Malaria PDF Print E-mail



General considerations

Malaria is a common and life-threatening disease in many tropical and subtropical
areas. It is currently endemic in over 100 countries, which are visited by more
than 125 million international travellers every year.


The malaria parasite is transmitted by various species of Anopheles mosquitoes,
which bite mainly between sunset and sunrise.

Nature of the disease

Malaria is an acute febrile illness with an incubation period of 7 days or longer.
Thus, a febrile illness developing less than one week after the first possible
exposure is not malaria.

Risk for travellers

During the transmission season in malaria-endemic areas, all non-immune
travellers exposed to mosquito bites, especially between dusk and dawn, are at
risk of malaria. This includes previously semi-immune travellers who have lost
(part of) their immunity during stays of 6 months or more in non-endemic areas.
Children of people who have migrated to non-endemic areas are particularly at
risk when they return to malarious areas to visit friends and relatives. Culturally
sensitive approaches are needed to advice different groups at risk. Most cases of
malaria in travellers occur because of poor compliance with prophylactic drug
regimens, or use of inappropriate medicines or no chemoprophylaxis at all,
combined with poor prevention of mosquito bites.
Travellers to countries where the degree of malaria transmission varies in different
areas should seek advice on the risk of malaria in the specific zones that they will
be visiting. If specific information is not available before travelling, it is
recommended to prepare as if the highest reported risk for the area or country
applies throughout. This applies particularly to individuals backpacking to remote
places and visiting areas where diagnostic facilities and medical care are not readily
available. Travellers staying overnight in rural areas may be at highest risk.


Travellers and their advisers should note the four principles of malaria protection:
  • Be Aware of the risk, the incubation period, and the main symptoms.
  • Avoid being Bitten by mosquitoes, especially between dusk and dawn.
  • Take antimalarial drugs (Chemoprophylaxis) when appropriate, to prevent infection from developing into clinical disease.
  • Immediately seek Diagnosis and treatment if a fever develops one week or more after entering an area where there is a malaria risk, and up to 3 months after departure from a risk area.

In general, travellers carrying stand-by emergency treatment should observe the following guidelines:
  • Consult a physician immediately if fever occurs 1 week or more after entering an area with malaria risk.
  • If it is impossible to consult a physician and/or establish a diagnosis within 24 hours of the onset of fever, start the stand-by emergency treatment and seek medical care as soon as possible for complete evaluation and to exclude other serious causes of fever.
  • Complete the stand-by treatment course and resume antimalarial prophylaxis 1 week after the first treatment dose. Mefloquine prophylaxis, however, should be resumed 1 week after the last treatment dose of quinine.
  • Vomiting of antimalarial drugs is less likely if fever is first lowered with antipyretics. A second full dose should be taken if vomiting occurs within 30 minutes of taking the drug. If vomiting occurs 30–60 minutes after a dose, an additional half-dose should be taken. Vomiting with diarrhoea may lead to treatment failure because of poor drug absorption.
  • Do not treat suspected malaria with the same drugs used for prophylaxis, because of the increased risk of toxicity and resistance.

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