Malaria Information for Travelers to Australia
and the South Pacific
NOTE:
Please check the Outbreaks section
for important updates on these and other countries. |
|
Australia,
Cook Island, Fiji, French Polynesia (includes the island groups of
Society Islands [Tahiti, Moorea, Bora-Bora], Marquesas Islands [Nuku
Hiva, Hiva Oa, Ua Huka], and Austral Islands [Tubuai, Rurutu, Rimatara,
Rapa]), Kiribati (includes the islands of Tarawa, Tabuaeran [Fanning
Island], Kiritimati [Christmas Island], and Banaba [Ocean Island]),
Marshall Islands, Micronesia (includes Yap Islands, Pohnpei, Chuuk,
Kosrae), Nauru, New Caledonia, New Zealand, Niue, Northern Mariana
Islands (includes Saipan, Tinian, Rota Island), Palau, Papua New Guinea,
Pitcairn, Samoa, Solomon Islands, Tokelau, Tonga, Tuvalu, U.S. Trust
Territory of the Pacific Islands (includes Guam, American Samoa, Johnston
Atoll, Wake Island, Midway Islands), Vanuatu, Wallis and Futuna |
|
Transmission and
Symptoms
Malaria is a serious disease 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 symptoms will occur at least 7 to 9 days after being bitten by
an infected mosquito. Fever in the first week of travel in a malaria-risk
area is unlikely to be malaria; however, any fever should be promptly
evaluated.
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
Papua New Guinea: Risk in all areas lower than 1800 meters (5906
feet). 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.Vanuatu: Risk in
all areas.
There is no risk of malaria in: Australia, Cook Island, Fiji,
French Polynesia (Tahiti, Moorea, Bora-Bora, etc.), Kiribati, Marshall
Islands, Micronesia, Nauru, New Caledonia, New Zealand, Niue, Northern
Mariana Islands, Palau, Pitcairn, Samoa, Tokelau, Tonga, Tuvalu, U.S.
Trust Territory of the Pacific Islands (Guam, American Samoa, Johnston
Atoll, Wake Island, Midway Island), and Wallis & Futuna.
Prevention
All travelers to malaria-risk areas in the South Pacific, including infants,
children, and former residents of the South Pacific, should take one of
the following antimalarial drugs (listed alphabetically):
Atovaquone/proguanil
(brand name: Malarone)
|
Atovaquone/proguanil is a fixed combination of two drugs, atovaquone
and proguanil. In the United States, it is available as the brand name,
Malarone™.
Directions for Use
- The adult dosage is 1 adult tablet (250mg atovaquone/100mg proguanil)
once a day.
- Take the first dose of atovaquone/proguanil 1 to 2 days before travel
to the malaria-risk area.
- Take atovaquone/proguanil once a day during travel in the malaria-risk
area.
- Take atovaquone/proguanil once a day for 7 days after leaving the
malaria-risk area.
- Take the dose at the same time each day with food or milk.
Atovaquone/proguanil Side Effects and Warnings
The most common side effects reported by travelers taking atovaquone/proguanil
are abdominal pain, nausea, vomiting, and headache. Most travelers taking
atovaquone/proguanil do not have side effects serious enough to stop taking
the drug. Other antimalarial drugs are available if you cannot tolerate
atovaquone/proguanil; see your health care provider.
Contraindications
The following travelers should NOT take atovaquone/proguanil
(other antimalarial drugs are available; see your health care provider):
- children weighing less than 11 kilograms (25 pounds);
- pregnant women;
- women breast-feeding infants weighing less than 11 kilograms (25 pounds);
- patients with severe renal impairment;
- patients allergic to atovaquone or proguanil.
Doxycycline
(many brand names and generics are available) |
Doxycycline is related to the antibiotic tetracycline.
Directions for Use
- The adult dosage is 100 mg once a day.
- Take the first dose of doxycycline 1 or 2 days before arrival in the
malaria-risk area.
- Take doxycycline once a day, at the same time each day, while in the
malaria-risk area.
- Take doxycycline once a day for 4 weeks after leaving the malaria-risk
area.
Doxycycline Side Effects and Warnings
The most common side effects reported by travelers taking doxycycline
include sun sensitivity (sunburning faster than normal). To prevent sunburn,
avoid midday sun, wear a high SPF sunblock, wear long-sleeved shirts,
long pants, and a hat. Doxycycline may cause nausea and stomach pain.
Always take the drug on a full stomach with a full glass of liquid. Do
not lie down for 1 hour after taking the drug to prevent reflux of the
drug (backing up into the esophagus).
Women who use doxycycline may develop a vaginal yeast infection. You
may either take an over-the-counter yeast medication or have a prescription
pill from your health care provider for use if vaginal itching or discharge
develops.
Most travelers taking doxycycline do not have side effects serious enough
to stop taking the drug. (Other antimalarial drugs are available if you
cannot tolerate doxycycline; see your health care provider.)
Contraindications
The following travelers should NOT take doxycycline (other
antimalarial drugs are available; see your health care provider):
- pregnant women;
- children under the age of 8 years;
- persons allergic to doxycycline or other tetracyclines.
Mefloquine
(brand name: Lariam
and generic) |
Directions for Use
- The adult dosage is 250 mg salt (one tablet) once a week.
- Take the first dose of mefloquine 1 week before arrival in the malaria-risk
area.
- Take mefloquine once a week, on the same day each week, while in the
malaria-risk area.
- Take mefloquine once a week for 4 weeks after leaving the malaria-risk
area.
- Mefloquine should be taken on a full stomach, for example, after a
meal.
Mefloquine Side Effects and Warnings
The most common side effects reported by travelers taking mefloquine include
headache, nausea, dizziness, difficulty sleeping, anxiety, vivid dreams,
and visual disturbances.
Mefloquine has rarely been reported to cause serious side effects, such
as seizures, depression, and psychosis. These serious side effects are
more frequent with the higher doses used to treat malaria; fewer occurred
at the weekly doses used to prevent malaria. Most travelers taking mefloquine
do not have side effects serious enough to stop taking the drug. (Other
antimalarial drugs are available if you cannot tolerate mefloquine; see
your health care provider.)
Contraindications
Some travelers should NOT take mefloquine (other antimalarial
drugs are available; see your health care provider):
- persons with active depression or a recent history of depression;
- persons with a history of psychosis, generalized anxiety disorder,
schizophrenia, or other major psychiatric disorder;
- persons with a history of seizures (does not include the typical seizure
caused by high fever in childhood);
- persons allergic to mefloquine;
- Mefloquine is not recommended for persons with cardiac conduction
abnormalities (irregular heartbeat).
Primaquine
(primary prophylaxis) |
In certain circumstances when other antimalarial drugs cannot be used
and in consultation with malaria experts, primaquine
may be used to prevent malaria while the traveler is in the malaria-risk
area (primary prophylaxis).
Directions for Use
Note: Travelers must be tested for
G6PD deficiency (glucose-6-phosphate dehydrogenase) and have a documented
G6PD level in the normal range before primaquine use.
Primaquine can cause a fatal hemolysis (bursting of
the red blood cells) in G6PD deficient persons. |
|
- The adult dosage is 52.6mg salt (30mg base primaquine)/once a day.
- Take the drug 1-2 days before travel to the malaria-risk area.
- Take the drug once a day, at the same time each day, while in the
malaria-risk area.
- Take the drug 7 days after leaving the malaria-risk area.
Primaquine Side Effects
The most common side effects reported by travelers taking primaquine include
abdominal cramps, nausea, and vomiting.
Contraindications
Some travelers should not take primaquine (other antimalarial
drugs are available; see your health care provider):
- persons with G6PD deficiency;
- pregnant women (the fetus may be G6PD deficient, even if the mother
is in the normal range);
- women breast-feeding infants unless the infant has a documented normal
G6PD level;
- persons allergic to primaquine.
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.
Protect
Yourself from 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.
- For details on how to protect yourself from insects and how to use
repellents, see Protection against Mosquitoes
and Other Arthropods.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. Permethrin or another insecticide, deltamethrin,
may be purchased overseas to treat bed nets and clothes.
Additional
Malaria Information
For information about other travel health risks, precautions, and vaccination
recommendations, please see Health Information
for Travelers to Australia and the South Pacific.
More Travel
Health Information
|