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

All travelers to areas with malaria transmission, including pregnant women, should protect themselves from malaria by taking an antimalarial drug and by preventing mosquito bites. Despite the risk, most travelers can avoid becoming ill with malaria by taking these precautions.

Caution: Travel to a Malaria Risk-area During Pregnancy is NOT Recommended

• It is best if you do not travel to a malaria risk-area during your pregnancy. If you get malaria, you may become more ill than a woman who is not pregnant would become.
• In addition, malaria can be a major risk to your pregnancy. The very high fevers, shaking chills, and rigors that occur with malaria can cause premature birth, miscarriage, and stillbirth.
• If you must travel, take an antimalarial drug (a drug to prevent malaria) and prevent mosquito bites to reduce, but not eliminate, the risk of developing malaria. Your health care provider will need to prescribe your antimalarial drug. Another section below has information on preventing mosquito bites.
• Experience with the recommended antimalarial drugs indicate that they are safe to take while pregnant - safer for you and your pregnancy than getting malaria would be.
• Depending on which countries you will travel to, your health care provider will recommend either chloroquine or mefloquine. Experience with chloroquine and limited experience with mefloquine indicates that they are safe to take during pregnancy, including the first trimester.
• Pregnant women should NOT take the following antimalarial drugs: Malarone J™, doxycycline, or primaquine. These drugs are either not safe to take during pregnancy or we don't have enough information to judge their safety.

To find out if your travel will take you 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.

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

• •Antimalarial drugs are only available by prescription through a health care provider.

• •You should be prescribed either chloroquine or mefloquine depending on the area of the world in which you are traveling and any other medical conditions you may have.

• •Find the drug below; read the directions for use and side effects. If you have any questions about the drug recommended, call your health care provider or pharmacist.

• Take your antimalarial drug exactly on schedule. Missing or delaying doses may increase your risk of getting malaria.
• For the best protection against malaria, it is important to continue taking your drug as recommended after leaving the malaria-risk area (4 weeks for mefloquine and chloroquine). Otherwise, you 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 to prevent accidental poisoning.
• Buy your drugs in the United States or Canada 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 an incorrect amount of active drug, or be contaminated.
• Halofantrine (also called Halfan) is widely used overseas to treat malaria. CDC recommends that you do not take Halfan 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 treatment options are available.

Pregnant women traveling to malaria-risk areas in South America, Africa, the Indian subcontinent, Asia, and the South Pacific should take mefloquine as their antimalarial drug.

Mefloquine

• The adult dosage is 250 mg (one tablet) once a week.
• Take the first dose 1 week before arrival in the malaria-risk area.
• Take your dose once a week, on the same day of the week, while in the risk area.
• Take your dose once a week for 4 weeks after leaving the risk area.
• Take the drug on a full stomach with a full glass of liquid.

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 travelers taking mefloquine do not have side effects serious enough to stop taking the drug. (Other antimalarial drugs may be available if you cannot tolerate mefloquine; 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 type of seizure caused by high fever in childhood)
• persons allergic to mefloquine.

Pregnant women traveling to malaria-risk areas in Mexico, Haiti, the Dominican Republic, and certain countries in Central America, the Middle East, and Eastern Europe should take either chloroquine or hydroxychloroquine sulfate as their antimalarial drug.

Chloroquine / brand name Aralen ™ and generics

Directions for use

• The adult dose is 500 mg chloroquine phosphate once a week.
• Take the first dose of chloroquine 1 week before arrival in the malaria-risk area.
• Take your dose once a week, on the same day of the week, while in the risk area.
• Take your 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.

Note: In malaria-risk areas where chloroquine is the recommended drug but chloroquine cannot be taken, mefloquine can be used as your antimalarial drug.

The following travelers should not take chloroquine and 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

• The adult dosage is 400 mg once a week.
• Take the first dose 1 week before arrival in the malaria-risk area.
• Take your dose once a week, on the same day of the week, while in the risk area.
• Take the dose once a week for 4 weeks after leaving the risk area.
• Take hydroxychloroquine sulfate on a full stomach 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, mefloquine can be used as your antimalarial drug.

Pregnant women should NOT take doxycycline, primaquine, or Malarone to prevent malaria.

Know the Signs and Symptoms of Malaria
You can still get malaria despite taking an antimalarial drug and using protection against mosquito bites. Although taking an antimalarial drug greatly reduces your chances of getting malaria, no antimalarial drug is 100% effective. You should be alert for the flu-like symptoms of malaria; symptoms can include fever, shaking chills, headache, muscle aches, and tiredness. Nausea, vomiting, and diarrhea may also occur.

Malaria symptoms will occur at least six to nine days after being bitten by an infected mosquito. Therefore, fever in the first week of travel in a malaria-risk area is unlikely to be malaria; however, ill travelers should still seek immediate medical care and any fever should be promptly evaluated.

If you become ill with a fever or flu-like illness while traveling in a malaria-risk area and up to 1 year after returning home, seek immediate medical care. Delaying treatment can lead to serious complications such as loss of your pregnancy (miscarriage), coma, kidney failure, and death. Tell your health care provider where you have been traveling and that you have been exposed to malaria.

Self-treatment

Travelers who will be more than 24 hours from professional medical care during their trip should ask their health care provider about a self-treatment drug. If you develop fever or other flu-like illness, and professional medical care is not available within 24 hours, take your self-treatment drug and seek medical care immediately after self-treatment.

If the recommended antimalarial drug cannot be taken, pregnant women and their health care providers should contact the Centers for Disease Control Malaria Hotline at 770-488-7788 for advice on alternative antimalarial drugs and a self-treatment regimen, if needed. Pregnant women should not travel to a malaria-risk area without appropriate antimalarial drug therapy.

If you are breast-feeding, a very small amount of chloroquine or mefloquine will be passed into your breast milk. This small amount of drug will not harm your infant, but it won't be enough drug to protect him or her against malaria. Children taken to a malaria-risk area should have their own antimalarial drug.

Women who are breastfeeding infants weighing less than 11 kg (25 pounds) should not take Malarone as their antimalarial drug. Primaquine should not be given to a breastfeeding woman unless both she and her infant have a documented normal G6PD level. Very limited data on doxycycline indicates that it is probably safe to use during breast-feeding and the chance of a problem developing is remote.

Children of any age can get malaria; infants traveling to an area with malaria risk need to be given their own antimalarial. See your pediatrician 4 to 6 weeks ahead of travel to allow time for vaccinations to take effect and malaria drug doses to be made by a pharmacist.

For more information, see Preventing Malaria in Infants and Children (Information for the Public) .

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.
• Pregnant women should use insect repellents containing DEET, as recommended for other adults, but use sparingly. Wash repellent off with soap and water after coming indoors.
• Use only when outdoors.
• 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.
• 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.