Malaria is a serious illness transmitted by the bite of an infected mosquito. Travelers to Central and South America, Hispaniola, Africa, Asia (including the Indian Subcontinent, South East Asia, and the Middle East ), Eastern Europe, and the South Pacific may be at risk for this potentially deadly disease .

Children of any age can get malaria. All travelers to areas with malaria transmission, including infants, children, and former residents of these areas, should protect themselves from malaria by taking an antimalarial drug and by preventing mosquito bites.

To find out if your foreign travel will take you and your family into an area with malaria:

• Visit CDC's Traveler's Health website at http://www.cdc.gov/travel
• Call CDC's Voice Information Line at 1-877-FYI-TRIP (1-877-394-8747) and listen to pre-recorded messages
• Request a fax from CDC's Fax Information Service at 1-888-232-3299.

Take your child to their health care provider at least 4-6 weeks before the time of your trip. Any vaccinations your child may need will have time to become fully protective. In addition, all the antimalarial drugs are prescription drugs and your child will need to start taking them before travel. Infant's and children's dosages usually have to be specially prepared; allow your pharmacist sufficient time to prepare your prescriptions.

CDC has three sources of information about malaria risk and prevention:

• Toll-free Voice Information Service. Call 1-877-FYI-TRIP.
• Toll-free Fax Information Service. Call 1-888-232-3299 and listen to the instructions. Request document number 000005 for a directory of all available travel faxes.
• This Travelers' Health website.

Identical malaria prevention information is provided at the CDC website and through CDC's toll-free Fax Information Service.
 

Your health care provider will decide which antimalarial drug is the right one for your child. Some drugs may not be effective in some countries in the world. A medical condition may prevent your child from taking a particular antimalarial drug. In addition, children's dosages are based on their age and weight and need to be carefully calculated.

• Give your child their antimalarial drug exactly on schedule. Missing or delaying doses may increase their risk of getting malaria.
• For the best protection against malaria, your child should continue taking their drug as recommended after leaving the malaria-risk area (4 weeks for mefloquine, doxycycline, or chloroquine; 7 days for atovaquone/proguanil or primaquine). Otherwise, they can develop malaria.
• Overdosage (taking too much of an antimalarial drug) can be fatal . Keep drugs in childproof containers out of the reach of children.
• Buy your drugs before traveling overseas. Drugs purchased overseas may not be made according to United States standards and may not be effective. They may also be dangerous, contain the wrong drug or no active drug, or be contaminated.
• Halofantrine (also called Halfan) is widely used overseas to treat malaria. CDC recommends that you and your child not use Halfan because of serious heart-related side effects, including deaths .
• You should avoid using antimalarial drugs that are not recommended unless your child has been diagnosed with life-threatening malaria and no other treatment options are available.

Infants and children traveling to malaria-risk areas in Africa, South America, the Indian Subcontinent, Asia, and the South Pacific should be given one of the following antimalarial drugs (listed alphabetically):

• atovaquone/proguanil
• doxycycline
• mefloquine
• primaquine (in special circumstances).

Atovaquone/proguanil (brand name: Malarone™)

Atovaquone/proguanil is a combination of two drugs, atovaquone plus proguanil, in one tablet. It is available in the United States as the brand name, Malarone.

• Your child's health care provider will prescribe atovaquone/proguanil based on your child's weight. Note: Atovaquone/proguanil should not be given to infants that weigh less than 25 pounds (11 kilograms).

Directions for Use

• Give the first dose of atovaquone/proguanil 1 to 2 days before travel to the malaria-risk area.
• Give atovaquone/proguanil once a day during travel in the malaria-risk area.
• Give atovaquone/proguanil once a day for 7 days after leaving the malaria-risk area.
• Give the dose at the same time each day and have your child take the pill after a meal or with milk. Atovaquone/proguanil is better absorbed if taken with food or a milky drink.

Travelers Who Should Not Take Atovaquone/proguanil

• children weighing less than 25 pounds (11 kilograms)
• pregnant women
• women breast-feeding infants weighing less than 25 pounds (11 kilograms)
• patients with severe renal impairment (severe kidney disease)
• patients allergic to atovaquone or proguanil

Doxycycline (many brand names and generic brands are available)

Doxycycline is related to the antibiotic tetracycline.

Directions for Use:

• Your child's health care provider will prescribe doxycycline based on your child's weight.
• Give the first dose of doxycycline 1-2 days before travel to the malaria-risk area.
• Give doxycycline once a day, at the same time each day, while in the risk area.
• Give doxycycline once a day for 4 weeks after leaving the risk area.

Side Effects and Warnings
One of the most common side effects reported in children taking doxycycline includes sunburning faster than normal (sun sensitivity). To prevent sunburn, your child should avoid midday sun, wear a high SPF sunblock, long-sleeved shirts, long pants, and a hat.

Doxycycline may cause nausea and stomach pain. Give your child the drug after a meal and have them drink a full glass of liquid. They should not lie down for 1 hour after taking the drug to prevent reflux of the drug (stomach contents backing up into the esophagus).

Most children taking doxycycline do not have side effects serious enough to stop taking it; If your child cannot tolerate doxycycline, see their health provider. Other drugs are available.

Travelers Who Should Not Take Doxycycline

• children under the age of 8 years; teeth may become permanently stained.
• children allergic to doxycycline or other tetracyclines
• pregnant women
• Very limited safety data exists on the use of doxycycline by breast-feeding women. Most experts consider the likelihood of harmful effects to be remote.

Mefloquine (brand name Lariam™ and generic)

Directions for use:

• Your child's health care provider will prescribe mefloquine based on your child's weight.
• Give the first dose of mefloquine 1 week before travel to the malaria-risk area.
• Give the drug once a week, on the same day of the week, while in the risk area.
• Give mefloquine once a week for 4 weeks after leaving the malaria-risk area.
• Mefloquine should be given on a full stomach after a meal.

Mefloquine is eliminated slowly by the body and thus may stay in the body for a while even after the drug is discontinued. Therefore, side effects caused by mefloquine may persist weeks to months after the drug has been stopped.

Most children taking mefloquine do not have side effects serious enough to stop taking the drug. (Other antimalarial drugs are available if your child cannot tolerate mefloquine; see your health care provider.)

Children Who Should Not Take Mefloquine
If your child has a condition that is listed below, they should not take mefloquine and you should ask their health care provider for a different antimalarial drug:

• 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 type of seizure caused by high fever in childhood)
• persons allergic to mefloquine

Mefloquine is not recommended for persons with cardiac conduction abnormalities (for example, an irregular heartbeat).

Primaquine (primary prophylaxis)

If your child cannot take other antimalarial drugs and if your health care provider thinks it is necessary, primaquine may be used to prevent malaria while the child is in the malaria-risk area. This is called primary prophylaxis . Usually, primaquine is given after return from travel to prevent relapses ( terminal prophylaxis ).

Directions for Use
Note: Children must be tested for G6PD deficiency (glucose-6-phosphate-dehydrogenase) and have a documented G6PD level in the normal range before primaquine use. G6PD is an enzyme; your health care provider will do a blood test to find out if your child has a high enough level of this enzyme to safely take primaquine. Primaquine can cause a bursting of the red blood cells (hemolysis) which can be fatal, if your child is deficient in G6PD.

• Your child's health care provider will prescribe primaquine based on your child's weight.
• Give the first dose 1-2 days before travel to the malaria-risk area.
• Give primaquine once a day, at the same time each day, while in the risk area.
• Give primaquine once a day for 7 days after leaving the risk area.

Side Effects and Warnings
The most common side effects reported by travelers taking primaquine include stomach cramps, nausea, and vomiting.

If your child has a condition listed below, they should not take primaquine and you should ask their health care provider for a different drug:

• persons with G6PD deficiency
• persons who have not had a blood test for G6PD deficiency
• pregnant women (the fetus may be G6PD deficient, even if the mother's blood test is in the normal range)
• women breast-feeding infants unless the infant has a documented normal G6PD level
• persons allergic to primaquine
• Do not share primaquine with others; they may be G6PD deficient and suffer bursting of their red blood cells, which can be fatal.

Travelers to malaria-risk areas in Mexico, Haiti, the Dominican Republic, and certain countries in Central America, the Middle East, and Eastern Europe should take chloroquine as their antimalarial drug. (Hydroxychloroquine sulfate is available as an alternative; see below.)

Chloroquine phosphate (brand name Aralen™ and generics)

Directions for Use

• Your child's health care provider will prescribe chloroquine based on your child's weight.
• Give the first dose of chloroquine 1 week before arrival in the malaria-risk area.
• Give the dose once a week, on the same day of the week, while in the risk area.
• Give the dose once a week for 4 weeks after leaving the risk area.
• Chloroquine should be taken on a full stomach to lessen the risk of nausea and stomach upset.

Side Effects and Warnings
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 children taking chloroquine do not have side effects serious enough to stop taking the drug. Other antimalarial drugs are available; see their health care provider

Note: In malaria-risk areas where chloroquine is the recommended drug but chloroquine cannot be taken, atovaquone/proguanil, doxycycline, mefloquine, or primaquine would also be effective and can be used as your child's antimalarial drug.

The following children should not take chloroquine; you should ask their health care provider for a different drug:

• patients allergic to chloroquine

Hydroxychloroquine sulfate (brand name: Plaquenil™ )

Hydroxychloroquine sulfate is an alternative to chloroquine phosphate, although less evidence exists on its effectiveness as an antimalarial drug.

Directions for use

• Your child's health care provider will prescribe hydroxychloroquine sulfate based on your child's weight.
• Give the first dose 1 week before arrival in the malaria-risk area.
• Give the dose once a week, on the same day of the week, while in the risk area.
• Give the dose once a week for 4 weeks after leaving the risk area.
• Give hydroxychloroquine sulfate after a meal to lessen nausea and stomach upset.

Side Effects and Warnings
Nausea and vomiting, headache, dizziness, blurred vision, difficulty sleeping, and itching have been reported with hydroxychloroquine sulfate use. Minor side effects usually do not require stopping the drug. Hydroxychloroquine sulfate may worsen the symptoms of psoriasis. Other antimalarial drugs are available; see your health care provider.

Note: In malaria-risk areas where hydroxychloroquine sulfate is the recommended drug but hydroxychloroquine sulfate cannot be taken, atovaquone/proguanil, doxycycline, mefloquine, or primaquine are also effective and can be used as your child's antimalarial drug.

Malaria is transmitted by the bite of an infected mosquito; these mosquitoes usually bite between dusk and dawn. To avoid being bitten, remain indoors in a screened or air-conditioned area during the peak biting period. If out-of-doors, wear long-sleeved shirts, long pants, and hats; apply insect repellent to exposed skin.

Use insect repellents that contain DEET (diethylmethyltoluamide) for the best protection against mosquitoes and other biting insects.

Follow these precautions when using repellents with DEET:

• 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 apply DEET 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.
• Pregnant women should use insect repellents containing DEET, as recommended for other adults, but use sparingly. Wash off with soap and water after coming indoors.
• 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 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. Overseas, 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.