Global Malaria Risk

Malaria in Africa: Risk, Resistance and Prophylaxis

CountryMalaria RiskSpeciesDrug ResistanceProphylaxis
AlgeriaSmall focus in Ihrir (Illizi Department); Sporadic P. vivax and imported P. falciparumSporadic P. vivax and imported P. falciparumSporadic casesAvoid mosquitoes
AngolaAll areasMainly P. falciparum (92%); P. ovale and P. malariae also occurResistance to chloroquine and Sulfa-PyrimethAtovaquone/proguanil or doxycycline or mefloquine
BeninAll areasMainly P. falciparum; P.n malariae alsoMulti-drug resistant P. falciparumAtovaquone/proguanil or doxycycline or mefloquine
BotswanaNorthern districts of Central, Chobe, Ngamiland, North East, and OkavangoMainly P. falciparumChloroquine resistance Atovaquone/proguanil or doxycycline or mefloquine
Burkina FassoAll areasP. falciparum in >95%; P. malariae, P. ovale knownResistance not commonAtovaquone/proguanil or doxycycline or mefloquine
BurundiAll areasMostly P. falciparum; P.n malariae in Rusizi valleyChloroquine resistance knownAtovaquone/proguanil or doxycycline or mefloquine
CameroonAll areasMainly P. falciparum; P. malariae and P. ovale alsoMulti drug resistanceAtovaquone/proguanil or doxycycline or mefloquine
Canary IslandsNo malariaNo malariaNo malariaNone
Cape VerdeAll areas; seasonalOnly P. falciparum; imported P. malariae and P. ovaleNo resistanceAvoid mosquitoes
Central African RepublicAll areasP. falciparum; imported P. malariae?Multi drug resistanceAtovaquone/proguanil or doxycycline or mefloquine
ChadMainly southern parts and bordering SudanP. falciparumChloroquine resistanceAtovaquone/proguanil or doxycycline or mefloquine
Comoros IslandAll areasP. falciparum?Multi drug resistanceAtovaquone/proguanil or doxycycline or mefloquine
CongoAll areasP. falciparum?Multi drug resistanceAtovaquone/proguanil or doxycycline or mefloquine
Cote d'IvoireAll areasP. falciparumChloroquine resistanceAtovaquone/proguanil or doxycycline or mefloquine
Democratic Republic of Congo (Zaire)All areasP. falciparumChloroquine resistanceAtovaquone/proguanil or doxycycline or mefloquine
DjiboutiAll areasAlmost all due to P. falciparum; P. vivax in Balbala areaChloroquine resistanceAtovaquone/proguanil or doxycycline or mefloquine
EgyptFree from malaria except in El Fayoum Oasis areaP. vivaxNot knownNone
Equatorial GuineaAll areasMostly P. falciparum; a few cases of P. malariae and P. vivaxChloroquine resistanceAtovaquone/proguanil or doxycycline or mefloquine
EritreaAll areasP. falciparum (90%) and P. vivax (10%)Chloroquine resistanceAtovaquone/proguanil or doxycycline or mefloquine
EthiopiaAll areas except border areas with Somalia and Djibouti and the city of Addis AbabaMostly P. falciparum; a few cases of P. malariae and P. vivaxChloroquine resistanceAtovaquone/proguanil or doxycycline or mefloquine
GabonAll areasMostly P. falciparum; a few cases of P. malariae and P. ovaleMulti drug resistanceAtovaquone/proguanil or doxycycline or mefloquine
GambiaAll areasP. falciparum?Multi drug resistanceAtovaquone/proguanil or doxycycline or mefloquine
GhanaAll areasP. falciparum?Multi drug resistanceAtovaquone/proguanil or doxycycline or mefloquine
GuineaAll areasP. falciparumChloroquine resistanceAtovaquone/proguanil or doxycycline or mefloquine
Guinea BissauAll areasP. falciparum (90%); a few cases of P. malariae and P. ovale (10%)Chloroquine resistanceAtovaquone/proguanil or doxycycline or mefloquine
KenyaAll areas at altitudes lower than 2,500 meters; no risk in NairobiP. falciparum?Multi drug resistanceAtovaquone/proguanil or doxycycline or mefloquine
LesothoNo malariaNo malariaNo malariaNone
LiberiaAll areasP. falciparum (82%), P. malariae (39%) and P. ovale (9%)Resistance to chloroquine and Sulfa-PyrimethAtovaquone/proguanil or doxycycline or mefloquine
LibyaNo malariaNo malariaNone
MadagascarAll areasP. falciparum?Multi drug resistanceAtovaquone/proguanil or doxycycline or mefloquine
MalawiAll areasP. falciparum?Multi drug resistanceAtovaquone/proguanil or doxycycline or mefloquine
MaliAll areasP. falciparum (95%); P. ovale and P. malariae (5%)?Multi drug resistanceAtovaquone/proguanil or doxycycline or mefloquine
MauritaniaAll areasMostly P. falciparum; a few cases of P. malariae and P. vivaxChloroquine resistanceAtovaquone/proguanil or doxycycline or mefloquine
MauritiusRural areas only; no risk on Rodrigues IslandMostly P. falciparumResistance to chloroquine and Sulfa-PyrimethAtovaquone/proguanil or doxycycline or mefloquine
MayotteAll areasOnly P. falciparum?Multi drug resistanceAtovaquone/proguanil or doxycycline or mefloquine
MoroccoLimited risk in rural areas of Khouribga ProvinceP. vivaxNo resistanceNone
MozambiqueAll areasP. falciparum?Multi drug resistanceAtovaquone/proguanil or doxycycline or mefloquine
NamibiaOnly northern parts- provinces of Kunene, Ohangwena, Okavango, Caprivi, Omaheke, Omusati, Oshana, Oshikoto, and Otjozondjupa.P. falciparumChloroquine resistanceAtovaquone/proguanil or doxycycline or mefloquine
NigerAll areasP. falciparumChloroquine resistanceAtovaquone/proguanil or doxycycline or mefloquine
NigeriaAll areasP. falciparum?Multi drug resistanceAtovaquone/proguanil or doxycycline or mefloquine
ReunionNo malariaNo malariaNo malariaNone
RwandaAll areasP. falciparumMulti drug resistanceAtovaquone/proguanil or doxycycline or mefloquine
Sao Tome and PrincipeAll areasMostly P. falciparum; P. malariae, P. ovale and P. vivax also reportedMulti drug resistanceAtovaquone/proguanil or doxycycline or mefloquine
SenegalAll areasMostly P. falciparum; a few cases due to P. malariae and P. ovaleMulti drug resistanceAtovaquone/proguanil or doxycycline or mefloquine
SeychellesNo malariaNo malariaNo malariaNone
Sierra LeoneAll areasMostly P. falciparumMulti drug resistanceAtovaquone/proguanil or doxycycline orn mefloquine
SomaliaAll areasMostly P. falciparum (90%); also P. malariae and P. vivaxChloroquine resistanceAtovaquone/proguanil or doxycycline or mefloquine
South AfricaAreas 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-PyrimethAtovaquone/proguanil or doxycycline or mefloquine
St. HelenaNo malariaNo malariaNo malariaNone
SudanAll areasP. falciparum (>85%);
P. vivax, P. ovale and P. malariae cause the rest
Multi drug resistanceAtovaquone/proguanil or doxycycline or mefloquine
SwazilandRisk in all lowlandsP. falciparumChloroquine resistanceAtovaquone/proguanil or doxycycline or mefloquine
TanzaniaAll areas at altitudes lower than 1,800 metersMostly P. falciparum?Multi drug resistanceAtovaquone/proguanil or doxycycline or mefloquine
TogoAll areasMostly P. falciparum (90%); also P. malariae and P. ovaleMulti drug resistanceAtovaquone/proguanil or doxycycline or mefloquine
TunisiaOnly imported casesMostly P. falciparumNo resistanceNone
UgandaAll areasMostly P. falciparumMulti drug resistanceAtovaquone/proguanil or doxycycline or mefloquine
ZambiaAll areasMostly P. falciparumMulti drug resistanceAtovaquone/proguanil or doxycycline or mefloquine
ZimbabweAll areas except the cities of Harare and BulawayoMostly P. falciparumMulti drug resistanceAtovaquone/proguanil or doxycycline or mefloquine

Malaria in Asia: Risk, Resistance and Prophylaxis

CountryMalaria RiskSpeciesDrug ResistanceProphylaxis
AfghanistanRisk in all areas at altitudes lower than 2000 meters from April to DecemberP. vivax and P. falciparumChloroquine-resistant P. falciparumChloroquine +proguanil; atovaquone/proguanil, doxycycline, mefloquine
BahrainNo malariaNo malariaNo Risk
BangladeshAll areas except city of DhakaP. vivax and P. falciparumP. falciparum resistant to chloroquine and Pyrimethamine/SulfaAtovaquone/proguanil or doxycycline or mefloquine
BhutanRisk in the southern belt of five districts: Chirang, Samchi, Samdrupjongkhar, Sarpang, and Shemgang. P. vivax and P. falciparumP. falciparum resistant ton chloroquine and Pyrimethamine/SulfaAtovaquone/proguanil, doxycycline, mefloquine
Brunei Darussalam No riskNo malariaNo 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. vivaxP. falciparum resistant ton chloroquine and Pyrimethamine/Sulfa; Mefloquine resistance reported in the eastern part ofn Shan StateAtovaquone/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 SapPredominantly due to P. falciparum; alson P. vivaxMulti drug resistance P. falciparum: Resistance to chloroquine and pyrimeth/sulfadoxine; resistance to mefloquine reported in western provinces near the Thai borderAtovaquone/proguanil, doxycycline, mefloquine (not in western provinces)
ChinaRisk 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 25u00b0 N: year-round); No malaria risk in urban areas nor in the densely populated plain areas.P. falciparum as well as P.n vivaxMultidrug-resistant P. falciparum in Hainan and Yunnan provincesNo 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 KongNo risk in urban areas; limited risk in extremely rural areasP. falciparum as well as P. vivaxNo resistanceChloroquine in remote rural areas
China - MacaoNo riskNo malariaNo risk
CyprusNo riskNo malariaNo risk
East TimorAll areasPredominantly P. falciparumP. falciparum resistant ton chloroquine and Pyrimetha/SulfaAtovaquone/proguanil, doxycycline, mefloquine
IndiaAll 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 statesAtovaquone/proguanil, doxycycline, mefloquine
IndonesiaAll 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 BaliP. falciparum and P. vivaxP. falciparum resistant ton chloroquine and Pyrimetha/Sulfa; P. vivax resistant to chloroquineAtovaquone/proguanil or doxycycline or mefloquine
IranP. 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 NovemberP. falciparum and P. vivaxP. falciparum resistant to chloroquine and Sulfa-PyrimethChloroquine in P. vivax risk areas; chloroquine + proguanil in P. falciparum risk areas
IraqAreas in the north below 1500 m - Provinces of Duhok, Erbil, Ninawa, Sulaimaniya, Tamim, and BasrahOnly P. vivaxNo chloroquine resistanceChloroquine only
IsraelFree from malariaNo malariaNo malaria
JapanNo riskNo malariaNo risk
JordanNo riskNo malariaNo risk
Korea, DPR (North)Limited risk in some southern areasOnly P. vivaxNo resistanceLimited risk
Korea, Republic (South)Risk limited to Demilitarized Zone and to rural areas in the northern parts of Kyonggi Do and Gangwon Do ProvincesOnly P. vivaxNo resistanceLimited risk
KuwaitNo riskNo malariaNo risk
Lao People's Democratic Republicn (Laos)All areas exceptu00a0the city of VientianeMostly P. falciparumChloroquine resistanceAtovaquone/proguanil or doxycycline or mefloquine
LebanonNo riskNo malariaNo risk
MalaysiaRisk limited to rural areas; no risk in urban and coastal areasP. falciparum; some cases of P. knowlesiResistance to chloroquine and Sulfa-PyrimethAtovaquone/proguanil or doxycycline or mefloquine
MaldivesNo riskNo malariaNo risk
MongoliaNo riskNo malariaNo risk
NepalRural 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 treksPredominantly due to P. vivax, also P. falciparumP. falciparum resistant to chloroquine and Sulfa-PyrimethAtovaquone/proguanil or doxycycline or mefloquine
OmanLimited risk in remote areas of Musandam Province; no cases since 2001P. falciparumChloroquine resistanceLimited risk; no need
PakistanAll areas, including the cities, at altitudes lower than 2,000 metersP. falciparum (~60%), P. vivax (~40%)Resistance to chloroquine and Sulfa-PyrimethAtovaquone/proguanil or doxycycline or mefloquine
PhilippinesThroughout 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 plainsPredominantly P. falciparum; Also P. vivaxP. falciparum resistant to chloroquine and Sulfa-PyrimethAtovaquone/proguanil or doxycycline or mefloquine
QatarNo riskNoneNo malariaNo risk
Saudi ArabiaThroughout 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. falciparumChloroquine resistanceChloroquine+Proguanil or Atovaquone/proguanil or doxycycline or mefloquine
SingaporeNo riskNoneNo malariaNo risk
Sri LankaRisk in all areas except the districts of Colombo, Galle Kalutara, and Nuwara EliyaP. vivax (87%), P. falciparum (13%)Resistance to chloroquine and Sulfa-PyrimethChloroquine+Proguanil or Atovaquone/proguanil or doxycycline or mefloquine
Syrian Arab RepublicLimited 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. vivaxNo resistanceOnly Chloroquine for areas with risk
TaiwanNo riskNoneNo malariaNo risk
ThailandLimited 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, SamuiP. vivax and P. falciparum; some cases of P. knowlesiP. 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
TurkeyRisk 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 countryOnly P. vivaxNo resistanceOnly Chloroquine
United Arab EmiratesNo riskNoneNo malariaNo risk
VietnamAll 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 HaiphongPredominantly P. falciparum; some cases of P. knowlesiResistance to chloroquine and Sulfa-PyrimethAtovaquone/proguanil or doxycycline or mefloquine
YemenAll areas at altitudes lower than 2,000 meters; no risk in Sana'aPredominantly P. falciparumChloroquine resistanceChloroquine+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

CountryMalaria RiskSpeciesDrug ResistanceProphylaxis
AustraliaNo malariaNo malariaNo malariaNo risk
Cook IslandNo malariaNo malariaNo malariaNo risk
FijiNo malariaNo malariaNo malariaNo 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 malariaNo malariaNo malariaNo risk
Kiribati (Tarawa, Tabuaeran [Fanning Island], Kiritimati [Christmas Island], and Banaba [Ocean Island])No malariaNo malariaNo malariaNo risk
Marshall IslandsNo malariaNo malariaNo malariaNo risk
Micronesia (Yap Islands, Pohnpei, Chuuk, Kosrae)No malariaNo malariaNo malariaNo risk
NauruNo malariaNo malariaNo malariaNo risk
New CaledoniaNo malariaNo malariaNo malariaNo risk
New ZealandNo malariaNo malariaNo malariaNo risk
NiueNo malariaNo malariaNo malariaNo risk
Northern Mariana Islands (Saipan, Tinian, Rota Island)No malariaNo malariaNo malariaNo risk
PalauNo malariaNo malariaNo malariaNo risk
Papua New GuineaRisk in all areas lower than 1800 metersPredominantly P. falciparum; also P. vivaxP. falciparum resistant to chloroquine and Sulfa-Pyrimeth; P. vivax resistant to chloroquineAtovaquone/proguanil or doxycycline or mefloquine
PitcairnNo malariaNo malariaNo malariaNo risk
SamoaNo malariaNo malariaNo malariaNo risk
Solomon IslandsRisk 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 FatutakaPredominantly P. falciparumP. falciparum resistant to chloroquine and pyrimeth/sulfadoxineAtovaquone/proguanil or doxycycline or mefloquine
TokelauNo malariaNo malariaNo malariaNo risk
TongaNo malariaNo malariaNo malariaNo risk
TuvaluNo malariaNo malariaNo malariaNo risk
U.S. Trust Territory of the Pacific Islands (Guam, American Samoa, Johnston Atoll, Wake Island, Midway Islands)No malariaNo malariaNo malariaNo risk
VanuatuRisk in all areas.Predominantly P. falciparum; also P. vivaxP. falciparum resistant to chloroquine and Sulfa-Pyrimeth; P. vivax resistant to chloroquineAtovaquone/proguanil or doxycycline or mefloquine
Wallis and FutunaNo malariaNo malariaNo malariaNo risk

Malaria in North America: Risk, Resistance, Prophylaxis

CountryMalaria RiskSpeciesDrug ResistanceProphylaxis
AnguillaNo malariaNo malariaNo malariaNo risk
Antigua & BarbudaNo malariaNo malariaNo malariaNo risk
BahamasNo malariaNo malariaNo malariaNo risk
BarbadosNo malariaNo malariaNo malariaNo risk
BelizeAll districts, but risk is highest in the southern region.Almost exclusively P. vivaxNo resistanceChloroquine
BermudaNo malariaNo malariaNo malariaNo risk
CanadaNo malariaNo malariaNo malariaNo risk
Cayman IslandsNo malariaNo malariaNo malariaNo risk
Costa RicaModerate 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. vivaxNo resistanceChloroquine
CubaNo malariaNo malariaNo malariaNo malaria
DominicaNo malariaNo malariaNo malariaNo malaria
Dominican RepublicLow risk throughout the year in rural areas of the western provinces (Castanuelas, Hondo Valle and Pepillo Salcedo)Only P. falciparumNo resistanceChloroquine
El SalvadorVery low risk throughout the year in Santa Ana, Ahuachapan and La Union Provinces, in rural areas of migratory influence from Guatemala.Only P. vivaxNo resistanceChloroquine
GrenadaNo malariaNo malariaNo malariaNo malaria
Guadeloupe and St. Martin Island No malariaNo malariaNo malariaNo malaria
GuatemalaRisk 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. vivaxNo resistanceChloroquine
HaitiThroughout the year in forest areas in Chantal, Gros Morne, Hinche, Jacmel and Maissade.Only P. falciparumNo resistanceChloroquine
HondurasHigh 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. falciparumNo resistanceNo resistance
JamaicaNo malariaNo malariaNo malariaNo malaria
MartiniqueNo malariaNo malariaNo malariaNo malaria
MexicoThroughout 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. vivaxNo resistanceChloroquine
MontserratNo malariaNo malariaNo malariaNo malaria
Netherlands Antilles (including Aruba, Bonaire, Curacao, and Sint Maarten islands)No malariaNo malariaNo malariaNo malaria
NicaraguaHigh risk throughout the year in Chinandega, Jinotega, Nueva Segovia, RAAN, RAAS and Rio San Juan; low or negligible risk in Carazo, Madriz and MasayaPredominantly P. vivaxNo resistanceChloroquine
PanamaLow 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. vivaxChloroquine-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 RicoNo malariaNo malariaNo malariaNo malaria
St. LuciaNo malariaNo malariaNo malariaNo malaria
St. Vincent & GrenadinesNo malariaNo malariaNo malariaNo malaria
St. Kitts & NevisNo malariaNo malariaNo malariaNo malaria
Trinidad & TobagoNo malariaNo malariaNo malariaNo malaria
Turks and CaicosNo malariaNo malariaNo malariaNo malaria
United StatesNo malariaNo malariaNo malariaNo malaria
Virgin Islands (U.S.)No malariaNo malariaNo malariaNo malaria
Virgin Islands (U.K.)No malariaNo malariaNo malariaNo risk

Malaria in South America: Risk, Resistance, Prophylaxis

CountryMalaria RiskSpeciesDrug ResistanceProphylaxis
ArgentinaLimited 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. vivaxNo resistanceChloroquine for risk areas
BoliviaThroughout 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. vivaxP. falciparum resistant to chloroquine and pyrimeth/sulfadoxineChloroquine; mefloquine for northern departments
BrazilMost 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 areasP. vivax (77%), P. falciparum (23%)Multidrug-resistant P. falciparumAtovaquone/proguanil or doxycycline or mefloquine
ChileNo malariaNo malariaNo malariaNo malaria
ColombiaHigh 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/sulfadoxineAtovaquone/proguanil or doxycycline or mefloquine
EcuadorRisk 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 ProvinceChloroquine for most; mefloquine for Esmeraldas province
Falkland IslandsNo malariaNo malariaNo malariaNo malaria
French GuianaHigh 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. falciparumAtovaquone/proguanil or doxycycline or mefloquine
GuyanaHigh 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. falciparumAtovaquone/proguanil or doxycycline or mefloquine
ParaguayModerate risk in the Alto Paraa, Caaguazu and Canendiyu areas; no or negligible risk in other aeras.Only P. vivaxNo resistanceChloroquine
PeruHigh 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/ sulfadoxineAtovaquone/proguanil or doxycycline or mefloquine
SurinameHigh risk throughout the year in the three southern districts; risk is low or negligible in Paramaribo city and the other seven coastal districtsP. falciparum (76%) and P. vivaxP. falciparum resistant to chloroquine and pyrimeth/ sulfadoxineAtovaquone/proguanil or doxycycline or mefloquine
UruguayNo malariaNo malariaNo malariaNo malaria
VenezuelaThroughout 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. falciparumP. falciparum resistant to chloroquineAtovaquone/proguanil or doxycycline or mefloquine

Malaria in Europe: Risk, Resistance, Prophylaxis

CountryMalaria RiskSpeciesDrug ResistanceProphylaxis
AlbaniaNo malariaNo malariaNo malariaNo malaria
AndorraNo malariaNo malariaNo malariaNo malaria
ArmeniaFrom June to October in some of the villages in Ararat Valley, (Masis, Ararat, and Artashat regions); no risk in tourist areas.Only P. vivaxNo resistanceChloroquine (limited risk)
AustriaNo malariaNo malariaNo malariaNo malaria
AzerbaijanLimited risk from June to September in lowland areas, (between the Kura and the Arax rivers, Lenkeran, Mugan-Salyan, Priaraks and Sirvan provinces)Only P. vivaxNo resistanceChloroquine (limited risk)
AzoresNo malariaNo malariaNo malariaNo malaria
BelarusNo malariaNo malariaNo malariaNo malaria
BelgiumNo malariaNo malariaNo malariaNo malaria
Bosnia/ HerzegovinaNo malariaNo malariaNo malariaNo malaria
BulgariaNo malariaNo malariaNo malariaNo malaria
CroatiaNo malariaNo malariaNo malariaNo malaria
Czech RepublicNo malariaNo malariaNo malariaNo malaria
DenmarkNo malariaNo malariaNo malariaNo malaria
EstoniaNo malariaNo malariaNo malariaNo malaria
Faroe IslandNo malariaNo malariaNo malariaNo malaria
FinlandNo malariaNo malariaNo malariaNo malaria
FranceNo malariaNo malariaNo malariaNo malaria
GeorgiaFrom 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. vivaxNo resistanceChloroquine (limited risk)
GermanyNo malariaNo malariaNo malariaNo malaria
GibraltarNo malariaNo malariaNo malariaNo malaria
GreeceNo malariaNo malariaNo malariaNo malaria
GreenlandNo malariaNo malariaNo malariaNo malaria
HungaryNo malariaNo malariaNo malariaNo malaria
IcelandNo malariaNo malariaNo malariaNo malaria
IrelandNo malariaNo malariaNo malariaNo malaria
ItalyNo malariaNo malariaNo malariaNo malaria
KazakhstanNo malariaNo malariaNo malariaNo malaria
KyrgyzstanFrom 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. vivaxNo resistanceChloroquine (limited risk)
LatviaNo malariaNo malariaNo malariaNo malaria
LiechtensteinNo malariaNo malariaNo malariaNo malaria
LithuaniaNo malariaNo malariaNo malariaNo malaria
LuxembourgNo malariaNo malariaNo malariaNo malaria
MadeiraNo malariaNo malariaNo malariaNo malaria
MacedoniaNo malariaNo malariaNo malariaNo malaria
Malta No malariaNo malariaNo malariaNo malaria
MoldovaNo malariaNo malariaNo malariaNo malaria
MonacoNo malariaNo malariaNo malariaNo malaria
NetherlandsNo malariaNo malariaNo malariaNo malaria
NorwayNo malariaNo malariaNo malariaNo malaria
PolandNo malariaNo malariaNo malariaNo malaria
PortugalNo malariaNo malariaNo malariaNo malaria
RomaniaNo malariaNo malariaNo malariaNo malaria
RussiaNo malariaNo malariaNo malariaNo malaria
San MarinoNo malariaNo malariaNo malariaNo malaria
Serbia/ MontenegroNo malariaNo malariaNo malariaNo malaria
Slovak RepublicNo malariaNo malariaNo malariaNo malaria
SloveniaNo malariaNo malariaNo malariaNo malaria
SpainNo malariaNo malariaNo malariaNo malaria
SwedenNo malariaNo malariaNo malariaNo malaria
SwitzerlandNo malariaNo malariaNo malariaNo malaria
TajikistanFrom 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 resistanceChloroquine plus proguanil in the southern part of the country
TurkmenistanFrom June to October in some villages in the south-eastern part of the country, mainly in Mary district.Only P. vivaxNo resistanceChloroquine (limited risk)
UkraineNo malariaNo malariaNo malariaNo malaria
United KingdomNo malariaNo malariaNo malariaNo malaria
UzbekistanSporadic cases in Surkhanda-rinskaya Region (Uzunskiy, Sariassiskiy and Shurchinskiy districts).P. vivaxNo resistanceChloroquine (limited risk)

Further Reading:

  1. http://wwwnc.cdc.gov/travel/yellowbook/2010/chapter-2/malaria-risk-information-and-prophylaxis.aspx
  2. WHO. International Travel and Health. 2010. Available at http://www.who.int/ith/ITH2010.pdf
  3. Kidson C, Indaratna K. Ecology, economics and political will: The vicissitudes of malaria strategies in Asia.  Parasitologia
    Jun 1998;40(1-2):39-46.
  4. WHO: Regional office for SEA. Malaria: Disease burden in SEA region. Available at http://www.searo.who.int/en/Section10/Section21/Section340_4018.htm
  5. 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
  6. 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
  7. Janet Cox-Singh, Balbir Singh. Knowlesi malaria: newly emergent and of public health importance? Trends in Parasitology. 2008;24(9):406-410
  8. 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
  9. 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
  10. World Malaria Report 2010. Available at http://whqlibdoc.who.int/publications/2010/9789241564106_eng.pdf
  11. Global Malaria Action Plan. Available at http://www.rollbackmalaria.org/gmap
  12. 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
  13. 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
  14. 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: Mar 9, 2015

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