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MIDDLE AND
NEAR EAST
There is no malaria in BAHRAIN,
the UNITED ARAB EMIRATES, ISRAEL, JORDAN, KUWAIT,
LEBANON or QATAR.
The malaria risk in OMAN
and SYRIA
is limited to a few remote areas; hence no
prophylactic antimalaria tablets are necessary for these countries.
AFGHANISTAN: There is
malaria in all areas of Afghanistan
below 2000 m, from May to November (the majority of cases are caused by the
benign vivax-malaria, but there is also some malaria falciparum). There is no
risk of malaria in the Central and Eastern part of the country, which lies
above 2000 metres. There is no prominent risk of malaria in
the capital Kabul.
The recommendations for prevention of malaria discussed in NOTE 2 are
applicable for stays in high risk rural areas.
IRAQ: There is only a malaria risk (exclusively due to the mild
vivax-malaria) from May to November in areas of the provinces north of 35
degrees latitude north (Duhok, Erbil, Sulaimaniya)
that are below 1500 m. There is also a risk in a few remote places in the province of Basra
in the extreme south, near the border with Iran. For stays in a risk area,
in the countryside, see the recommendations for malaria prevention described
in NOTE 1.
IRAN:
There is only a (limited) malaria risk :
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during summer (from May to November) in the
provinces Ardebil and East
Azerbijan (in the far north, north of the Zagros mountain
chain) (only benign vivax malaria): see NOTE 1.
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from March to November in various remote rural
areas of some southeastern provinces (tropical region of Iran), i.e. the provinces Hormozgan, the
tropical region of Kerman and
the Southern part of Sistan and Baluchestan.
Chloroquine-resistant malaria falciparum is possible. See NOTE 2.
OMAN: Very limited risk in a few remote
areas (in the province
of Musandam, the
extreme tip of the peninsula in the North of the country). No cases have been
reported since 2003. No chemoprophylaxis is necessary.
PAKISTAN:
There is no risk of malaria in areas higher than 2000 m (mainly the high
mountains in the far North of the country), nor in the centers of large cities. The
recommendations for prevention of malaria discussed in NOTE 2 apply in the
rest of the country.
SAUDI ARABIA: The
risk of malaria (especially P. falciparum) is restricted to the
southwest
coast in the Western Province "South Western region" (including the border with Yemen and the coastal area around the Red Sea). There is no risk in the towns of Jeddah, Mecca, Taif and Medina.
There is no risk of malaria in the other provinces (Eastern, Northern and Central Provinces), nor in the highlands of the Asir Province.
The recommendations for prevention of malaria discussed in NOTE 2 apply for
trekking trips in the rural areas.
SYRIA: There is a only a very limited risk of malaria, focal in a number of
rural areas in the El Hasaka Governorate in the northeastern
border area with Iraq (no malaria cases have been reported since 2005), and only from May to October (exclusively due to
benign vivax malaria). There is no malaria risk in the rest of the country. The
standard precautions against mosquito bites in the evening and at night are
sufficient. No preventive measures against malaria are necessary according
to the World Health Organisation.
TURKEY: There is no risk of malaria in most parts of Turkey. There
is a small risk – exclusively of the benign vivax type - from May to
October in rural areas restricted to a narrow strip in the South of Turkey,
on the border with Syria
(South Anatolia): the region around the coastal town of Mersin,
the area around Adana,
Çukurova/Amikova up to the Iraqi border. The recommendations for prevention
of malaria discussed in NOTE 1 apply here for a trekking trip in the
rural regions.
YEMEN: There is no risk of malaria in the capital San’a.
In the rest of the country there is a limited risk from March to August.
Precautions should therefore be taken to protect yourself
against mosquito bites in the evenings and at night. Between September and
February recommendations for prevention of malaria outlined in NOTE 2
apply for stays in primitive conditions. There is only a
limited risk on Socotra
Island (from March to August), precautions against mosquito bites in the
evening and at night are sufficient.
In case of fever after a stay in Yemen, malaria
should always be considered.
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PREVENTION
OF MALARIA
Precautions against mosquito bites in the evenings and at night are always essential to protect against malaria. People
visiting a malaria area during the daytime and staying in good hotels in the
evenings and overnight run no risk, and do not need to take antimalaria
tablets. They should always have a mosquito-repellent to be applied to their
skin at hand just in case they are unable to get back to the hotel on time in
the evening, for example because of problems such as illness, car breakdown,
etc. You should also generously apply mosquito-repellent to the skin when travelling in the early morning, in the evening or at
night. Those taking an outdoor trip (especially to rural areas) and spending
the night in primitive conditions are advised to impregnate the mosquito net
with permethrine or deltamethrine, a chemical
substance that provides an extra mosquito-repellent and mosquitocidal effect;
antimalaria tablets are also necessary.
N.B. In many Asian regions
(http://www.dtg.org/21.0.html) one can dispense with the
chemoprophylaxis (also for adventurous travellers) after having had an
extensive talk with a specialized doctor who will evaluate the malaria risk
depending on the type of lodging and only when strict measures are taken
against mosquito bites from dusk till dawn and malaria emergency treatment
is
available (Malarone®) with complete instructions.
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NOTE 1
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NIVAQUINE® 3 tablets per week, taken all in one dose, starting from 1
week before departure, and continuing until 4 weeks after returning home.
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NOTE 2
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MALARONE® (1 tablet
daily from 1 day before departure until 7 days after returning home) OR
DOXYCYCLINE (1 tablet daily from 1 day before departure until 4 weeks
after return; in some cases it is better to start the medication a few days
in advance to check the tolerance) OR
LARIAM® (1 tablet once a week
from 2-3 weeks before departure until 4 weeks after returning home) are
the first-choice antimalaria drugs.
In order to have an effective level of LARIAM® in the blood, it is best to
start taking the medication 2 to 3 weeks before departure. People who have
never taken this medication before should start 2 to 3 weeks beforehand in
order to deal with possible side effects (e.g. dizziness, insomnia,
nightmares, agitation, inexplicable anxiety, cardiac palpitations). Lariam will not be prescribed if the doctor considers
that there are contra indications (women trying to get pregnant, epilepsy, depression, or cardiac rhythm
disorders for which certain medications such as beta-blockers, calcium
antagonists or digitalis are taken) or unless Lariam
was not tolerated on an earlier occasion. The medication should be
continued for 4 weeks after returning home. If Lariam®
is well tolerated, it can if necessary be taken
for many months and even years.
For short trips MALARONE is generally well tolerated and is an
excellent but expensive alternative. It can also be taken for several
months, but is in that case an expensive choice.
DOXYCYCLINE
(100 mg per day, starting the day before departure until 4 weeks after
returning home or after leaving risk area). Doxycycline must be taken while
sitting down, with plenty of liquid or during a meal. It can sometimes give
rise to phototoxicity and fungal infections of the mouth or genitals.
Doxycycline can be taken for several months.
All this should be individually discussed with your doctor
or with the doctor at a travel advice centre.
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VACCINATIONS
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No vaccinations are required.
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YELLOW FEVER vaccination is NOT required if
you are departing from Belgium.
There is no risk of yellow fever. If you are travelling from another country where yellow fever
can occur (Africa, South America, see
http://www.who.int/ith/en/index.html
®
disease distribution maps),
you should be vaccinated from the age of 1 year, for Afghanistan,
Bahrain, Iraq,
Jordan, Oman, Saudi Arabia and Syria, and for Pakistan and Lebanon from the
age of 6 months.
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Going on a trip is also an
ideal opportunity
for bringing TETANUS, DIPHTHERIA, PERTUSSIS, MEASLES and POLIOMYELITIS VACCINATIONS up to date.
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Anyone travelling
to Asia, regardless the duration and
conditions of the trip, should be vaccinated against HEPATITIS A. If you
are staying in poor hygienic conditions, go abroad frequently or for a long
time (e.g. for at least 2-3 weeks), vaccination against TYPHOID is also recommended.
In many cases, vaccination against HEPATITIS B should also
be considered. For further information, please consult the general
information on VACCINATIONS.
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In specific circumstances, travellers should
consider having a vaccination against RABIES. Pilgrims to Mecca are obliged
to have a vaccination against MENINGOCOCCUS ACWY MENINGITIS.
All this
should be individually discussed with your doctor or with the doctor at the
travel advice centre.
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