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Malaria and Travelers

Fall and Winter Travel Spotlight

Are you planning to travel somewhere warm in the coming months? If you travel to the tropics or subtropics, you may be in an area where malaria is a problem. If so, you need to know how to protect yourself from this potentially deadly disease.

On this Page:

• How To Protect Yourself
• Malaria-Risk Areas
• What Determines Your Individual Risk of Getting Malaria
• Special Note for Travelers from Countries without Malaria
• Recent Immigrants to the US from Malarious Countries Returning "Home" to Visit Friends and Relatives
• Counterfeit ("fake") drugs

This information is intended for travelers who reside in the United States. Travelers from other countries may find this information helpful; however, because malaria prevention recommendations and the availability of antimalarial drugs vary, travelers from other countries should consult health care providers in their respective countries.

How To Protect Yourself

A woman takes her malaria pills; afterwards she will apply insect repellent. Behind her a bednet is set up to protect her from mosquitoes at night.

Persons who are traveling to malaria-risk areas can almost always prevent this potentially deadly disease if they correctly take an effective antimalarial drug and follow measures to prevent mosquito bites.

CDC's Travelers' Health web site provides information on protecting the health of international travelers, including detailed country-specific malaria prevention information plus vaccination recommendations, food and water precautions, and safety information.

 Preventing Malaria in Travelers (brochure) (280 KB/8 pages)

Despite these protective measures, travelers may become infected with malaria. Malaria symptoms can include fever and flu-like illness, including chills, headache, muscle aches, and fatigue. Malaria may also cause low blood cell counts (anemia) and yellowing of the skin and whites of the eye (jaundice). If not promptly treated, infection with Plasmodium falciparum, the most harmful malaria parasite, may cause coma, kidney failure, and death.

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

Malaria-Risk Areas

Malaria is transmitted in large areas of Central and South America, the island of Hispaniola (includes Haiti and the Dominican Republic), Africa, Asia (including the Indian subcontinent, Southeast Asia and the Middle East), Eastern Europe, and the South Pacific.

Travelers to sub-Saharan Africa have the greatest risk of both acquiring malaria and dying from their infection. However, all travelers to countries with malaria risk may acquire this potentially deadly disease.

Malaria-risk countries in the Americas, 2002 View enlarged map

Malaria-risk countries in Africa, the Middle East, Asia and the South Pacific, 2002 View enlarged map

See CDC's Travelers' Health Travel Destinations for a map with links to malaria prevention information and other health recommendations.

What Determines Your Individual Risk of Getting Malaria

All visitors to malaria-risk areas are at risk of acquiring malaria; however, many factors determine the risk to an individual traveler. Even in the same locale, these factors can vary widely over time. From year to year, conditions such as amount of rainfall, the number of mosquitoes, and the number of infected persons in the area will change and may produce a different level of risk than previously seen.

Factors that determine a traveler's risk of acquiring malaria include:

• Amount of malaria transmission in the area to be visited
  Most malaria transmission occurs in rural areas, although malaria occurs in urban areas in many countries. Low altitudes with warm temperatures allow for larger populations of infective mosquitoes. Transmission is generally higher in Africa south of the Sahara than in most other areas of the world; in 2002, 73% of imported malaria cases among U.S. and foreign civilians occurred in persons who traveled to Africa.
• Time of the year
  Seasons with more rainfall and higher temperatures will have more malaria transmission than colder, drier seasons. However, in most tropical and semi-tropical countries, transmission may occur even during cooler months or periods of less rainfall.
• Type (species) of malaria parasite present in the area
  While all species of malaria parasites can make a person feel very ill, Plasmodium falciparum causes severe, potentially fatal malaria. Persons who travel to areas where P. falciparum malaria is present should be extra careful to take their antimalarial drug and preventing mosquito bites.
• Nighttime exposure to mosquito bites
  Because the mosquito that transmits malaria bites at night, travelers who are frequently out of doors between dusk and dawn will be at greater risk for malaria.
• Preventive measures taken by travelers
  Individual measures, such as taking an effective antimalarial drug and preventing mosquito bites, are the most important factors in minimizing risk. While other risk factors may be difficult to change or avoid, travelers can greatly reduce their risk of malaria by following recommended travel precautions.
• Immunity (or lack of immunity) to malaria
  Because malaria was eliminated from the United States in the late 1940s, most residents have never developed resistance to the disease (immunity). Malaria infection in a non-immune person can quickly result in a severe and life-threatening illness.
  

Special Note for Travelers from Countries Without Malaria

Travelers from countries without malaria (such as the United States, Canada, the countries of Western Europe among others) are often at a high risk of becoming severely ill with malaria.

Since malaria was eliminated from the United States in the late 1940s, most residents have never had malaria, have never developed resistance to the disease (immunity), and so are non-immune>. Malaria infection in a non-immune person can quickly result in a severe and life-threatening illness, sometimes in as few as 1-2 days after the start of symptoms.

In addition, many U.S. travelers, their health-care providers, and tour companies may be unaware that their travel itinerary includes malaria-risk areas.

Finally, health-care providers and laboratories in the United States rarely see cases of malaria and may be unfamiliar with the diagnosis and treatment of the disease, and this can delay effective treatment.

Recent Immigrants to the U.S. from Malarious Countries Returning 'Home' to Visit Friends and Relatives

A mother with her sons talks with a healthcare provider about avoiding illness while they travel.

If you now live in the United States and are planning a return visit home to your country of origin, please consult the Recommendations for Recent Immigrants from Malarious Countries Returning 'Home' to Visit Friends and Relatives to help protect the health of you and your family.

Several factors increase the risk of malaria in this group:

• In the immigrant's country of origin, malaria is regarded as a familiar, easily managed illness, similar to colds and influenza. But for the returning immigrant, malaria can be life-threatening.
• Most residents in malaria-risk areas do not take antimalarial drugs to prevent the disease; usually, cases of malaria are treated as symptoms occur. Immigrants who return may be unfamiliar with using drugs to prevent malaria.
• Repeated attacks of malaria will produce immunity to the disease. However, once a person is no longer exposed, any immunity declines and is no longer protective. Immigrants returning after only a few years away from their country of origin often become severely ill.
• Children born in the United States who have never had malaria have no immunity to the disease; some immigrants mistakenly believe that their children inherit their immunity.
• Immigrants may not have good access to medical care, including traveler's health clinics. The cost of pre-travel care, vaccinations, and antimalarial drugs may deter them from seeking pre-travel advice and filling prescriptions.
  

Counterfeit (“fake”) Drugs

In some countries (including those with malaria risk), drugs may be sold that are counterfeit (“fake”) or substandard (not made according to United States standards). Such drugs may not be effective. Purchase your antimalarial drugs before traveling overseas!

More: Counterfeit and Substandard Antimalarial Drugs