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SOUTH-EAST
ASIA
THAILAND: There is no
malaria risk in Bangkok, other large towns, main tourist resorts - hence Chiang Mai, Chiang Rai, Pattaya
and the islands Phuket, Ko Phi Phi, Ko Samui and Ko Samet.
The malaria risk is very small in
practically all tourist areas, also around the River Kwai and on Ko Phangan
island; there is a small risk on the eastern islands of Ko Chang, Ko Mak and
Ko Kut; measures for protection against
mosquito bites from dusk until dawn certainly suffice when travelling in good conditions in the
River Kwai region and on the above mentioned islands. For the great
majority of tourist trips there is therefore no need to take antimalaria
tablets. However, it is always advisable to have a mosquito repellent in your
bag for application to your skin in the evening or in the early morning.
Taking tablets is not necessary when visiting the rainforest in a malaria
area during the day and when staying in good hotels in the evenings and
nights (e.g. for a stay in Chiang Mai, Chiang Rai and neighbouring areas). In
case of fever malaria should always be considered.
Additional
antimalaria measures are necessary for travellers on organized hikes from
Chiang Mai and Chiang Rai and staying with local mountain tribes for 1 or
more nights or travellers staying in primitive conditions on the eastern
islands Ko Chang, Ko Mak and Ko Kut. See NOTE 2, Malarone® or
Doxycycline.
There is
a malaria risk during the whole year in different rural, forested
areas in the entire country, but mainly in the border provinces (also those
situated in the extreme south).
In the
northern border areas with Myanmar
(starting from the Tak province) and the border with Cambodia
(Trat province), there may be a very high malaria risk. There is serious resistance to Lariam®
in practically all border areas with Myanmar (Birma) and Cambodja (CDC
2010 -
http://wwwnc.cdc.gov/travel/yellowbook/2010/chapter-2/malaria.aspx).
For a stay of 1 or more nights in primitive conditions in these rural areas, additional antimalaria measures are necessary:
see NOTE 2: Malarone® or Doxycycline.
http://www.searo.who.int/EN/Section10/Section21/Section340_4015.htm
® Thailand
MALAYSIA:
There is no risk of malaria in coastal regions, towns and most tourist
areas. There is only a risk of malaria in remote regions of the interior. For overnight
stays in towns or on a well-organized tourist trip with stays in luxury
hotels and if only daytime trips are made to the rain forest, the protection
measures against mosquito bites in the evening and at night are certainly
adequate. It is always advisable, however, to have a mosquito repellent
available for use in the evening or in the early morning. In case of fever
malaria should always be considered.
There is definitely a risk of malaria (but rather small) on adventure trips with more
than 2 overnight stays in primitive conditions of the inland jungle: in the
province of Sarawak and Sabah (on the island of Borneo), in the provinces of Kelantan, Perak
and Pahang (on the Malacca Peninsula; as well as in Teman
Negara National
Park, but not in the Cameron Highlands
tourist resorts), the recommendations described in NOTE 1 apply.
INDONESIA:
There is no malaria risk in the large towns of all Indonesian islands
except in the western part of New-Guinea. When staying only in the
big towns, no antimalaria measures are necessary except for protection
against mosquito bites in the evening and at night. There is practically no
malaria risk in the tourist areas (WHO: "tourist resorts") of Java (except Borobodur temple complex), Bali and southwest Sulawesi.
There is
risk of malaria during the whole year in all regions of the 5 eastern
provinces East Nusa Tenggara, Maluku, North Maluku, Papua and West Papua
(West Irian Jaya).
In the rest of Indonesia
there is a varying risk of malaria in some regions. A well-organized tourist trip with
stays only in luxury hotels, measures for protection against mosquito bites
in the evening and at night are essential and also adequate protection
against malaria. In case of fever malaria should always be considered. For people staying overnight in more primitive conditions
out in the countryside, it is advisable to use an impregnated mosquito net and anti malaria tablets are necessary (see NOTE
1).
In a number of circumstances the malaria risk is higher and anti
malaria tablets are always necessary (NOTE 1):
(1) for a stay of any duration in
Papua and West Irian Jaya
(western part of New
Guinea)
(2)
for high risk adventure
trips under primitive conditions in remote areas of Sumatra, Lombok or to
the eastern islands such as Kilamantan (Borneo), Flores, Moluccas, North Celebes
(Sulawesi), Timor, etc.
http://www.searo.who.int/EN/Section10/Section21/Section340_4015.htm ®
Indonesia
PHILIPPINES: There is no
malaria risk in Manilla and other large urban areas, on the islands of Aklan,
Albay, Benguet, Bilaran, Bohol,
Camiguin, Capiz, Catanduanes, Cavite, Cebu, Guimaras, Iloilo, northern &
southern Leyte, Marinduque, Masbate,
eastern, western & northern Samar, Sequijor, Sorsogon, Surigao Del Norte nor on the plateaus and in areas above 600 m. On
the remaining islands (also Luzon) there is a varying malaria risk: during a
well-organised tourist trip (in luxury hotels), measures for protection
against mosquito bites in the evening and at night are essential and also
adequate protection against malaria (in case of fever malaria should always be
considered). For other travellers staying
in rural areas the recommendations in NOTE 1 apply.
http://hdr.undp.org/docs/publications/background_papers/2003/Philippines/Philippines_2003_Annex_1.pdf
EAST TIMOR: See NOTE 1.
http://www.searo.who.int/EN/Section10/Section21/Section340_4015.htm
®
Timor Leste
PAPUA NEW GUINEA:
There is a substantial malaria risk in all areas lower than 1800 m. See NOTE
1.
MELANESIA:
·
VANUATU:
There is a
substantial malaria risk, except on Futuna Island. See NOTE 1.
·
SOLOMON ISLANDS:
There is a
substantial malaria risk on most of the islands, with the exception of a few
islands in the east and south. See NOTE 1.
·
There
is no malaria risk in BRUNEI (Borneo Island), in SINGAPORE,
nor on the rest of THE ISLANDS IN THE PACIFIC OCEAN, AUSTRALIA and
NEW ZEALAND.
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MALARIA
PREVENTION
Measures to protect oneself against mosquito bites in the evening and at
night are always essential for protection against possible malaria. Persons visiting
a malaria region during the day and spending the nights in good hotels run no
risk, and do not need to take any antimalaria tablets, although they should
always have a mosquito repellent product with them for application to the
skin, in case they cannot get back to the hotel in time in the evening, for
example because of problems such as illness, car breakdown, etc. The mosquito
repellent should also be generously applied to the skin when on a trip or a
safari in the early morning, in the evening or at night. When on adventure
type trips with overnight stays in primitive conditions out in the
countryside, it is also advisable to impregnate the mosquito net with
permethrine or deltamethrine, a chemical substance which produces an extra
mosquito-repellent and mosquitocidal effect. Taking antimalaria tablets is
also necessary.
P.N. In many Asian regions (http://www.dtg.org/21.0.html) one can dispense with the malaria
tablets (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 (Malarone®)
is available 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,
starting 2-3 weeks before departure until 4 weeks after returning home) are the
first-choice antimalaria drugs.
In order to have an effective dose of LARIAM®
in the blood upon arrival in the malaria region, it is best to start taking the medication 2 to 3 weeks before
departure. If you have never taken this medication before, it is certainly better
to 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 thinks
that there are contra indications (women trying to become 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 choice. It can be taken for many months, but is in that case an
expensive alternative.
DOXYCYCLINE
(100 mg daily, starting the day before
departure, and continuing until 4 weeks after returning home). Doxycycline
must be taken sitting down with plenty of liquid or during a meal.
Doxycycline can sometimes give rise to phototoxicity and fungal infections
in the mouth or genitals. Doxycycline can be taken for several months.
Everywhere in Thailand
it is always possible to get a fast and reliable diagnosis and treatment.
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 returning home) OR DOXYCYCLINE (100 mg daily, starting the day before
departure, and continuing until 4 weeks after returning home; in some cases
a tolerance test during a few days is necessary). Doxycycline
must be taken sitting down with plenty of liquid or during a meal.
Doxycycline can sometimes give rise to phototoxicity and fungal infections
in the mouth or genitals. Doxycycline can be taken for several months.
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