Malaria traveler guide

Before you travel

Arrange a travel-health visit about 4–6 weeks before departure when possible; last-minute advice is still worthwhile. Discuss the exact destination and itinerary, pregnancy, age, medical conditions and all medicines. People visiting friends and relatives also need prevention, even if they once lived in an endemic area.

Prevention medicines to discuss

Atovaquone–proguanil is taken daily: usually start 1–2 days before entering the risk area and continue for 7 days after leaving. It is unsuitable with severe kidney impairment and is not routinely recommended in pregnancy.

Doxycycline is taken daily: usually start 1–2 days before entry and continue for 4 weeks after leaving. It is not suitable during pregnancy or for children under 8; sun sensitivity and irritation of the food pipe can matter.

Mefloquine is taken weekly: usually start at least 2 weeks before entry and continue for 4 weeks after leaving. Certain mental-health conditions, seizures or heart-conduction problems can rule it out.

These are options to discuss, not interchangeable prescriptions. Choice and dose depend on the destination, resistance, age, weight and health history. Primaquine and tafenoquine require a documented normal G6PD blood-test result and have additional restrictions, including pregnancy. Follow the prescribed course before, during and after travel.

Prevent bites as well

Use an insect repellent such as DEET or picaridin according to its label, cover arms and legs, and sleep under an insecticide-treated net or in screened accommodation. Permethrin products are for suitable clothing and equipment, not bare skin. Protect young children with age-appropriate measures.

If fever develops

Get prompt medical assessment for fever during or after the trip, even if you took prevention medicine. Tell the clinician where and when you travelled; malaria can appear months after return. Confusion, breathing difficulty, collapse or inability to drink need emergency care.