Transmission and Symptoms

Malaria is a serious disease that is transmitted to humans by the bite of an infected female Anopheles mosquito. Symptoms may include fever and flu-like illness, including chills, headache, muscle aches, and fatigue. Malaria may cause anemia and jaundice. Plasmodium falciparum infections, if not immediately treated, may cause kidney failure, coma, and death. Malaria can often be prevented by using antimalarial drugs and by using personal protection measures to prevent mosquito bites. However, in spite of all protective measures, travelers may still develop malaria.

Malaria is always a serious disease and may be a deadly illness. If you become ill with a fever or flu-like illness either while traveling in a malaria-risk area or after you return home (for up to 1 year), you should seek immediate medical attention and should tell the physician your travel history.

Malaria Risk by Country

Armenia : Risk limited to western border areas: Masis, Ararat, and Artashat regions in Ararat District. Azerbaijan : Rural lowlands of Lenkeran, Mugan-Salyan, Priaraks, and Sirvan provinces. Georgia : Risk in the southeastern part of the country, in the districts of Lagodekhi, Sighnaghi, Dedophilistskaro, Saraejo, Gardabani, and Marneuli in the Kakheti and Kveno Kartli regions. No risk in Tbilisi . Kyrgyzstan : Risk in some southern and western parts of the country, mainly in the provinces of Batken, Oas, and Zhele-Abadskaya in the areas bordering Tajikistan and Uzbekistan . Tajikistan : Southern border; some central ( Dushanbe ), western (GornoBadakhshan), and northern (Leninabad ) areas. Turkmenistan : Risk in some villages in the Mary district. Uzbekistan***: Sporadic casesin Uzunskiy, Sariassiskiy, and Shurchinskiy districts (Surkhanda-rinskaya Region).

Albania, Belarus, Bosnia/Herzegovina, Bulgaria, Croatia, Czech Republic, Estonia, Hungary, Kazakhstan, Latvia, Lithuania, Macedonia, Moldova, Poland, Romania, Russia, Serbia and Montenegro, Slovak Republic, Slovenia, and Ukraine: No risk.

All travelers to malaria-risk areas in Armenia , Azerbaijan , Georgia , Kyrgyzstan , Tajikistan , Turkmenistan , and Uzbekistan *** should take chloroquine as their antimalarial drug, including infants, children, and former residents of these countries.

***In Uzbekistan, the risk of malaria is low and varies along its border with Tajikistan. Travelers to Uzbekistan or their health care provider should contact CDC (Malaria Hotline 770-488-7788) for advice on risk and prevention.

Prevention

Directions for Use

• The adult dosage is 500 mg chloroquine phosphate once a week.
• Take the first dose of chloroquine 1 week before arrival in the malaria-risk area.
• Take chloroquine once a week, on the same day of the week, while in the malaria-risk area.
• Take chloroquine once a week for 4 weeks after leaving the malaria-risk area.
• Chloroquine should be taken on a full stomach to lessen nausea.

Chloroquine Side Effects
The most common side effects reported by travelers taking chloroquine include nausea and vomiting, headache, dizziness, blurred vision and itching. Chloroquine may worsen the symptoms of psoriasis. Most travelers taking chloroquine do not have side effects serious enough to stop taking the drug. Other antimalarial drugs are available if you cannot tolerate chloroquine; see your health care provider.

Contraindications
The following travelers should not take chloroquine (other antimalarial drugs are available; see your health care provider):

• patients allergic to chloroquine

Antimalarial Drugs Purchased Overseas

You should purchase your antimalarial drugs before travel. Drugs purchased overseas may not be manufactured according to United States standards and may not be effective. They also may be dangerous, contain counterfeit medications or contaminants, or be combinations of drugs that are not safe to use.

Halofantrine (marketed as Halfan) is widely used overseas to treat malaria. CDC recommends that you do NOT use halofantrine because of serious heart-related side effects, including deaths.

You should avoid using antimalarial drugs that are not recommended unless you have been diagnosed with life-threatening malaria and no other options are immediately available.

Preventing Mosquito Bites

Malaria is transmitted by the bite of an infected mosquito; these mosquitoes usually bite between dusk and dawn. If possible, remain indoors in a screened or air-conditioned area during the peak biting period. If out-of-doors, prevent mosquito bites by wearing long-sleeved shirts, long pants, and hats; apply insect repellent to exposed skin. Use insect repellents that contain DEET (diethylmethyltoluamide) for the best protection.

When using repellent with DEET, follow these precautions:

• Read and follow the directions and precautions on the product label.
• Use only when outdoors and wash skin with soap and water after coming indoors.
• Do not breathe in, swallow, or get into the eyes. (DEET is toxic if swallowed.) If using a spray product, apply DEET to your face by spraying your hands and rubbing the product carefully over the face, avoiding eyes and mouth.
• Do not put repellent on wounds or broken skin.
• Higher concentrations of DEET may have a longer repellent effect; however, concentrations over 50% provide no added protection.
• timed-release DEET products may have a longer repellent effect than liquid products.
• DEET may be used on adults, children, and infants older than 2 months of age. Protect infants by using a carrier draped with mosquito netting with an elastic edge for a tight fit.
• Children under 10 years old should not apply insect repellent themselves. Do not apply to young children's hands or around eyes and mouth.

Travelers should also take a flying-insect spray on their trip to help clear rooms of mosquitoes. The product should contain a pyrethroid insecticide; these insecticides quickly kill flying insects, including mosquitoes.

If you are not staying in well-screened or air-conditioned rooms, you should take additional precautions, including sleeping under mosquito netting (bed nets). Bed nets sprayed with the insecticide permethrin are more effective; permethrin both repels and kills mosquitoes. In the United States, permethrin is available as a spray or liquid (e.g. Permanone) to treat clothes and bed nets. Bed nets may be purchased that have already been treated with permethrin.

Additional Malaria Information

• Frequently Asked Questions
• Guidelines for diagnosis and treatment (for clinicians)
• Preventing Malaria in the Pregnant Woman (Information for the Public)
• Preventing Malaria in the Pregnant Woman (Information for Health Care Providers)
• Preventing Malaria in Infants and Children (Information for the Public)
• Preventing Malaria in Infants and Children (Information for Health Care Providers)
• Prescription Drugs for Preventing Malaria (Information for the Public)
• Prescription Drugs for Preventing Malaria (Information for Health Care Providers)

For information about other travel health risks, precautions, and vaccination recommendations, please see Health Information for Travelers to Eastern Europe and the Newly Independent States of the Former Soviet Union (NIS).

More Travel Health Information

• View CDC’s website on the Internet www.cdc.gov/travel
• Call CDC’s toll free voice information system at 1-877-FYI-TRIP
• Download or order a copy of Health Information for International Travel (the "Yellow Book").