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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:
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
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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. |
Every
year, millions of United States residents travel to countries where malaria
is present; about 800 cases of malaria are diagnosed in these returning
travelers each year. From 1985-2002, 78 U.S. travelers died from malaria.
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.
If
you are traveling outside of the United States, Canada, and Western
Europe, you may be at risk for malaria.
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Malaria-risk
countries in Africa, the Middle East, Asia and the South Pacific,
2002
View
enlarged map
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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
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A mother with her sons talks with a healthcare
provider about avoiding illness while they travel. |
Each
year, many cases of malaria are diagnosed in immigrants living in the
United States who return to their country of origin to visit friends and
relatives. This group of travelers and their children born in the United
States are at particularly high risk of acquiring malaria. In 2002, 45%
of imported malaria cases among U.S. civilians were among recent immigrants
from malarious countries returning "home" to visit.
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:
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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.
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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.
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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.
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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.
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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
Date: October
22,
2004
Content source: National Center for Infectious Diseases, Division of Parasitic Diseases
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