Guidelines for malaria prevention in South East Asia
Written by Helen Marshall, pharmacist
The risk of malaria transmission varies greatly in South East Asia, with low risk in many areas; but falciparum malaria that is resistant to many drugs prevalent in some hilly, forested areas along international borders. Malaria tends to be absent from major cities and tourist resorts in this area of the world.
The risk is low in most of Thailand, and visitors to most tourist areas, including Bangkok, Chang Ri and the coastal holiday resorts of Pattaya, Phuket and Koh Samui do not need to take antimalarials. However, people travelling to these areas should still be aware of the risk of malaria, and should seek medical advice if they develop a fever while in these areas, or up to a year after leaving.
On the Thai borders with Cambodia, Laos and Myanmar (formerly Burma) malaria is resistant to many drugs, including mefloquine, so people who work or spend substantial periods of time in this area should take regular doxycycline or possibly Malarone. Overland travellers who go backpacking in northern Thailand near the Myanmar border have a low but significant risk of contracting malaria. If you are travelling in this area you should take either doxycycline or Malarone, or take all possible precautions against being bitten. The non-drug approach may be more appropriate for people only spending a short time near the border, however if you do take this approach, remember to seek immediate medical attention if any fever occurs.
The malaria risk is low in coastal areas of peninsula Malaysia and Malaysian Borneo and avoiding mosquito bites is enough prevention. However, there is a higher risk in inland, forested areas, where mefloquine, doxycycline or Malarone are recommended.
There is no risk of malaria in Singapore or Hong Kong.
In Indonesia the recommended preventive medicines are proguanil plus chloroquine, except in Lombok and Irian Jaya, where there is a higher risk requiring mefloquine, doxycycline or Malarone. This also applies to East Timor. There is a relatively low risk in Bali and medicines are not specifically needed, but travellers should be aware of the potential risk.
There is little or no risk in most of China and preventive medicines are not usually needed. However, those going to remote areas off the tourist route should seek specialist advice or take chloroquine. Falciparum malaria is only found in Yunnan and Hainan provinces, where mefloquine, doxycycline or Malarone are recommended.
Chloroquine-resistant Plasmodium vivax strains of malaria are becoming prevalent in parts of South East Asia.
|Risk great, widespread chloroquine and mefloquine resistance present||Cambodia (western provinces; see below for other
Laos (along the Laos-Myanmar border in the provinces of Bokeo and Louang Namtha and along the Laos-Thailand border in the province of Champasak and Saravan)
Myanmar (formerly Burma; except no risk in the cities of Mandalay and Yangon - see below)
Thailand (rural forested borders with Cambodia, Laos and Myanmar; risk very low elsewhere - see below)
Vietnam (southern part of the country in the provinces of Tay Ninh, Lam Dong, Dac Lac, Gia Lai and Kon Tum, and all other rural areas)
|Doxycycline OR Malarone|
|Risk substantial, drug resistance common||Borneo (Indonesia)
Borneo (Malaysia) (inland areas of eastern Sabah and inland, forested areas of Sarawak; elsewhere including coastal areas low risk - see below)
Cambodia (except low risk in some areas - see below, and great risk in western provinces - see above)
China (only in Yunnan and Hainan provinces; see also very low risk below)
Indonesia (Lombok and Irian Jaya [Papua]; see below for other areas)
Laos (all areas except western borders - see above and Vientiane - see below)
Malaysia (inland, forested areas of peninsular Malaysia; very low risk in the rest of peninsular Malaysia - see below)
|Mefloquine OR doxycycline OR Malarone|
|Risk variable, some chloroquine resistance||Indonesia (areas except Bali and cities, which
are very low risk - see below, and Irian Jaya and Lombok, which are
substantial risk - see above)|
Philippines (rural areas below 600m and on the islands of Luzon, Mindanao, Mindoro and Palawan; see below for other areas)
|Chloroquine plus proguanil|
|Risk very low||Borneo (Malaysia) (including coastal areas of Sabah and Sarawak; substantial risk in some inland areas - see above)|
Cambodia (Angkor Wat and and around Lake Tonle Sap, no risk in Phnom Penh, higher risk in other areas - see above)
China (including main tourist areas, but substantial risk in Yunnan and Hainan, see above)
Indonesia (Bali and cities on the islands of Java and Sumatra; no risk in the city of Jakarta; other areas variable and substantial risk - see above)
Laos (city of Vientiane; high risk elsewhere - see above)
Malaysia (peninsular Malaysia, including the Cameron Highlands and Kuala Lumpur; except high risk in inland forests - see above)
Myanmar (cities of Mandalay and Yangon only; high risk elsewhere - see above)
North Korea (some southern areas)
Philippines (no risk in cities or on the islands of Boracay, Bohol, Catanduanes, Cebu and Leyte; see above for other areas)
South Korea (northern areas, in Gangwon-do and Gyeonggi-do Provinces and Incheon City [towards the Demilitarized Zone or DMZ])
Thailand (most areas, including Kanchanaburi (Kwai Bridge); no risk in Bangkok, Chiang Mai, Chiang Rai, Koh Phangan, Koh Samui, and Pattaya; BUT great risk on rural forested borders, see above)
Vietnam (Mekong River delta until the border area with Cambodia; large cities, including Hanoi and Ho Chi Minh (Saigon), and the Red River delta and coastal areas north of Nha Trang; great risk in other areas, see above)
|No medicines recommended, but avoid mosquito bites and remember the possibility of malaria if you have a fever|
Always see your pharmacist for more detailed information about the risks of malaria in each country you are visiting. Your pharmacist will be able to tell you which medicines are recommended.
Remember to tell your pharmacist:
- if you are pregnant, planning a pregnancy or breastfeeding
- if you suffer from any diseases or conditions
- if you are taking any regular medications
- if a child is travelling with you.
This information will help the pharmacist recommend the most appropriate regimen for you.
Remember to leave yourself enough time before you leave to obtain your medicines. All the malaria prevention medicines must be started before you travel. Mefloquine needs to be started two to three weeks before travel, chloroquine and proguanil should be started a week before, and Malarone and doxycycline one to two days before travelling.
Chloroquine (Avloclor or Nivaquine) and proguanil (Paludrine) can be bought from pharmacies, but may have to be ordered in if you are going for a long trip. Mefloquine (Lariam), doxycycline (eg Vibramycin) and Malarone all require a prescription from your doctor.
For these reasons always see your pharmacist at least three weeks before you plan to travel, to find out which (if any) medicines are recommended, when you need to start taking them, and whether you need a prescription to obtain them.
Remember to take your medicines regularly while you are away, and continue taking them for four further weeks after leaving the malarious area, with the exception of Malarone, which only needs to be continued for one week after leaving.
Always suspect malaria and seek urgent medical advice if you develop a fever or flu-like illness whilst you are away (even if you are taking preventive medicines) or up to a year after you return, in particular in the first three months.