | No malaria | No malaria | No malaria |
| Netherlands Antilles (including Aruba, Bonaire, Curacao, and Sint Maarten islands) | No malaria | No malaria | No malaria | No malaria |
| Nicaragua | High risk throughout the year in Chinandega, Jinotega, Nueva Segovia, RAAN, RAAS and Rio San Juan; low or negligible risk in Carazo, Madriz and Masaya | Predominantly P.vivax | No resistance | Chloroquine |
| Panama | Low risk throughout the year in Bocas del Toro in the west and Darien and San Blas in the east; no or negligible risk in other areas. | Predominantly P.vivax | Chloroquine-resistant P. falciparum in Darien and San Blas provinces. | Chloroquine for Bocas Del Toro Province; atovaquone/proguanil or doxycycline or mefloquine for Dariu00e9n Province and San Blas Province (including the San Blas Islands) |
| Puerto Rico | No malaria | No malaria | No malaria | No malaria |
| St. Lucia | No malaria | No malaria | No malaria | No malaria |
| St. Vincent & Grenadines | No malaria | No malaria | No malaria | No malaria |
| St. Kitts & Nevis | No malaria | No malaria | No malaria | No malaria |
| Trinidad & Tobago | No malaria | No malaria | No malaria | No malaria |
| Turks and Caicos | No malaria | No malaria | No malaria | No malaria |
| United States | No malaria | No malaria | No malaria | No malaria |
| Virgin Islands (U.S.) | No malaria | No malaria | No malaria | No malaria |
| Virgin Islands (U.K.) | No malaria | No malaria | No malaria | No risk |
Malaria in South America: Risk, Resistance, Prophylaxis
| Country | Malaria Risk | Species | Drug Resistance | Prophylaxis |
|---|---|---|---|---|
| Argentina | Limited risk in rural areas along the borders with Bolivia (lowlands of Jujuy and Salta provinces) and with Paraguay (lowlands of Corrientes and Misiones provinces). | Only P. vivax | No resistance | Chloroquine for risk areas |
| Bolivia | Throughout the year below 2500 m in the departments of Beni, Pando, Santa Cruz and Tarija, and in the provinces of Lacareja, Rurenabaque, and North and South Yungas in La Paz Department. Lower risk exists in Cocha-bamba and Chuquisaca. Falciparum malaria occurs in Beni and Pando, especially in the localities of Guayaramerin, Puerto Rico and Riberalta. | Predominantly due to P. vivax | P. falciparum resistant to chloroquine and pyrimeth/sulfadoxine | Chloroquine; mefloquine for northern departments |
| Brazil | Most forested areas below 900 m within the nine states of the "Legal Amazonia" region (Acre, Amapa, Amazonas, Maranhao (western part), Mato Grosso (northern part), Para (except Belem City), Rondonia, Roraima and Tocantins; risk is negligible or non-existent in other areas | P. vivax (77%), P. falciparum (23%) | Multidrug-resistant P. falciparum | Atovaquone/proguanil or doxycycline or mefloquine |
| Chile | No malaria | No malaria | No malaria | No malaria |
| Colombia | High risk throughout the year in rural/jungle areas below 800 m, especially in the Amazonia, Orinoquia, Pacifico and Uraba-Bajo Cauca regions; highest risk in Amazonas, Choco, Cordoba, Guainia, Guaviare, Putumayo and Vichada. Chloroquine-resistant P. falciparum exists in Amazonia, Pacifico and Uraba-Bajo Cauca. | P. vivax (54%), P. falciparum (46%) | P. falciparum resistant to chloroquine and pyrimeth/sulfadoxine | Atovaquone/proguanil or doxycycline or mefloquine |
| Ecuador | Risk throughout the year below 1500 m; some risk in Cotopaxi, Loja and Los Rios, higher risk in El Oro, Esmeraldas and Manabi, no risk in Guayaquil or Quito. | P.vivax (77%), P.falciparum (23%) | Chloroquine resistant P. falciparum in Esmeraldas Province | Chloroquine for most; mefloquine for Esmeraldas province |
| Falkland Islands | No malaria | No malaria | No malaria | No malaria |
| French Guiana | High risk throughout the year in nine municipalities bordering Brazil (Oiapoque river valley) and Suriname (Maroni river valley); risk is low or negligible in the other 13 municipalities. | P. falciparum (70%), P. vivax (30%) | Multidrug-resistant P. falciparum | Atovaquone/proguanil or doxycycline or mefloquine |
| Guyana | High risk throughout the year in all parts of the interior; sporadic cases in the densely populated coastal belt. | P. vivax (52%), P. falciparum (48%) | Chloroquine-resistant P. falciparum | Atovaquone/proguanil or doxycycline or mefloquine |
| Paraguay | Moderate risk in the Alto Paraa, Caaguazu and Canendiyu areas; no or negligible risk in other aeras. | Only P. vivax | No resistance | Chloroquine |
| Peru | High risk in Ayacucho, Cajamarca, Cerro de Pasco, Chachapoyas, Chanca-Andahuaylas, Cutervo, Cusco, Huancavelica, Jaen, Junin, La Libertad, Lambayeque, Loreto, Madre de Dios, Piura, San Martin, Tumbes and Ucayali araes. P. falciparum in Jaen, Lambayeque, Loreto, Luciano Castillo, Piura, San Martin, Tumbes and Ucayali araes. | P. vivax (78%), P. falciparum (22%) | P. falciparum resistant to chloroquine and pyrimeth/ sulfadoxine | Atovaquone/proguanil or doxycycline or mefloquine |
| Suriname | High risk throughout the year in the three southern districts; risk is low or negligible in Paramaribo city and the other seven coastal districts | P. falciparum (76%) and P. vivax | P. falciparum resistant to chloroquine and pyrimeth/ sulfadoxine | Atovaquone/proguanil or doxycycline or mefloquine |
| Uruguay | No malaria | No malaria | No malaria | No malaria |
| Venezuela | Throughout the year in some rural areas of Apure, Amazonas, Barinas, Bolivar, Sucre and Tachira states; P. falciparum restricted to jungle areas of Amazonas (Atabapo), Bolivar (Cedeno, Gran Sabana, Raul Leoni, Sifontes and Sucre) and Delta Amacuro (Antonia Diaz, Casacoima and Pedernales). | P. vivax and P. falciparum | P. falciparum resistant to chloroquine | Atovaquone/proguanil or doxycycline or mefloquine |
Malaria in Europe: Risk, Resistance, Prophylaxis
| Country | Malaria Risk | Species | Drug Resistance | Prophylaxis |
|---|---|---|---|---|
| Albania | No malaria | No malaria | No malaria | No malaria |
| Andorra | No malaria | No malaria | No malaria | No malaria |
| Armenia | From June to October in some of the villages in Ararat Valley, (Masis, Ararat, and Artashat regions); no risk in tourist areas. | Only P. vivax | No resistance | Chloroquine (limited risk) |
| Austria | No malaria | No malaria | No malaria | No malaria |
| Azerbaijan | Limited risk from June to September in lowland areas, (between the Kura and the Arax rivers, Lenkeran, Mugan-Salyan, Priaraks and Sirvan provinces) | Only P. vivax | No resistance | Chloroquine (limited risk) |
| Azores | No malaria | No malaria | No malaria | No malaria |
| Belarus | No malaria | No malaria | No malaria | No malaria |
| Belgium | No malaria | No malaria | No malaria | No malaria |
| Bosnia/ Herzegovina | No malaria | No malaria | No malaria | No malaria |
| Bulgaria | No malaria | No malaria | No malaria | No malaria |
| Croatia | No malaria | No malaria | No malaria | No malaria |
| Czech Republic | No malaria | No malaria | No malaria | No malaria |
| Denmark | No malaria | No malaria | No malaria | No malaria |
| Estonia | No malaria | No malaria | No malaria | No malaria |
| Faroe Island | No malaria | No malaria | No malaria | No malaria |
| Finland | No malaria | No malaria | No malaria | No malaria |
| France | No malaria | No malaria | No malaria | No malaria |
| Georgia | From July to October in some villages in the south-eastern part of the country (districts of Lagodekhi, Sighnaghi, Dedophilistskaro, Saraejo, Gardabani, and Marneuli in the Kakheti and Kveno Kartli regions). No risk in Tbilisi | Only P. vivax | No resistance | Chloroquine (limited risk) |
| Germany | No malaria | No malaria | No malaria | No malaria |
| Gibraltar | No malaria | No malaria | No malaria | No malaria |
| Greece | No malaria | No malaria | No malaria | No malaria |
| Greenland | No malaria | No malaria | No malaria | No malaria |
| Hungary | No malaria | No malaria | No malaria | No malaria |
| Iceland | No malaria | No malaria | No malaria | No malaria |
| Ireland | No malaria | No malaria | No malaria | No malaria |
| Italy | No malaria | No malaria | No malaria | No malaria |
| Kazakhstan | No malaria | No malaria | No malaria | No malaria |
| Kyrgyzstan | From June to September in some southern and western parts of the country, (Batken, Osh and Zhele-Abadskaya provinces in areas bordering Tajikistan and Uzbekistan). | Only P. vivax | No resistance | Chloroquine (limited risk) |
| Latvia | No malaria | No malaria | No malaria | No malaria |
| Liechtenstein | No malaria | No malaria | No malaria | No malaria |
| Lithuania | No malaria | No malaria | No malaria | No malaria |
| Luxembourg | No malaria | No malaria | No malaria | No malaria |
| Madeira | No malaria | No malaria | No malaria | No malaria |
| Macedonia | No malaria | No malaria | No malaria | No malaria |
| Malta | No malaria | No malaria | No malaria | No malaria |
| Moldova | No malaria | No malaria | No malaria | No malaria |
| Monaco | No malaria | No malaria | No malaria | No malaria |
| Netherlands | No malaria | No malaria | No malaria | No malaria |
| Norway | No malaria | No malaria | No malaria | No malaria |
| Poland | No malaria | No malaria | No malaria | No malaria |
| Portugal | No malaria | No malaria | No malaria | No malaria |
| Romania | No malaria | No malaria | No malaria | No malaria |
| Russia | No malaria | No malaria | No malaria | No malaria |
| San Marino | No malaria | No malaria | No malaria | No malaria |
| Serbia/ Montenegro | No malaria | No malaria | No malaria | No malaria |
| Slovak Republic | No malaria | No malaria | No malaria | No malaria |
| Slovenia | No malaria | No malaria | No malaria | No malaria |
| Spain | No malaria | No malaria | No malaria | No malaria |
| Sweden | No malaria | No malaria | No malaria | No malaria |
| Switzerland | No malaria | No malaria | No malaria | No malaria |
| Tajikistan | From June to October, in Khatlon Region, Dushanbe, Gorno-Badakhshan and Leninabad Region. | Predominantly P. vivax; P. falciparum in the southern part of the country. | Chloroquine resistance | Chloroquine plus proguanil in the southern part of the country |
| Turkmenistan | From June to October in some villages in the south-eastern part of the country, mainly in Mary district. | Only P. vivax | No resistance | Chloroquine (limited risk) |
| Ukraine | No malaria | No malaria | No malaria | No malaria |
| United Kingdom | No malaria | No malaria | No malaria | No malaria |
| Uzbekistan | Sporadic cases in Surkhanda-rinskaya Region (Uzunskiy, Sariassiskiy and Shurchinskiy districts). | P. vivax | No resistance | Chloroquine (limited risk) |
Further Reading:
- http://wwwnc.cdc.gov/travel/yellowbook/2010/chapter-2/malaria-risk-information-and-prophylaxis.aspx
- WHO. International Travel and Health. 2010. Available at http://www.who.int/ith/ITH2010.pdf
- Kidson C, Indaratna K. Ecology, economics and political will: The vicissitudes of malaria strategies in Asia. Parasitologia
Jun 1998;40(1-2):39-46. - WHO: Regional office for SEA. Malaria: Disease burden in SEA region. Available at http://www.searo.who.int/en/Section10/Section21/Section340_4018.htm
- Chaturong Putaporntip, Thongchai Hongsrimuang, Sunee Seethamchai et al. Differential Prevalence of Plasmodium Infections and Cryptic Plasmodium knowlesi Malaria in Humans in Thailand. The Journal of Infectious Diseases 2009;199:1143–1150
- Balbir Singh, Lee Kim Sung, Anand Radhakrishnan et al. A large focus of naturally acquired Plasmodium knowlesi infections in human beings. The Lancet 2004;363(9414):1017-1024
- Janet Cox-Singh, Balbir Singh. Knowlesi malaria: newly emergent and of public health importance? Trends in Parasitology. 2008;24(9):406-410
- Peter Van den Eede, Hong Nguyen Van, Chantal Van Overmeir et al. Human Plasmodium knowlesi infections in young children in central Vietnam. Malaria Journal 2009;8:249. Full Text at http://www.malariajournal.com/content/8/1/249
- Cyrus Daneshvar, Timothy ME Davis, Janet Cox-Singh, Mohammad Zakri Rafa’ee, Siti Khatijah Zakaria, Paul CS Divis, Balbir Singh. Clinical and Laboratory Features of Human Plasmodium knowlesi Infection. Clinical Infectious Diseases 2009;49:852–860
- World Malaria Report 2010. Available at http://whqlibdoc.who.int/publications/2010/9789241564106_eng.pdf
- Global Malaria Action Plan. Available at http://www.rollbackmalaria.org/gmap
- Roll Back Malaria. Progress & Impact Series. Number 2. April 2010. World Malaria Day 2010: Africa Update. Available at http://www.unicef.org/media/files/rbm-reportII-en.pdf
- Roberts DR, Tren R. International advocacy against DDT and other public health insecticides for malaria control. Research and Reports in Tropical Medicine January 2011;2011(2):23-30. DOI 10.2147/RRTM.S16419. Available at http://www.dovepress.com/getfile.php?fileID=8597
- Rowe AK et al. Caution is required when using health facility-based data to evaluate the health impact of malaria control efforts in Africa. Malaria Journal 2009;8:209 doi:10.1186/1475-2875-8-209. Available at http://www.malariajournal.com/content/pdf/1475-2875-8-209.pdf
©malariasite.com ©BS Kakkilaya | Last Updated: Jan 2, 2018