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Central & South America, Malaria Prevention

Click on the name of the required country or scroll down for the relevant information Argentina Belize Bolivia Brazil Chile Columbia Costa Rica El Salvador Ecuador French Guiana Guatemala Guyana Honduras Marguerita Island Mexico Nicaragua Panama Paraguay Peru Surinam Uruguay Venezuela   A key to the abbreviations used and information on the different anti-malarial drug regimens can be found below the main tables

COUNTRY MAL 1 MAL 2 YEL HEP A TYP TET POL MEN ENC DIP RAB HEP B Argentina malaria risk only in a small area in the north west of the country along the border with Bolivia and Paraguay 3 - - R R R R - - - L - Belize malaria risk in rural areas only 3 - C R R R R - - - L L Bolivia malaria risk in rural areas below 2500m regimen 2 or 1, the Amazon Basin regimen 1 or 2 1/2 2/1 RC R R R R R - L L L Brazil the Amazon Basin region, Mato Grosso and Maranhao 1 or 2 all other areas regimen 4 1/4 2 RC R R R R - - L L L Chile - - - R R R R - - L L - Columbia malaria risk in areas below 800 metres 1 2 R R R R R - - L L L Costa Rica malaria risk in rural areas below 700 metres 3 - - R R R R - - - L L COUNTRY MAL 1 MAL 2 YEL HEP A TYP TET POL MEN ENC DIP RAB HEP B Ecuador malaria prophylaxis: Esmeraldas Province regimen 1, all other areas below 1500 metres 2 or 1 1/2 1 RC R R R R - - R L L El Salvador 3 - C R R R R - - - L L French Guiana malaria risk in the whole country 1 2 M R R R R - - L L L Guatemala malaria risk in areas below 1500 metres 3 - C R R R R - - L L L Guyana malaria risk in all interior regions 1 2 RC R R R R - - L L L Honduras 3 - C R R R R - - - L L Margarita Island - - - R R R R - - - - L Mexico malaria risk in some rural areas not regularly visited by tourists. no risk in major tourist resorts eg. Mexico City, Acapulco,Cancun, Puerto Vallarta & Veracruz. 3 - - R R R R - - - L L COUNTRY MAL 1 MAL 2 YEL HEP A TYP TET POL MEN ENC DIP RAB HEP B Nicaragua 3 - C R R R R - - - L L Panama malaria risk east of the canal regimen 2 or 1, west of the canal regimen 3, no risk for cruises on the canal regimen 4 2/3 1 R R R R R - - - L L Paraguay malaria risk in rural areas only 3 - C R R R R - - L L L Peru malaria risk in rural areas below 1500m regimen 2 or 1 Amazon Basin area regimen 1 or 2 1/2 2/1 RC R R R R - - L L L Surinam 1 2 RC R R R R - - L L L Uruguay - - - R R R R - - - L - Venezuela malaria risk in rural areas other than on the coast regimen 2 or 1, Amazon Basin area regimen 1 or 2, no risk in Caracas. 2/1 1/2 R R R R R - - L L L

YEL Yellow Fever HEP A Hepatitis A TYP Typhoid TET Tetanus POL Polio MEN Meningitis ENC Encephalitis B DIP Diphtheria RAB Rabies HEP B Hepatitis B M Vaccination is mandatory and a certificate of vaccination is required for entry. C A certificate of vaccination may be required if entering from an endemic country, (except for children <1 year old). R Vaccination is recommended for the country but no evidence is required for entry. L Long Term. Vaccination recommended for travellers staying in endemic areas for 3 months or more.   Countries requiring malaria prophyllaxis should be regarded as being at risk all year round and you should also assume that the whole country is at risk unless otherwise indicated. The 1st malaria regimen (MAL 1) is the preferred regimen for a country. The 2nd malaria regimen (MAL 2) is an alternative that should only be used when the 1st Regimen is either unavailable or badly tolerated. The preferred regimen should always be used whenever possible. Use of the 2nd regimen in some instances may not provide adequate cover. When there are two different regimens for the same country, they are area specific. Read the text to find out which regimen is suitable for the area you require. Where regimen 1 is indicated there is Chloroquine resistance in that region and it is very likely to be the Falciparum malaria which is the most serious form of the disease. In this instance it is vitally important that travellers take adequate prophylaxis. Remember:- No prophylaxis is 100% effective but not taking anti-malarials where they are indicated will put you at greater risk should you get the disease. Malaria is a killer!   The Different Drug Regimens Regimen 1 Mefloquine one 250mg tablet weekly. OR Doxycycline one 100mg capsule daily. OR Malarone one tablet daily. Regimen 2 Chloroquine 300mg weekly (2x150mg tablets). PLUS Proguanil 200mg daily (2x100mg tablets). Regimen 3 Chloroquine 300mg weekly (2x150mg tablets) OR Proguanil 200mg daily (2x100mg tablets). Regimen 4 No prophylactic tablets required but anti mosquito measures such as insect repellents, mosquito nets, long sleeved clothing, etc. should be strictly observed. .   Proguanil 100mg tablets are supplied as Paludrine Tablets Chloroquine 150mg tablets are supplied as Nivaquine or Avloclor Tablets Mefloquine 250mg tablets are supplied as Lariam Tablets   Malarone is a combination of Atovaquone 250mg and Proguanil 100mg   Length of Prophylaxis Chloroquine, Proguanil & Maloprim Start one week before travel, throughout your stay in an endemic area and continue for four weeks after return. Mefloquine (Lariam) Start two and a half weeks before travel, throughout your stay in an endemic area and continue for four weeks after return. Doxycycline Start two days before travel, throughout your stay in an endemic area and continue for four weeks after return. Malarone Start two days before travel, throughout your stay in an endemic area and continue for one week after return. IMPORTANT! Take the tablets absolutely regularly, preferably with or after a meal.   Long Term Use of Anti-Malaria Drugs Chloroquine May be taken for periods exceeding five years. Paludrine May be taken for periods exceeding five years. Maloprim Can be taken for periods up to one year. Mefloquine Can be taken for periods up to one year. Doxycycline Can be taken for periods up to six months. Malarone Can be used for travel periods up to three months.   Compatibility of Anti-Malaria Drugs   Pregnancy Breast Feeding Epilepsy Psoriasis Altitude Scuba Diving Chloroquine OK OK NO NO OK OK Paludrine OK OK OK OK OK OK Mefloquine OK* NO NO OK NO NO Doxycycline NO NO OK OK OK OK Malarone NO NO OK OK OK OK * These drugs are not suitable during the first trimester of pregnancy.   Childrens' Dosages: Calculate the dose by weight rather than by age if possible Age/Weight Chloroquine (once weekly) Proguanil (once daily) Mefloquine (once weekly) Doxycycline (once daily) Malarone (once daily) 0 - 12 weeks under 6kg ¼ tablet ¼ tablet - - - 3 - 12 months 6 - 10kg ½ tablet ½ tablet ¼ tablet - - 1 - 3 years 10 - 16kg ¾ tablet ¾ tablet ¼ tablet - 1 child's tablet 4 - 7 years 16 - 25kg 1 tablet 1 tablet ½ tablet - 1 child's tablet 8 - 12 years 25 - 45 Kg 1½ tablets 1½ tablets ¾ tablet - 2 child's tablets 13 years and over 45kg and over 2 tablets 2 tablets 1 tablet 1 capsule 1 adult tablet The above dosages are based upon the guidelines issued by the Advisory Committee on Malaria Prevention.   Adult Dosages Regimen Dose for Chemoprophylaxis Usual amount per tablet (mg) Areas without drug resistance: Chloroquine Proguanil 2 tablets weekly 2 tablets daily 150mg (base) 100mg Areas of little chloroquine resistance (poorly effective where marked resistance): Chloroquine plus Proguanil 2 tablets weekly 2 tablets daily 150mg (base) 100mg Areas of chloroquine resistant P. falciparum: Mefloquine Doxycycline Malarone (atovaquone & proguanil) 1 tablet weekly 1 tablet/capsule daily 1 tablet daily 250mg (228 in USA) 100mg 250mg atovaquone & 100mg proguanil