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SOUTH ASIA
INDIA:
In India there is
risk of malaria infection (also on the Andaman and Nicobar islands), but
this varies greatly according to the area and the season; there can also
be strong annual variations. However it is impossible to specify the place
and/or season of the states and the regions with an actual risk in the
Indian subcontinent, because there are no reliant data available.
We state
the following:
·
For
travellers spending the night in
very good conditions (luxury hotels) the precautions on mosquito bites in
the evening and at night are sufficient.
·
All other
travellers
(backpackers, travellers on the night train or hiker
via hostels and lodges,..), should follow the recommendations discussed in
NOTE 1.
Map: malaria in
India:
http://www.itg.be/ITG/Uploads/MedServ/India2010.pdf
No risk
> 2000 m
1. Jammu & Kashmir
2. Sikkim
3. Himachal Pradesh |
B
variable limited risk (Note 1)
4. Punjab
5. Haryana
6. Uttaranchal
7. Rajasthan
8. Uttar Pradesh
9. Bihar
10. Andhra Pradesh
11. Kerla
12. Tamilnadu |
C
variable elevated risk (Note 1)
13. Gujarat
23. Arunachal Pradesh
14. Madhya Pradesh 24. Assam
15. Chhatisgarh
25. Nagaland
16. Jharkhand
26. Manipur
17. Orissa
27. Tripura
18. Maharashtra
28. Mizoram
19. Goa
29. Andaman & Nicobar
20. Karnataka
21. Bengale
22. Meghalaya
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-
There is no
malaria risk in the mountainous areas (above 2000 m) of the northern
provinces
Kashmir, Jammu,
Sikkim and Himachal Pradesh. No preventive measures are
therefore necessary there.
-
The
risk of malaria is low to non-existent in the large town
centres and is on average somewhat lower in the southern
tip of the Indian continent, namely south of the line connecting
Madras, Bangalore and Mangalore. The measures discussed in
NOTE 1 apply for travellers staying their nights in primitive
conditions. (Malarone, Lariam).
-
The
risk of falciparum malaria and drug resistance are relatively
higher in the north-eastern states (in the Assam
region between Bangladesh, China and Myanmar), on the Andaman and
Nicobar Islands, and in the states Chhattisgarh, Goa,
Gujarat, Jharkhand, Karnataka (with exception of the city of
Bangalore), Madhya Pradesh, Maharashtra (with exception of
the cities of Mumbai, Nagpur, Nasik and Pune), Orissa and West
Bengal (with exception of the city of Kolkata). The measures
discussed in NOTE 1 apply here. (Malarone, doxycycline, Lariam).
http://www.searo.who.int/EN/Section10/Section21/Section340_4015.htm
® India
SRI LANKA: There is no malaria risk in
Colombo, Galle, Gampaha (North of Colombo), the Kalutara
& Matara
districts (South of Colombo), nor in the central district
of Nuwara Eliya (http://www.malariajournal.com/content/2/1/22/
Figures 1 & 2). Measures for protection against mosquito bites in the
evenings and at night are sufficient here.
In case of fever, malaria should always be considered.
However, in the rest of the country below 800 m, which is most areas, there
is a variable but relatively low malaria risk, and the protective measures against
mosquito bites in the evenings and at night are sufficient for travellers
who spend the nights in very good conditions (exclusively luxury hotels);
however, the recommendations for prevention of malaria discussed in NOTE 1
apply for other travellers.
In case of fever, malaria should always be
considered.
http://www.searo.who.int/EN/Section10/Section21/Section340_4015.htm ®
Sri Lanka
MALDIVES:
There is no malaria risk.
http://www.searo.who.int/EN/Section10/Section21/Section340_4015.htm ®
Maldives
NEPAL:
There is only risk of malaria (mainly vivax malaria) in a number of rural Terai
areas. These are the southern provinces in the narrow border strip with India, lying
below 1200 metres. Occasionally epidemics of
Plasmodium falciparum malaria still occur between July and October. The risk
of vivax malaria is seasonal. There is no risk of malaria in
the rest of Nepal, or in
the capital Kathmandu.
The recommendations for prevention of malaria discussed in NOTE 1 apply
for travellers spending the night in primitive conditions in the malaria
risk regions in the Teraļ, especially in the border areas with India.
http://www.searo.who.int/EN/Section10/Section21/Section340_4015.htm
® Nepal
BANGLADESH:
There is a risk of malaria. In the large towns (such as Dakka,
the capital, and Chittagong)
the risk is non-existent or extremely low, and the precautions against
mosquito bites in the evenings and at night are sufficient. In case of fever,
malaria should always be considered.
The risk is very high in the "Chittagong Hill Tract districts", the border districts in the north and east
along the border with the Assam region of India and the border with Myanmar (Burma),
especially in the forested regions and in the foothills of the mountains
(mainly in Sylhet, Moulavibazar,
Habiganj, Sunaganj, Netrokona, Mymensingh, Sherpur, Kurigram, Cox’s Bazar, Bandarban, Rangamati, Chittagong, Khagrachar). The recommendations for prevention of
malaria discussed in NOTE 1 apply here. (Serious resistance to Nivaquine has been reported).
In the rest of Bangladesh
(outside the capital Dhakka,
and the border provinces) there is a varying malaria risk. Travellers
who spend the night in very good conditions (exclusively luxury hotels) can
follow the recommendations against mosquito bites in the evening and at
night. In case of fever, malaria should always be considered. Other travellers in these regions should
follow the instructions of NOTE 1.
http://www.searo.who.int/EN/Section10/Section21/Section340_4015.htm
® Bangladesh
BHUTAN: There is no
malaria in areas above 1700 metres, or in the
capital Thimbu.
There is some risk of malaria in the rural areas of five southern districts (Chhukha, Samchi, Samdrup Jongkhar, Geylegphug and Shemgang) bordering on India, below 1700 m, where the
recommendations as discussed in NOTE 1 apply.
http://www.searo.who.int/EN/Section10/Section21/Section340_4015.htm ®
Bhutan
MYANMAR (Burma): There is no risk of malaria in
the cities of Yangon (Rangoon) and
Mandalay. There is a varying risk of
malaria in areas
below 1000 m.
·
The protective measures against mosquito bites in the evening and at night
are sufficient for travellers who spend the night in the
large resorts in very good conditions (only luxury hotels). In case of
fever, malaria should always be considered.
·
Additional protective measures depending on the risk area are indicated for
other travellers:
a) The whole year in the Karen
State (Kayin),
on the border with Thailand
(see NOTE 2)
b) Seasonal risk:
-
From March to
December in the eastern states of Kachin, Kayah and Shan; the measures discussed in NOTE 2
apply; in the other states of Chin, Mmon, Rakhine, the provinces of Pegu, Hlegu
and Hmawbi and
the Taikkyi municipal districts of the Yangon Province
(formerly Rangoon);
the measures discussed in NOTE 1 apply.
-
From April to December in the rural areas of
the Tenasserim
province (NOTE 1).
-
From May to December in Irrawaddy Div. and the rural areas of the Mandalay province.
In these frequently visited areas of the central plateau between Mandalay and Yangon (Rangoon), which are irrigated by the Irrawady river, the malaria risk is very low, especially
on the eastern side. Mosquito protection measures are sufficient when staying
in good conditions.
-
From June to November in the rural areas of the Magwe
and Sagaing
Provinces.
(NOTE 1).
There is
important Lariam resistance in the eastern half of the country, therefore
Malarone® or Doxycycline is recommended (CDC 2010).
http://www.searo.who.int/EN/Section10/Section21/Section340_4015.htm
® Myanmar
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MALARIA PREVENTION
Protective measures against mosquito bites in the evening and at night are
always essential for protection against malaria. Individuals who visit a
malaria area during the daytime and stay in a good hotel in the evening run
no risk and do not need to take any antimalaria tablets.
A mosquito repellent (for application to the skin) should always be carried,
in case returning to the hotel in time in the evening proves impossible i.e.
due to problems such as illness, car breakdown, etc. The mosquito repellent
should also be generously applied to the skin when going on a trip in the
early morning, in the evening or at night. On outdoor trips to the
countryside with an overnight stay in primitive conditions it is certainly
advisable to impregnate the mosquito net with permethrine
or deltamethrine, a chemical substance that
produces an extra mosquito-repellent and mosquitocidal
effect. Taking antimalaria tablets is also
necessary.
N.B. In many Asian regions (http://www.dtg.org/21.0.html)
one can dispense with the chemoprophylaxis (even for adventurous travellers)
after having had an extensive talk with a specialized doctor who will
evaluate the malaria risk depending on the type of accomodation
and only if strict measures are taken against mosquito bites from dusk till
dawn and emergency malaria treatment is available (Malarone®) with complete instructions.
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NOTE 1
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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 returning
home; in some cases a tolerance test during a few days is necessary) 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 upon arrival, 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.
DOXYCYCLINE: (100 mg daily, starting the day before
departure, and continuing until 4 weeks after returning home). Doxycycline must be taken while sitting down with
plenty of liquid or during a meal. Doxycycline
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 discussed with your doctor or with the
doctor at the travel advice centre.
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NOTE 2
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MALARONE® (1
tablet daily from one day before departure until 7 days after return) OR DOXYCYCLINE
(100 mg daily, starting the day before
departure, and continuing until 4 weeks after returning home. Doxycycline must be taken while sitting down with
plenty of liquid or during a meal. Doxycycline
can sometimes give rise to phototoxicity and
fungal infections of the mouth or genitals. Doxycycline can be taken for
several months).
This should be discussed with
your doctor or with the doctor at the specialist travel advice centre.
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VACCINATIONS
· No vaccinations are required for.
· YELLOW FEVER vaccination is not required if you are departing from Belgium. There
is no yellow fever in Belgium.
However, 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 for India, Sri Lanka, Bangladesh, Nepal,
Bhutan, Maldives from the age of 1 year (for India from the age of 6 months).
· Going on a trip is also an ideal opportunity for bringing TETANUS, DIPHTHERIA,
PERTUSSIS, POLIOMYELITIS and MEASLES VACCINATIONS up to date.
·
Anyone travelling to Asia, regardless of the duration
and the circumstances of their stay, should be protected against HEPATITIS
A. Vaccination against TYPHOID is in any case advised for people who
stay in poor hygienic conditions, or
go abroad frequently or for long periods (e.g. for more than 2-3
weeks), even if in good hygienic conditions.
In a lot of cases vaccination against
HEPATITIS B should also be considered. For more information, please consult
the general text on VACCINATIONS.
· People spending more than 4 weeks trekking through the countryside or people
who will be staying there for a long time should consider vaccination
against JAPANESE ENCEPHALITIS and RABIES.
All this should be individually discussed with your doctor or with the doctor
at the travel advice centre.
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