Recommendations for Prevention of Malaria

1. Recommendations for Prevention of Malaria http://wwwnc.cdc.gov/travel/yellowbook/2010/chapter-2/malaria.aspx

2. Mosquito Avoidance Measures • remain in well-screened areas • Use of mosquito nets (preferably insecticide-treated nets) • Using a pyrethroid-containing flying-insect spray in living and sleeping areas during evening and nighttime hours • Wearing clothes that cover most of the body • Use of effective mosquito repellent http://wwwnc.cdc.gov/travel/yellowbook/2010/chapter-2/malaria.aspx

3. DEET (N,N-diethylmetatoluamide) • The most effective repellent against a wide range of vectors • DEET formulations • 50% are recommended for both adults and children older than 2 months of age • should be applied to the exposed parts of the skin • Permethrin-containing product may be applied to bed nets and clothing for additional protection. http://wwwnc.cdc.gov/travel/yellowbook/2010/chapter-2/malaria.aspx

4. Chemoprophylaxis • Primary chemoprophylaxis regimens • taking medicine before travel, during travel, and for a period of time after leaving the malaria endemic area. • Beginning the drug before travel allows the antimalarial agent to be in the blood before the traveler is exposed to malaria parasites. • Presumptive antirelapse therapy (terminal prophylaxis) • medication taken towards the end of the exposure period • generally indicated only for prolonged exposure in malaria-endemic areas • most malarious areas of the world (except the Caribbean) have at least one species of relapsing malaria • Prevent relapses or delayed-onset clinical presentations of malaria caused by hypnozoites (dormant liver stages) • P. vivax or P. ovale. http://wwwnc.cdc.gov/travel/yellowbook/2010/chapter-2/malaria.aspx

5. Choosing the appropriate chemoprophylactic agent • Country of travel • Significant reports of antimalarial drug resistance in that location • medical conditions, medications being taken, cost of the medicines, potential side effects http://wwwnc.cdc.gov/travel/yellowbook/2010/chapter-2/malaria.aspx

6. Medications Used for Chemoprophylaxis • Atovaquone/Proguanil (Malarone) • Chloroquine (Aralen) and Hydroxychloroquine (Plaquenil) • Doxycycline (Many Brand Names and Generic) • Mefloquine • Primaquine http://wwwnc.cdc.gov/travel/yellowbook/2010/chapter-2/malaria.aspx

7. Drugs used for Prophylaxis http://wwwnc.cdc.gov/travel/yellowbook/2010/chapter-2/malaria.aspx

8. Drugs used for Prophylaxis http://wwwnc.cdc.gov/travel/yellowbook/2010/chapter-2/malaria.aspx

9. Drugs used for Prophylaxis http://wwwnc.cdc.gov/travel/yellowbook/2010/chapter-2/malaria.aspx

10. Travel to Areas with Limited Malaria Transmission • mosquito avoidance measures only, and no chemoprophylaxis should be prescribed http://wwwnc.cdc.gov/travel/yellowbook/2010/chapter-2/malaria.aspx

11. Travel to Areas with Mainly P. vivaxMalaria • mosquito avoidance measures • primaquine - primary prophylaxis for travelers who are not G6PD-deficient http://wwwnc.cdc.gov/travel/yellowbook/2010/chapter-2/malaria.aspx

12. Travel to Areas with Chloroquine-Sensitive Malaria • mosquito avoidance measures • chemoprophylaxis alternatives: • chloroquine, atovaquone/proguanil, doxycycline, mefloquine, • primaquinefor travelers who are not G6PD-deficient • Longer-term travelers - weekly chloroquine • shorter-term travelers - atovaquone/proguanilor primaquine. http://wwwnc.cdc.gov/travel/yellowbook/2010/chapter-2/malaria.aspx

13. Travel to Areas with Chloroquine-Resistant Malaria • to mosquito avoidance measures • chemoprophylaxis limited to atovaquone/proguanil, doxycycline, and mefloquine. http://wwwnc.cdc.gov/travel/yellowbook/2010/chapter-2/malaria.aspx

14. Travel to Areas with Mefloquine-Resistant Malaria • mosquito avoidance measures • chemoprophylaxis options are reduced to either atovaquone/proguanil or doxycycline http://wwwnc.cdc.gov/travel/yellowbook/2010/chapter-2/malaria.aspx

15. Chemoprophylaxis for Infants, Children, and Adolescents • All children traveling to malaria-risk areas should take an antimalarial drug. • Pediatric dosages should be calculated according to body weight but should never exceed adult dosage. • Chloroquine and mefloquine • Primaquinecan be used for children who are not G6PD-deficient traveling to areas with principally P. vivax. • Doxycycline may be used for children who are at least 8 years of age. • Atovaquone/proguanil may be used for prophylaxis for infants and children weighing at least 5 kg (11 lbs). http://wwwnc.cdc.gov/travel/yellowbook/2010/chapter-2/malaria.aspx

16. Chemoprophylaxis during Pregnancy and Breastfeeding • Malaria can increase the risk for adverse pregnancy outcomes, including prematurity, abortion, and stillbirth. • Women who are pregnant or likely to become pregnant should be advised to avoid travel to areas with malaria transmission if possible. • If travel to a malarious area cannot be deferred, use of an effective chemoprophylaxis regimen is essential. • Chloroquine • to areas where chloroquine-resistant P. falciparum has not been reported • has not been found to have any harmful effects on the fetus • pregnancy is not a contraindication for malaria prophylaxis • If Chloroquine resistance is present: • mefloquineis currently the only medication recommended for malaria chemoprophylaxis during pregnancy. http://wwwnc.cdc.gov/travel/yellowbook/2010/chapter-2/malaria.aspx