World Malaria Day- Malaria Risk For Travelers April 25, 2012 marks this year’s World Malaria Day. The Public Health Agency of Canada (PHAC) reminds travelers that there is risk of malaria transmission in many tropical countries around the world. Malaria is a serious and occasionally fatal disease. It is caused by a parasite which is spread to humans by infected mosquitoes. There is no vaccine available against malaria. All travellers are at risk if going to a destination where malaria occurs. Travellers can reduce their risk by following four principles of malaria prevention, called the “ABCD” of malaria: be Aware of malaria risks and symptoms know how to prevent mosquito Bites take anti-malarial drugs or “Chemoprophylaxis”, if appropriate seek medical help early for Diagnosis, if malaria-like symptoms develop Where is Malaria a Concern? Globally, there are over 100 countries or areas at risk of malaria transmission. Malaria risk can change based on season (rainy/dry), location (rural/urban), and altitude. If travelling to any of these areas, you may be at risk: Most of sub-Saharan Africa and limited areas in Northern Africa (most malaria cases and deaths occur in sub-Saharan Africa). Large areas of South Asia, Southeast Asia, and some parts of East Asia. Areas in South and Central America as well as the Caribbean, including parts of Mexico, the Dominican Republic and Haiti. Limited areas in the Middle East, as well as limited parts of Europe. Papua New Guinea and in parts of other small islands in the Oceania region. The following table shows regions of risk for malaria among popular Canadian tourist destinations: Countries with Malaria Risk* in the Top 50 Destinations** among Canadian Travellers (other than the USA) Country Risk of Malaria * Risk of malaria according to: World Health Organization (WHO). International travel and health: Situation as on January 1 2011. Geneva: WHO, 2011 & The Committee to Advise on Tropical Medicine and Travel (CATMAT). Canadian Recommendations for the Prevention and Treatment of Malaria in International Travellers. Canada Communicable Disease Report (CCDR) vol 35S1, 2009; WHO- International travel and health updates. Greece- Malaria. Accessed November 11, 2011. Retrieved from: http://www.who.int/ith/updates/20111111/en/index.html ** Top 50 destinations among Canadian travellers according to: Statistics Canada. Characteristics of International Travelers: Custom Extraction Commissioned by the Public Health Agency of Canada, 2010. Argentina Limited risk in rural areas along the borders with Bolivia and Paraguay. Bahamas Risk on Great Exuma Island only. Brazil Moderate to high risk in certain areas of the country. China (mainland) Risk varies within certain areas of the country and during certain seasons; no risk in urban areas. Costa Rica Risk in the province of Limón, mostly in the canton of Matina. No risk in Limón city and little to no risk in other cantons of the country. Dominican Republic Risk is highest in the provinces bordering Haiti. There is little to no risk in other areas of the country. Ecuador Risk exists below 1500m. Moderate risk in the coastal provinces. No risk in Guayaquil, Quito and other cities of the inter-Andean region. Greece Very limited risk exists in villages of the Evrotas delta area of Lakonia district. There is no risk in tourist areas. Guatemala Risk exists below 1500m and varies within certain areas of the country. No risk in Guatemala City, Antigua or Lake Atitlán. India Risk exists throughout the year in the whole country in areas below 2000m. Jamaica Very limited risk in Kingston area only. Malaysia Risk varies within rural areas of the country. No risk in urban and costal areas. Mexico Risk in some rural areas not often visited by travellers. No risk along the United States-Mexico border or in the major resorts along the Pacific and Gulf/Caribbean coasts. Philippines Risk in rural areas and islands below 600m with the exception of several provinces. No risk in Manila and other urban areas. Peru Risk exists throughout the year within rural areas below 2000m. Highest risk areas include regions of Ayacucho, Junín, Loreto, Madre de Dios, Piura, San Martin and Tumbes. South Africa Risk within certain eastern provinces, including Kruger National Park. No risk in major cities. South Korea Limited risk in rural northern areas. Thailand Risk in rural areas bordering Cambodia, Laos, and Myanmar (Burma). No risk in cities (i.e.: Bangkok, Chiang Mai, Pattaya) and the main tourist resorts of Phuket island. Turkey Risk limited to the southeastern part of the country during certain seasons. No risk in the main tourist areas in the west and southwest of the country. Countries with no Malaria Risk* in the Top 50 Destinations** among Canadian Travellers (other than the USA) Australia, Austria, Barbados, Belgium, Bermuda, Croatia, Cuba, Czech Republic, Denmark, Egypt (U.A.R), France, Germany, Hong Kong, Hungary, Israel, Italy, Japan, Netherlands Antilles, New Zealand, Norway, Portugal, Puerto Rico, Republic of Ireland, Singapore, Spain, Sweden, Switzerland, Taiwan (R.O.C.), The Netherlands, Trinidad & Tobago, and the United Kingdom. * Risk of malaria according to: World Health Organization (WHO). International travel and health: Situation as on January 1 2011. Geneva: WHO, 2011 & The Committee to Advise on Tropical Medicine and Travel (CATMAT). Canadian Recommendations for the Prevention and Treatment of Malaria in International Travellers. Canada Communicable Disease Report (CCDR) vol 35S1, 2009; WHO- International travel and health updates. Greece- Malaria. Accessed November 11, 2011. Retrieved from: http://www.who.int/ith/updates/20111111/en/index.html ** Top 50 destinations among Canadian travellers according to: Statistics Canada. Characteristics of International Travelers: Custom Extraction Commissioned by the Public Health Agency of Canada, 2010. A complete list of countries (PDF) and a map of the areas where malaria transmission occurs are available from the World Health Organization (WHO). Recommendations Consult a doctor, nurse or health care provider, or visit a travel health clinic preferably six weeks before you travel. It is recommended that travelers: Protect themselves from mosquito bites Discuss the benefits of taking antimalarial medication with a health care provider before departure Discuss your risks with a health care provider, preferably six weeks before travel, to determine whether to take antimalarial medication and which one to take. Antimalarial medication is very effective but is not 100% effective in preventing the disease; therefore, travellers should always follow protective measures to avoid mosquito bites. Recommended antimalarial medication for regions with risk of malaria can be found at the following: CATMAT – Canadian Recommendations for the Prevention and Treatment of Malaria Among International Travellers WHO – Malaria Situation by Country (PDF) Know the symptoms of malaria and see a health care provider if they develop. Seek medical attention immediately if a fever arises during or after travel (for up to three months or longer) to regions at risk of malaria. Be sure to tell your health care provider that you have travelled to a region where malaria is present.