south africa travel malaria prevention

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• How It Spreads
• Where Malaria Occurs
• World Malaria Day 2024
• Clinical Guidance: Malaria Diagnosis & Treatment in the U.S.
• Clinical Features
• Clinical Testing and Diagnosis
• Malaria Risk Assessment for Travelers

Choosing a Drug to Prevent Malaria

• How to Report a Case of Malaria
• Public Health Strategy
• Malaria's Impact Worldwide
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• Malaria Surveillance & Case Investigation Best Practices
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At a glance

• Drugs to prevent malaria differ by country of travel.
• Counsel patients to use personal protective measures along with malaria chemoprophylaxis.
• Consider contraindications and drug-drug interactions when prescribing a malaria prophylaxis.
• Consider the timing of when to start and stop chemoprophylaxis. Some medications require patients take them weeks in advance of travel and continued after leaving the malaria-endemic area.

Medication shortage

Mefloquine shortage‎, considerations, considerations when choosing a drug for malaria prophylaxis:.

• Recommendations for drugs to prevent malaria differ by country of travel and can be found in CDC's Yellow Book chapter on Malaria Prevention Information, by Country. Recommended drugs for each country are listed in alphabetical order and have comparable efficacy in that country.
• When used correctly malaria chemoprophylaxis is very effective. Using multiple prevention strategies together offer additional protection. Counsel patients on the use of personal protective measures, (i.e., insect repellent, long sleeves, long pants, sleeping in a mosquito-free setting or using an insecticide-treated bed net) along with malaria chemoprophylaxis.
• For all medicines, also consider the possibility of drug-drug interactions with other medicines that the person might be taking as well as other medical contraindications, such as drug allergies.
• When several different drugs are recommended for an area, the following table might help in the decision process.
• CDC has replaced the Malaria Prevention Country Tables with the Yellow Book 2024 chapter on Malaria Prevention Information, by Country . You can find the same information regarding chemoprophylaxis by country or region.

Drug/Dosage

Reasons that might make you consider using this drug

Reasons that might make you avoid using this drug

Atovaquone/Proguanil (Malarone)

Begin 1 – 2 days before travel, daily during travel, and for 7 days after leaving.

Adults: 1 adult tablet daily.

Children: 5-8 kg: ½ pediatric tablet daily. >8-10 kg: ¾ pediatric tablet daily. >10-20 kg: 1 pediatric tablet daily. >20-30 kg: 2 pediatric tablets daily. >30-40 kg 3 pediatric tablets daily. >40 kg and over: 1 adult tablet daily.

• Good for last-minute travelers because the drug is started 1-2 days before traveling to an area where malaria transmission occurs
• Some people prefer to take a daily medicine
• Good choice for shorter trips because you only have to take the medicine for 7 days after traveling rather than 4 weeks
• Very well tolerated medicine – side effects uncommon
• Pediatric tablets are available and may be more convenient
• Cannot be used by women who are pregnant or breastfeeding a child less than 5 kg
• Cannot be taken by people with severe renal impairment
• Tends to be more expensive than some of the other options (especially for trips of long duration)
• Some people (including children) would rather not take a medicine every day

Chloroquine

Begin 1 – 2 weeks before travel, once/week during travel, and for 4 weeks after leaving.

Adults: 300 mg base (500 mg salt), once/week.

Children: 5 mg/kg base (8.3 mg/kg salt) (maximum is adult dose), once/week.

• Some people would rather take medicine weekly
• Good choice for long trips because it is taken only weekly
• Some people are already taking hydroxychloroquine chronically for rheumatologic conditions. In those instances, they may not have to take an additional medicine
• Can be used in all trimesters of pregnancy
• Cannot be used in areas with chloroquine or mefloquine resistance
• May exacerbate psoriasis
• Some people would rather not take a weekly medication
• For trips of short duration, some people would rather not take medication for 4 weeks after travel
• Not a good choice for last-minute travelers because drug needs to be started 1-2 weeks prior to travel

Doxycycline

Begin 1 – 2 days before travel, daily during travel, and for 4 weeks after leaving.

Adults: 100 mg daily.

Children: ≥8 years old: 2.2 mg/kg (maximum is adult dose) daily.

• Tends to be the least expensive antimalarial
• Some people are already taking doxycycline chronically for prevention of acne. In those instances, they do not have to take an additional medicine
• Doxycycline also can prevent some additional infections (e.g., Rickettsiae and leptospirosis) and so it may be preferred by people planning to do lots of hiking, camping, and wading and swimming in fresh water
• Cannot be used by pregnant women and children <8 years old
• Some people would rather not take a medicine every day
• Women prone to getting vaginal yeast infections when taking antibiotics may prefer taking a different medicine
• Persons planning on considerable sun exposure may want to avoid the increased risk of sun sensitivity
• Some people are concerned about the potential of getting an upset stomach from doxycycline

Begin 1 – 2 weeks before travel, weekly during travel, and for 4 weeks after leaving.

Adults: 228 mg base (250 mg salt), weekly.

Children: ≤9 kg: 4.6 mg/kg base (5 mg/kg salt), weekly. >9-19 kg: ¼ tablet weekly. >19-30 kg: ½ tablet weekly. >30-45 kg: ¾ tablet weekly. >45 kg: 1 tablet weekly.

• Can be used during pregnancy
• Cannot be used in areas with mefloquine resistance
• Cannot be used in patients with certain psychiatric conditions
• Cannot be used in patients with a seizure disorder
• Not recommended for persons with cardiac conduction abnormalities
• Not a good choice for last-minute travelers because drug needs to be started at least 2 weeks prior to travel

Begin 1 – 2 days prior to travel, daily during travel, and for 7 days after leaving

Adults: 30 mg base (52.6 mg salt), daily

Children: 0.5 mg/kg base (0.8 mg/kg salt) up to adult dose daily

• It is one of the most effective medicines for preventing P. vivax and so it is a good choice for travel to places with > 90% P. vivax
• Cannot be used in patients with glucose-6-phosphatase dehydrogenase (G6PD) deficiency
• Cannot be used in patients who have not been tested for G6PD deficiency
• There are costs and delays associated with getting a G6PD test done; however, it only has to be done once. Once a normal G6PD level is verified and documented, the test does not have to be repeated the next time primaquine is considered
• Cannot be used by pregnant women
• Cannot be used by women who are breastfeeding unless the infant has also been tested for G6PD deficiency
• Some people are concerned about the potential of getting an upset stomach from primaquine

Tafenoquine (Arakoda TM )

Begin daily for 3 days prior to travel, weekly during travel, and for 1 week after leaving.

Adults only: 200 mg per dose.

• One of the most effective drugs for prevention of P. vivax malaria, but also prevents P. falciparum
• Good choice for shorter trips because you only have to take the medicine once, 1 week after traveling rather than 4 weeks
• Good for last-minute travelers because the drug is started 3 days before traveling to an area where malaria transmission occurs
• There are costs and delays associated with getting a G6PD test done; however, it only has to be done once. Once a normal G6PD level is verified and documented, the test does not have to be repeated the next time tafenoquine is considered
• Cannot be used by children
• Not recommended in those with psychotic disorders

Malaria is a serious disease caused by a parasite that infects the Anopheles mosquito. You get malaria when bitten by an infective mosquito.

For Everyone

Health care providers, public health.

Where does malaria occur in South Africa and how can I prevent infection?

Malaria is a serious and sometimes fatal disease caused by a parasite that infects a certain type of mosquito. You may contract malaria if bitten by an infected mosquito.

Malaria is endemic in some areas of South Africa, namely north-eastern KwaZulu-Natal, parts of Mpumalanga and Limpopo. September to May is considered the malaria season.

Some of the precautionary measures you can take to avoid being bitten by mosquitoes:

• Mosquitoes which carry malaria generally bite between dusk and dawn. Close windows and doors and remain indoors during this time.
• Use mosquito repellent on exposed skin.
• Spray your accommodation with an aerosol insecticide or use mosquito coils.
• Wear long-sleeved, light-coloured clothing, long trousers and socks.
• Sleep under a net (preferably impregnated with an approved insecticide) or in a netted tent or use screens to prevent mosquitoes from flying in.
• Ceiling fans and air conditioners are also effective in preventing mosquito bites.
• Chemoprophlyaxis help to reduce the chances of getting ill with malaria. These medicines must be taken according to the instructions given by your local medical practitioner or pharmacist.

Malaria symptoms may only develop 10-14 days after being bitten by an infected mosquito. Even if you have taken chemoprophylaxis, you can still contract malaria, and then this incubation period might be longer.

• Flu-like symptoms such as fever, headache, sweating, fatigue, myalgia (back and limbs), abdominal pain, diarrhoea, appetite loss, nausea and vomiting, could be an indication of malaria.
• You should seek immediate medical attention if you have flu-like symptoms for up to six months after visiting a malaria area.

Get more information at:

• The South African National Travel Health Network (SaNTHNet)
• World Health Organisation (WHO) .

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South Africa

Travel Advisory February 5, 2024

South africa - level 2: exercise increased caution.

Updated to reflect safety consideration when using GPS navigation. 

Exercise increased caution in South Africa due to  crime  and  civil unrest . 

Country Summary:   Violent crime, such as armed robbery, rape, carjacking, mugging, and "smash-and-grab" attacks on vehicles, is common. There is a higher risk of violent crime in the central business districts of major cities after dark.

Using GPS navigation can lead to unsafe routes. GPS navigation may suggest shortcuts through townships as the quickest preferred route but can lead to increased risks of crime.

There have been incidents in which tourists traveling in Cape Town while using GPS navigation apps have been routed through residential areas with high rates of violent crime. The safest approach to return a rental car to Cape Town International Airport is to take the N2 highway and follow signs to Airport Approach Rd ( exit 16 ). Alternatively, request the rental car company to collect your vehicle and subsequently arrange an airport transfer from established taxi companies or established ridesharing services to reach the airport.

Demonstrations, protests, and strikes occur frequently. These can develop quickly without prior notification, often interrupting traffic, transportation, and other services; such events have the potential to turn violent. 

Please see our  Alerts  for up-to-date information. 

Read the  country information page  for additional information on travel to South Africa. 

 If you decide to travel to South Africa: 

• Research your route in advance, stay on major highways, avoid shortcuts through townships, and avoid reliance on GPS navigation apps.
• Avoid walking alone, especially after dark. 
• Avoid visiting informal settlement areas unless you are with someone familiar with the area. 
• Do not display cash or valuables. 
• Drive with doors locked and windows closed. 
• Always carry a copy of your U.S. passport and visa (if applicable). Keep original documents in a secure location. 
• Enroll in the  Smart Traveler Enrollment Program  ( STEP ) to receive Alerts and make it easier to locate you in an emergency. 
• Follow the Department of State on  Facebook  and  Twitter . 
• Review the  Country Security Report  for South Africa. 
• Prepare a contingency plan for emergency situations. Review the  Traveler’s Checklist . 
• Visit the CDC page for the latest  Travel Health Information  related to your travel. 

Embassy Messages

View Alerts and Messages Archive

Quick Facts

30 days beyond your intended date of exit from South Africa..

2 consecutive empty visa pages per entry (not including endorsement pages).

No, if visiting 90 days or less.

Yellow fever at least 10 days before arrival is required for travelers originating from or transiting through WHO-designated yellow fever countries.

ZAR 25,000; Foreign currency unlimited if declared; No Kruger coins.

ZAR 25,000; Foreign currency unlimited if amount was declared on entry; Up to 15 Kruger coins if proof purchased with foreign currency.

Embassies and Consulates

U.S. Embassy Pretoria 877 Pretorius Street, Arcadia Pretoria 0083 South Africa Telephone: +(27)(12) 431-4000 / 012-431-4000 Fax: +(27)(12) 431-5504 / 012-431-5504 The U.S. Embassy in Pretoria does not provide consular services to the public. Facebook Twitter Email: [email protected]

U.S. Consulate General Johannesburg 1 Sandton Drive (opposite Sandton City Mall) Johannesburg 2196 South Africa Telephone: +(27)(11) 290-3000 / 011-290-3000 (Monday – Thursday: 8:00 a.m. to 5:00 p.m.; Friday: 8:00 a.m. to 12:00 p.m.) Emergency After-Hours Telephone: +(27) 79-111-1684 / 079-111-1684 (from within South Africa) Fax: +(27)(11) 884-0396 / 011-884-0396 Email: [email protected]

U.S. Consulate General Cape Town 2 Reddam Avenue, West Lake 7945, Cape Town, South Africa Telephone: +(27)(21) 702-7300 / 021-702-7300 (from within South Africa) Emergency After-Hours Telephone: +(27) 702-7300 / 079-111-0391 (from within South Africa) Fax: +(27)(21) 702-7493 / 021-702-7493 (from within South Africa) Email: [email protected]

U.S. Consulate General Durban 303 Dr. Pixley KaSeme Street (formerly West Street) 31st Floor Delta Towers Durban 4001 South Africa Telephone:  +(27) (31) 305-7600/031-305-7600 (from within South Africa) Emergency After-Hours Telephone:  +(27) (31) 305-7600 or +(27) 079-111-1445 / (031) 305-7600 or 079-111-1445 (from within South Africa) Fax: (+27)(31) 305-7691 / 031-305-7691 (from within South Africa) Email:   [email protected]

Destination Description

See the Department of State’s Fact Sheet on South Africa for information on U.S.-South Africa relations.

Entry, Exit and Visa Requirements

South Africa strictly enforces entry and exit requirements and other immigration laws. Failure to observe these requirements may result in the traveler being denied entry, detained, deported, or deemed inadmissible to enter South Africa in the future.

Please visit the  Department of Home Affairs website  for the most up to date entry and exit requirements.

The Embassy of the Republic of South Africa is located at 3051 Massachusetts Avenue, NW, Washington, DC 20008, telephone (202) 232-4400. Visit the  Embassy of South Africa  for the most current visa information.

Two Consecutive Blank Visa Pages:  South Africa requires travelers to have two consecutive completely blank visa pages in their passports upon every arrival in South Africa.  YOU WILL BE DENIED ENTRY  if you do not have two consecutive blank visa pages in your passport. This does not include the endorsement pages.

Traveling with minors:  There are special requirements for minors traveling through South African ports of entry. Visit the  Department of Home Affairs  website for the most up-to-date requirements for traveling with minors to or from South Africa.

Immunizations:  Travelers entering South Africa from WHO-designated countries with risk of yellow fever virus (YFV) transmission must present their current and valid International Certificate of Vaccination as approved by the World Health Organization (WHO) (“yellow card”). See the  Centers for Disease Control and Prevention’s South Africa page .

The U.S. Department of State is not aware of any HIV/AIDS entry restrictions for visitors to or foreign residents of South Africa. However, South Africa has a high HIV/AIDS prevalence.

Other:  Find information on  dual nationality ,  prevention of international child abduction  and  customs regulations  on our websites.

Safety and Security

Alerts regarding important safety and security information such as demonstrations, road security, and weather events are posted on the  Embassy’s website .

In South Africa the equivalent to the “911” emergency line is 10111.

The following paragraphs provide a summary, but please read the Department of State’s most recent Overseas Security Advisory Council  Country Security Report  on South Africa, which provides detailed information about safety and security concerns for travelers to South Africa.

Civil Unrest: Strikes and demonstrations occur frequently. These can develop quickly without prior notification and occasionally turn violent, and may include the burning of vehicles, buildings, or tires – which may serve as roadblocks; throwing rocks or other objects; or physical attacks. Strikes and demonstrations can also interrupt traffic and the provision of electricity, water, public transportation, fuel, and other goods and services. Periodic incidents of mob violence directed against refugees and immigrants from other African countries occur in South Africa. During labor protests, strike breakers or those perceived to be strike breakers have been violently attacked. Protests involving taxis and ride hailing services can turn violent. See Travel and Transportation section below for guidance.

Precautions:

• Avoid demonstrations and use vigilance during your movements around the country. Even events intended to be peaceful can become violent.
• Maintain caution in areas frequented by foreigners.
• Monitor news and  Alerts .

Crime: Crime in South Africa is very high. Violent crimes happen in places where people live, work, travel, or go out. This includes armed home invasions by criminal groups, which lead to assaults, rapes, and murder. Popular tourist spots and big hotels have their own security to prevent these incidents. But visitors and residents are still affected by armed robbery, rape, kidnapping, carjacking, mugging, and "smash-and-grab" attacks on vehicles. It's important to be extra careful at traffic lights and on/off ramps where cars slow down or stop. To avoid being robbed when buying jewelry or electronics outside high-end stores, many vendors offer to deliver your purchase to your home or hotel for a fee. Crime can happen anywhere and at any time, even in and around Kruger National Park. U.S. government staff and visitors have been robbed near our diplomatic facilities. It's especially important to be cautious in the central business districts (CBDs) of major cities, especially after dark. Crime victims have also been followed from OR Tambo Airport in Johannesburg and then robbed when they reach their home or hotel. 

Theft can be bold and in broad daylight. Travelers and U.S. diplomats report having cell phones stolen from their hands, as well as purses or wallets taken off counters while paying for goods at stores. Car theft and hijacking continues to plague the country, particularly in large cities. Travelers should choose secure parking options and double check locked doors before leaving a parked car.

Throughout South Africa, U.S. citizens should:

•  Avoid walking alone especially after dark.
• Avoid visiting informal settlement areas unless you are with someone familiar with the area. Please note that U.S. mission staff are required to use fully armored vehicles when visiting many townships in and around the Cape Town area and visiting hours are restricted to between 0700-1500 hours.
• Do not display cash and valuables.
• Avoid cash-in-transit vehicles both on the road, as well as ATMs when being refilled. Armed criminal gangs frequently target cash-in-transit vehicles while stopped at customer sites, but also ambush cash-in-transit vehicles while on the road. Such violent armed attacks involve automatic weapons, explosives, and gangs of criminals. Criminals frequently use remote jamming and signal interceptors with success.
• Drive with doors locked and windows closed.
• Always carry a copy of your U.S. passport and visa (if applicable). Keep original documents in a secure location.
• Avoid driving during periods of load shedding (rolling blackouts) as the roads can become extremely congested due to a lack of traffic signals. These traffic jams and slow-moving traffic can provide opportunities for smash and grab robberies.

Student Groups:  There have been instances of student groups being robbed while conducting outreach and service visits in townships. On these occasions, student groups coordinated with officials to conduct service visits and upon arrival were held and then robbed by armed perpetrators.

Demonstrations  occur frequently. They may take place in response to political or economic issues, on politically significant holidays, and during international events.

• Demonstrations can be unpredictable, avoid areas around protests and demonstrations.
• Past demonstrations have turned violent.
• Check local media for updates and traffic advisories.

Internet romance and financial scams  are prevalent in South Africa. Scams are often initiated through Internet postings/profiles or by unsolicited emails and letters. Scammers almost always pose as U.S. citizens who have no one else to turn to for help.

Tips to avoid scammers:

• Look for red flags such as individuals who say they live in a remote location, a profile that was recently created or seems to be too good to be true, the pace of the relationship is moving too quickly, or requests for money.

• Set up a phone call/video chat in the initial stages.
• Do a reverse image search on the profile picture.
• If the individual asking for help claims to be a U.S. citizen, rather than helping them, you should refer them to the closest U.S. Embassy or Consulate so we can work with local authorities to assist them.

Common scams include:

• Romance/Online dating
• Money transfers
• Lucrative sales
• Gold purchase
• Contracts with promises of large commissions
• Grandparent/Relative targeting
• Free Trip/Luggage
• Inheritance notices
• Work permits/job offers
• Bank overpayments

Technology Usage Abroad: Mobile devices are vulnerable to compromise, theft, and physical damage anywhere in the world. Best practices prior to traveling abroad include keeping all software (for operating systems and apps) updated and using virtual private network (VPN) and encrypted voice over IP (VoIP) applications if possible. Make sure that all VPN/VoIP are reputable, and U.S. based. Do not connect to unknown open Wi-Fi.

GPS navigation apps . Prior to using the GPS navigation apps, make sure you research the route to make sure it is safe. GPS navigation apps may give you the shortest route without safety consideration.

Dating apps and websites . Be careful when using dating apps and online dating websites in foreign countries as scammers may target U.S. citizens. Let your friends and family know where you are, meet in a popular public place, and avoid eating or drinking anything suspicious. Don't go to bars or nightclubs alone. 

Credit cards and ATMs. Travelers need not surrender their credit card to any vendor. They will bring a credit card machine to customers.

Be cautious when using ATMs outside of banks and reputable hotels because ATM and Credit Card skimming is common. Thieves may pretend to help you use a malfunctioning ATM and steal your ATM cards. Skimmers have also been found on machines used to pay parking tickets at shopping malls and office buildings. To avoid this risk, pay parking fees with cash. 

See the  FBI  pages for information.

Victims of Crime:

U.S. citizen victims of sexual assault or domestic violence should report crimes to the local police at 10111. Remember that local authorities are responsible for investigating and prosecuting the crime.

See our webpage on  help for U.S. victims of crime overseas .

The U.S. Consulates General in South Africa can:

• help you find appropriate medical care
• assist you in reporting a crime to the police
• contact relatives or friends with your written consent
• explain the local criminal justice process in general terms
• provide a list of local attorneys
• provide information on  victim’s compensation programs in the U.S.
• provide an emergency loan for repatriation to the United States and/or limited medical support in cases of destitution
• help you find accommodation and arrange flights home
• replace a stolen or lost passport

Terrorism Threat:  Extremists with ties to international terrorist organizations, such as al-Qai’ida, al-Shabaab, and ISIS, historically have used South Africa as a logistical hub to conduct recruitment and financial facilitation. There has been increased activity by ISIS sympathizers and supporters locally, including the placement of incendiary devices and kidnapping for ransom operations. South African authorities have periodically arrested individuals and charged them with terrorism related crimes. The U.S. Department of Treasury’s Office of Foreign Assets Control has publicly designated ISIS members operating in South Africa who have provided technical, financial, or material support to the terrorist group. Check the  Mission’s website  to review Alerts to U.S. citizens, and  register  with the U.S. Mission to South Africa to receive new Alerts by email during your travels.

For more information, see our Terrorism page.

Game parks and outdoor safety:  Visitors have been injured and killed by wild animals in South Africa. It is dangerous to leave your vehicle in game parks outside of designated areas. Observe all park regulations and follow the instructions of guides. Be mindful of sharks when swimming. Rip tides are common and very dangerous. Do not swim alone in isolated areas or dive into unfamiliar waters.

Hikers must be prepared for rapidly changing weather conditions and ensure they have proper clothing and supplies. Many areas, especially in the Western Cape province, experience brush fires during the summer months (December-February). These fires can burn for several days. Monitor local media and follow fire crew instructions regarding road closures and evacuations.

Tourism:  The tourism industry is regulated. Rules for best practices and safety inspections are enforced. Hazardous areas are marked with signs and professional staff are available for organized activities. If you get hurt, there is medical treatment available. Outside of big cities, it might take longer for help to come. It's a good idea for U.S. citizens to get medical evacuation insurance. U.S. citizens are strongly encouraged to purchase medical evacuation insurance.

See our webpage for more information on  insurance providers for overseas coverage .

Infrastructure:  In the country, there are often scheduled blackouts called "Load Shedding". These blackouts are meant to protect the electrical grid, but they cause the whole country to lose power for up to six hours every day. This is bad for businesses that don't have another way to get power, like hotels. Load shedding also causes traffic lights to stop working, which leads to traffic jams and more crime. It can also affect access to water, cell phone signal, fuel availability, and safety features in rural areas.

Local Laws & Special Circumstances

Criminal Penalties:  If you break local laws, even if you don't know, you can be deported, arrested, or put in prison. If you want to start a business or do a job that needs special permission, you should ask the local authorities for information before you start.

Some crimes can also be punished in the United States, even if they are not against local law. For examples, see our website on  crimes against minors abroad  and the  Department of Justice website .

Arrest Notification:  If you are arrested or held, ask police or prison officials to notify the nearest U.S. Consulate in South Africa  immediately . See our  webpage  for further information.

Counterfeit and Pirated Goods: Counterfeit and pirated goods are prevalent in many countries and may be illegal according to the local laws. Counterfeit and pirated goods may pose significant risks to consumer health and safety. You may be subject to fines and/or have to give up counterfeit and pirated goods if you bring them back to the United States. See the U.S. Customs and Border Protection website and U.S. Department of Justice website for more information.

Faith-Based Travelers: See our following webpages for details:

• Faith-Based Travel Information
• International Religious Freedom Report  
• Human Rights Report  
• Best Practices for Volunteering Abroad

LGBTQI+ Travelers:  There are no legal restrictions on same-sex sexual relations or the organization of LGBTQI+ events in South Africa.

See   our  LGBTQI+ Travel Information  page and section 6 of our  Human Rights Report  for further details.

Travelers with Disabilities:  South Africa law mandates access to buildings for persons with disabilities, but these laws are rarely enforced. Some tourist attractions, and restaurants near tourist attractions, are equipped with ramps and other options to facilitate access. Conditions vary significantly across the country.

The law in South Africa prohibits discrimination against persons with physical, sensory, intellectual and mental disabilities, and the law is enforced unevenly. Social acceptance of persons with disabilities in public is as prevalent as in the United States. Expect accessibility to be limited in public transportation, lodging, communication/information, and general infrastructure.

Students:  See our  Students Abroad  page and  FBI travel tips .

Women Travelers: South Africa has one of the highest rates of sexual assault and gender-based violence in the world. Women travelers should take special care to follow safety and security precautions listed on this page when traveling in South Africa  

See our travel tips for  Women Travelers .

Special Circumstances: Parts of South Africa may face drought conditions, water scarcity, and rainfall patterns that may be erratic. Water supplies in some areas may be affected. Water-use restrictions may be in place in the affected municipalities.

For emergency services in South Africa, dial  10111 . Ambulance services are:

• not widely available and training and availability of emergency responders may be below U.S. standards;
• not present throughout the country or are unreliable in most areas except in major cities and may;  
• not be equipped with state-of-the-art medical equipment.

We highly recommend that all travelers review the U.S. Centers for Disease Control and Prevention’s Travelers’ Health webpage and general Traveler Advice for South Africa.

• Select your destination in the Travelers’ Health webpage .
• Review all sub-sections including the Travel Health Notices, Vaccines and Medicines, Non-Vaccine-Preventable Diseases, Stay Healthy and Safe, Healthy Travel Packing List, and After Your Trip.
• Reasons for Travel (for example: Adventure Travel, Spring Break Travel)
• Travelers with Special Considerations (for example: Allergies, Long-Term Travelers and Expatriates)
• and General Tips (for example: Traveling with Medications, Travel Vaccines)

Private medical facilities are good in urban areas and in the vicinity of game parks but limited elsewhere. Private medical facilities require a deposit before admitting patients. Pharmacies are well-stocked, but you should carry an adequate supply of prescription medication in original packaging, along with your doctor’s prescription. HIV and AIDS is a major public health concern.

The Department of State, U.S. embassies and U.S. consulates do not pay medical bills. Be aware that U.S. Medicare/Medicaid does not apply overseas. Most hospitals and doctors overseas do not accept U.S. health insurance.

Medical Insurance:  Make sure your health insurance plan provides coverage overseas. Private medical facilities will require payment before care is administered. See  insurance providers for overseas coverage . Visit the U.S. Centers for Disease Control and Prevention  for more information on type of insurance you should consider before you travel overseas. for more information on type of insurance you should consider before you travel overseas.

If your health insurance plan does not provide coverage overseas, we strongly recommend your Health Abroad .

If traveling with prescription medication, check with the  Embassy of South Africa  to ensure the medication is legal in South Africa. Always, carry your prescription medication in original packaging with your doctor’s prescription.

The following diseases are prevalent:

• Hepatitis A
• Hepatitis B
• Yellow Fever
• Leptospirosis
• Schistosomiasis
• African Tick-bite Fever
• Chikungunya
• Crimean-Congo Hemorrhagic Fever
• Rift River Valley
• Avian/Bird Flu
• Tuberculosis (TB)

Vaccinations:  Be up to date on  vaccinations  recommended by the U.S. Centers for Disease Control and Prevention.

For further health information:

• World Health Organization
• U.S. Centers for Disease Control and Prevention (CDC)

Air Quality:  Visit  Air Now Department of State  for information on air quality at U.S. Embassies and Consulates.

Air pollution is a significant problem in several major cities in South Africa. Consider the impact seasonal smog and heavy particulate pollution may have on you and consult your doctor before traveling if necessary.

The air quality varies considerably and fluctuates with the seasons. It is typically at its worst in the Winter (Southern Hemisphere). People at the greatest risk from particle pollution exposure include:

• Infants, children, and teens
• People over 65 years of age
• People with lung disease such as asthma and chronic obstructive pulmonary disease (COPD), which includes chronic bronchitis and emphysema.
• People with heart disease or diabetes
• People who work or are active outdoors
• The U.S. Embassy maintains a list of  doctors and hospitals.  We do not endorse or recommend any specific medical provider or clinic.
• Adequate health facilities are available major cities but health care in rural areas may be below U.S. standards.
• Public medical clinics lack basic resources and supplies.
• Hospitals and doctors often require payment “up front” prior to service or admission. Credit card payment is not always available. Most hospitals and medical professionals require cash payment.

Medical Tourism and Elective Surgery

Medical tourism is a rapidly growing industry. People seeking health care overseas should understand that medical systems operate differently from those in the United States and are not subject to the same rules and regulations. Anyone interested in traveling for medical purposes should consult with their local physician before traveling and visit the U.S. Centers for Disease Control and Prevention website for more information on Medical Tourism.

Visit the U.S. Centers for Disease Control and Prevention website for information on Medical Tourism, the risks of medical tourism, and what you can do to prepare before traveling to South Africa.

We strongly recommend supplemental insurance to cover medical evacuation in the event of unforeseen medical complications.

Your legal options in case of malpractice are very limited in South Africa.

Although South Africa has many elective/cosmetic surgery facilities that are on par with those found in the United States, the quality of care varies widely. If you plan to undergo surgery in South Africa, make sure that emergency medical facilities are available, and professionals are accredited and qualified.

Pharmaceuticals

Exercise caution when purchasing medication overseas. Pharmaceuticals, both over the counter and requiring prescriptions, are often readily available for purchase with minimal regulation. Counterfeit medication is common and may be ineffective, the wrong strength, or contain dangerous ingredients. Medication should be purchased in consultation with a medical professional and from reputable establishments.

U.S. Customs and Border Protection and the Food and Drug Administration are responsible for rules governing the transport of medication back to the United States. Medication purchased abroad must meet their requirements to be legally brought back into the United States. Medication should be for personal use and must be approved for usage in the United States. Please visit the U.S. Customs and Border Protection and the Food and Drug Administration websites for more information.

Water Quality & Food Safety

In many areas, tap water is not potable. Bottled water and beverages are generally safe, although you should be aware that many restaurants and hotels serve tap water unless bottled water is specifically requested. Be aware that ice for drinks may be made using tap water.

Johannesburg is at high altitude (5,751 feet). Be aware of the symptoms of altitude sickness and take precautions before you travel. Visit the U.S. Centers for Disease Control and Prevention website for more information about Travel to High Altitudes .

Adventure Travel

Visit the U.S. Centers for Disease Control and Prevention website for more information about Adventure Travel .

Travel and Transportation

Road Conditions and Safety:  Road conditions are generally good in South Africa, but the road traffic death rate is nearly three times higher in South Africa than in the United States. The high incidence of road traffic mortality is due to a combination of poor driving, limited enforcement of traffic laws, road rage, aggressive driving, distracted driving, and driving under the influence of alcohol. Use extreme caution driving at night. U.S. government employees are discouraged from driving after dark outside of major metropolitan areas, except for highway travel between Pretoria and Johannesburg. Traffic lights are frequently out of order.

Traffic Laws:  Traffic in South Africa moves on the left, and the steering wheel is on the right-hand side of the car. Under South African law, all occupants of motor vehicles equipped with seatbelts are required to wear them while the vehicle is in operation. Texting or talking on a cell phone without a hands-free unit while driving is illegal. Treat all intersections with malfunctioning traffic lights as a four-way stop.

South African law does not require an international driver’s license. A valid driver’s license from any U.S. state or territory that has the signature and photo of the driver is valid to drive in South Africa for stays of less than six months.

Please refer to the  Road Safety page  for more information. Also, visit the websites of  South African Tourism  and the  South African National Roads Agency  for more information regarding local transportation trends and laws.

Public Transportation:

Taxis:  The use of individual metered taxis dispatched from established taxi companies, hotel taxis, and tour buses is recommended. U.S. government personnel are not allowed to use minibus taxis or hail taxis on the street or use a taxi stand. Minibus taxi drivers are often unlicensed and drive erratically.

Transportation Network Companies:  Transportation Network Companies (TNCs), such as Uber, also operate in South Africa. U.S. government personnel may only use TNCs with a dispatch application that provides vehicle description, license plate number, and the driver’s name, picture, user rating, and the ability to share trip information. The user should verify the information provided by the company, such as the vehicle make/model, license plate number, and driver’s name/picture, prior to entering the vehicle. TNCs should not be used to travel outside major metropolitan areas. Pick up and drop off should not be done near a traditional taxi stand due to tensions between rideshare and taxi drivers that have resulted in altercations.

Rail Service:  The long-distance rail service, Shosholoza Meyl; the rapid rail Gautrain in Gauteng Province; and luxury rail services, such as Shosholoza Meyl Premier Classe, Blue Train, and Rovos Rail are generally safe and reliable, though mechanical problems and criminal incidents do sometimes occur. U.S. government personnel are not allowed to use the Metrorail commuter rail service because of safety and crime concerns. There have been recent reports of fires being set on Metrorail train cars.

See our Road Safety page for more information. Visit the website of South Africa’s Road Safety authority and Traffic Management Corporation. 

Aviation Safety Oversight:  The U.S. Federal Aviation Administration (FAA) has assessed the government of South Africa’s Civil Aviation Authority as being in compliance with International Civil Aviation Organization aviation safety standards for oversight of South Africa’s air carrier operations. Further information may be found on the  FAA’s safety assessment page .

Maritime Travel:  Mariners planning travel to South Africa should also check for  U.S. maritime advisories  and  alerts  on the Maritime Administration website. Information may also be posted to the websites of the  U.S. Coast Guard  and the  National Geospace Intelligence Agency  (select “broadcast warnings”).

For additional travel information

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• See the  State Department’s travel website  for the  Worldwide Caution  and  Travel Advisories .
• Follow us on  Twitter  and  Facebook .
• See  traveling safely abroad  for useful travel tips.

Review information about International Parental Child Abduction in South Africa . For additional IPCA-related information, please see the International Child Abduction Prevention and Return Act ( ICAPRA ) report.

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• Health and social care
• Public health
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• Immunisation

Malaria prevention guidelines for travellers from the UK

The UKHSA Advisory Committee on Malaria Prevention updates and reissues these guidelines every year for UK travellers.

Ref: UKHSA publication gateway number GOV-15858

PDF , 6.92 MB , 166 pages

This file may not be suitable for users of assistive technology.

Information regarding malaria incidents, announcements and guidance amendments is available on GOV.UK.

The guidelines are for healthcare workers who advise travellers, but may also be of use to prospective travellers who wish to read about the options themselves.

The Advisory Committee on Malaria Prevention ( ACMP ) prophylaxis guidelines are for UK-based visitors to malaria-endemic areas, and may not be appropriate for use by people who live in endemic areas.

Occasionally, there may be a need to issue temporary recommendations. Please see the temporary recommendations from the National Travel Health Network and Centre for the latest updates for Pakistan.

These guidelines deal with malaria, but malaria prevention is only one aspect of pre-travel advice. An overall risk-assessment-based package of travel health advice should be provided to the traveller.

For previous malaria guidelines, see the archive of older reports on the UK government web archive .

Updated guidance.

Added link to malaria news and updates.

Added notice about discontinuation of proguanil in the UK.

Updated status of Azerbaijan and Tajikistan to malaria free.

Added notice about reported increases in malaria cases in Sudan and the impact of current civil unrest.

Update to doses of prophylactic antimalarials for children.

Added notice about the first identification of Plasmodium falciparum artemisinin resistance in the UK.

Updated to reflect the temporary recommendations currently in place.

Added temporary change to malaria advice for travellers to Pakistan.

Updated map of Namibia and section on visits to national parks.

Updated with 2021 guidelines.

Updated Malaria guidance for travellers.

Updated with 2018 guidelines.

South Africa has been added to the list of countries with temporary recommendations.

Updated with 2017 guidelines.

Updated with 2016 guidance.

Updated with 2015 guidelines.

First published.

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BRETT A. JOHNSON, MD, AND MONICA G. KALRA, DO

A more recent article on  malaria  is available.

This is a corrected version of the article that appeared in print.

Am Fam Physician. 2012;85(10):973-977

Patient information : See related handout on prevention of malaria , written by the authors of this article.

Author disclosure: No relevant financial affiliations to disclose.

There are approximately 300 million cases of malaria each year, resulting in 1 million deaths worldwide. Family physicians often encounter patients preparing to travel to malaria-endemic regions. Physicians should have basic knowledge of parasite transmission and malaria prevention. The risk of malaria acquisition is based largely on geographic location and travel season. Most cases occur in sub-Saharan Africa, the Indian subcontinent, and Southeast Asia between the months of May and December. Key elements in prevention include barrier protection and chemoprophylaxis. Travelers to malaria-endemic areas should be advised to use mosquito repellent at all times and bed netting at night. Prophylactic medication should be initiated before travel and continued after return. Travelers should be warned that malaria symptoms can present up to one year after a mosquito bite. Symptoms are vague, and may include fever, chills, arthralgias, and headaches. Travelers experiencing symptoms should seek prompt medical attention.

There are approximately 300 million cases of malaria each year, resulting in 1 million deaths worldwide. 1 Reports from the Centers for Disease Control and Prevention (CDC) indicate that there are between 1,200 and 1,600 cases of malaria annually in the United States. 2 In 2009, there was a 14 percent increase in reported cases of malaria (from 1,298 cases in 2008 to 1,484 cases in 2009). 2 One factor contributing to disease resurgence is global climate change. 3 Between 2011 and 2020, the global mean temperature is expected to rise by 0.4°C. 3 This increase in temperature has been projected to lead to a 30 to 100 percent increase in mosquito abundance worldwide. 3

Most malaria infections in this country occur among persons who have traveled to areas with ongoing malaria transmission. In the United States, cases also can occur through exposure to infected blood products, congenital transmission, or local mosquito-borne transmission. 2

Not only are mosquitoes proliferating with environmental change, but recent findings also suggest that malaria is becoming resistant to treatment. Family physicians can address these issues with a preventive approach that includes traveler education, risk assessment, barrier protection, and chemoprophylaxis.

Sources of Transmission

Five main species of parasites are responsible for transmission of malaria in humans: Plasmodium falciparum , Plasmodium vivax , Plasmodium ovale , Plasmodium knowlesi , and Plasmodium malariae . 4 These protozoa are concentrated in different areas of the world, and each produces a different manifestation of infection. P. falciparum is the most life-threatening form of malaria.

These parasites are transmitted to humans by the bite of an infective female Anopheles mosquito. To produce eggs, the mosquito usually consumes a blood meal, thus needing humans and animals as hosts. The development of the protozoa in the mosquito takes 10 to 21 days, depending on the species of the parasite. After the parasites enter the host's liver, the replication stage begins. Subsequent replication occurs in erythrocytes and may last from one week to one year. Symptoms of malaria appear after the parasites leave the liver and start lysing red blood cells.

Risk Assessment

An individual risk assessment should be conducted for every traveler, taking into account the destination and season of travel. 5 Physicians should provide travelers with resources that discuss risk factors for malaria transmission ( Table 1 ) .

According to the World Health Organization, malaria was endemic in 106 countries in 2010. 6 Most cases occur in sub-Saharan Africa, the Indian subcontinent, and Southeast Asia. A map of worldwide malaria endemicity is available on the CDC Web site at http://cdc.gov/malaria/map/ . Malaria accounts for 5 percent of febrile illnesses in Ethiopia between the months of January and April, and up to 30 percent between the months of May and December. 7

Precipitation is also a contributing factor for vector transmission because riverbeds and stagnant pools of water are breeding grounds for the Anopheles mosquito. Travelers should be advised that the highest risk of malaria is during and after the rainy season. 8

Mosquito Bite Prevention

Mosquito sprays and bed netting are effective in preventing malaria transmission. A trial in the Bolivian Amazon showed that episodes of malaria were reduced by 80 percent among persons using insect repellent and insecticide-treated bed netting. 9

The CDC recommends diethyltoluamide (DEET) and picaridin as repellents for malaria prevention. 10 DEET concentrations between 4 and 30 percent are effective for malaria protection. 11 Higher concentrations are not associated with increased levels of toxicity. The effectiveness of DEET plateaus at a concentration of 30 percent. A formulation of 4 percent offers a complete mean protection time of approximately 90 minutes, whereas a 23 percent formulation offers more than five hours of protection. Adverse effects of DEET include dermatitis, allergic reactions, and rare neurotoxicity. The American Academy of Pediatrics does not recommend DEET for infants younger than two months. 12 The recommendations for DEET use in pregnant and lactating women are similar to those for nonpregnant adults. 11

A 20 percent solution of picaridin is comparable to a 35 percent DEET solution. 13 The highest concentration of picaridin sold in the United States is 15 percent, and the data are insufficient to support adequate protection against Anopheles mosquitoes at this concentration. Picaridin does not cause skin irritation and is safe to use in children and pregnant women.

In 2007, scientists in South America developed a mosquito repellent containing p -menthane-3,8-diol (PMD), a eucalyptus plant extract. 14 The formula is less toxic, cheaper, and more effective against malaria than a 20 percent solution of DEET. 14 In the United States, PMD is available as 65 percent and 10 percent concentrations. 15 The U.S. Environmental Protection Agency recommends these products as repellents against mosquitoes, biting flies, and gnats. 15 Adverse effects include skin and eye irritation. 15

Barriers such as insecticide-treated netting and clothing are as important as repellents in the prevention of malaria. A study in sub-Saharan Africa concluded that bed netting reduces the incidence of malaria by at least 50 percent. 16 Use of clothing treated with permethrin (a synthetic mosquito repellent) is effective in preventing mosquito bites. 17

Chemoprophylaxis

All recommended chemoprophylactic regimens involve taking medication before travel, during travel, and for a period of time after leaving the malaria-endemic region ( Table 2 ) . 18 – 22 Beginning the regimen before travel is necessary to allow the antimalaria agent to enter the bloodstream before exposure to malaria-carrying parasites. 18 Atovaquone/proguanil (Malarone), doxycycline, and mefloquine are the drugs of choice for malaria prevention in most malaria-endemic regions. 18

ATOVAQUONE/PROGUANIL

Atovaquone/proguanil is a good choice for last-minute travelers because it can be started one to two days before travel, as opposed to one to two weeks with some of the other drugs. 18 Common adverse effects include abdominal pain, nausea, vomiting, and elevated alanine transaminase levels. It is contraindicated in patients with a creatinine clearance of less than 30 mL per minute per 1.73 m 2 (0.50 mL per second per m 2 ). 18 Atovaquone/proguanil is a U.S. Food and Drug Administration (FDA) pregnancy category C medication.

DOXYCYCLINE

Doxycycline is taken daily and provides additional protection against many infections, including tick-borne illnesses. 18 Travelers should be aware that photosensitivity may increase in persons with prolonged sun exposure. Other adverse effects include vaginal candidiasis, abdominal pain, and diarrhea. Doxycycline is FDA pregnancy category D, and should be used only if maternal benefits outweigh fetal risks. It is contraindicated in children younger than eight years.

Mefloquine is taken weekly. It is considered safe to use during the second and third trimesters of pregnancy. 18 Resistance to mefloquine is found in areas of China, Myanmar, Laos, Vietnam, and Cambodia. 23 Five percent of patients taking mefloquine will experience neuropsychiatric effects (e.g., insomnia, paranoia, hallucinations, seizures) that lead to discontinuation of the drug. 19 , 20

CHLOROQUINE

Chloroquine (Aralen) was the standard of care for malaria prevention for many years. However, as P. falciparum has become largely resistant to chloroquine, it is now recommended only for travelers going to the Middle East, Central America, Haiti, and the Dominican Republic. 18 Chloroquine can be used in all trimesters of pregnancy and in children of all ages. 18 Adverse effects may include blurry vision, tinnitus, and hearing loss.

Primaquine is used mainly in areas where P. vivax is the primary strain of malaria (e.g., parts of Central and South America). Patients must be tested for glucose-6-phosphate dehydrogenase deficiency before taking primaquine because it may cause hemolysis in affected persons. 21 Other adverse effects include nausea, vomiting, and abdominal pain. 21 Primaquine is an FDA pregnancy category C medication.

Five to 80 percent of patients treated for P. vivax malaria will relapse. 22 As a preemptive measure, patients with P. vivax infection should be treated with a 14-day course of primaquine to prevent further disease. 22 Primaquine therapy should be started on the same day as malaria treatment. 22

Recognition of Illness

Travelers should be warned that adequate chemoprophylaxis does not guarantee full protection against malaria. Symptoms may appear from one week to one year after infection with the parasite. Relapsing illness may occur in patients who have completed a course of treatment. 10 Travelers to malaria-endemic areas should seek medical attention for signs and symptoms of malaria, including fever, chills, headaches, and arthralgias. 10

Presumptive Treatment

Travelers who decline malaria prophylaxis or who will be traveling to remote areas with limited access to health care may be prescribed a three-day supply of presumptive malaria treatment before travel. 23 Travelers should be advised that self-treatment of a possible malaria infection is only a temporary measure, and that prompt medical evaluation is imperative. 23 A three-day course of high-dose oral atovaquone/proguanil or artemether/lumefantrine (Coartem) may be prescribed. 23 Travelers should take the medication if they experience high fevers, chills, or myalgias. 23 Physicians who need assistance with the diagnosis or treatment of malaria should call the CDC Malaria Hotline (855-856-4713).

The Future of Malaria Prevention

A malaria vaccine is being developed for delivery through the World Health Organization's Expanded Programme on Immunization. 24 It is being studied in African infants during the first 13 months of life, and has been reported to reduce transmission of malaria by 65 percent with few adverse effects. 24 Along with barrier protection and chemoprophylaxis, vaccination may eventually play a key role in the eradication of malaria worldwide. 24

Data Sources: We searched PubMed, Essential Evidence Plus, the Cochrane database, and UpToDate using variations of the key term malaria prevention. Search dates: July to September 2010, and July 2011.

Centers for Disease Control and Prevention. Malaria—malaria facts. http://www.cdc.gov/malaria/about/facts.html . Accessed December 12, 2011.

Mali S, Tan KR, Arguin PM Division of Parasitic Diseases and Malaria. Center for Global Health; Centers for Disease Control and Prevention. Malaria surveillance—United States, 2009. MMWR Surveill Summ. 2011;60(3):1-15.

Pascual M, Ahumada JA, Chaves LF, Rodó X, Bouma M. Malaria resurgence in the East African highlands: temperature trends revisited. Proc Natl Acad Sci USA. 2006;103(15):5829-5834.

Freedman DO. Clinical practice. Malaria prevention in short-term travelers. N Engl J Med. 2008;359(6):603-612.

Centers for Disease Control and Prevention. Malaria—disease. http://www.cdc.gov/malaria/about/disease.html . Accessed August 15, 2010.

World Health Organization. World Malaria Report: 2010. http://www.who.int/malaria/world_malaria_report_2010/en/index.html . Accessed December 12, 2011.

Muhe L, Oljira B, Degefu H, Enquesellassie F, Weber MW. Clinical algorithm for malaria during low and high transmission seasons. Arch Dis Child. 1999;81(3):216-220.

Briët OJ, Vounatsou P, Gunawardena DM, Galappaththy GN, Amerasinghe PH. Temporal correlation between malaria and rainfall in Sri Lanka. Malar J. 2008;7:77.

Hill N, Lenglet A, Arnéz AM, Carneiro I. Plant based insect repellent and insecticide treated bed nets to protect against malaria in areas of early evening biting vectors: double blind randomised placebo controlled clinical trial in the Bolivian Amazon. BMJ. 2007;335(7628):1023.

Centers for Disease Control and Prevention. Malaria—malaria and travelers. http://www.cdc.gov/malaria/travelers/index.html . Accessed July 8, 2011.

Fradin MS, Day JF. Comparative efficacy of insect repellents against mosquito bites. N Engl J Med. 2002;347(1):13-18.

American Academy of Pediatrics. Follow safety precautions when using DEET on children. AAP News . 2003;22(5):200-399. http://aapnews.aappublications.org/cgi/content/full/e200399v1 (subscription required). Accessed July 1, 2011.

Frances SP, Waterson DG, Beebe NW, Cooper RD. Field evaluation of repellent formulations containing deet and picaridin against mosquitoes in Northern Territory, Australia. J Med Entomol. 2004;41(3):414-417.

Moore SJ, Darling ST, Sihuincha M, Padilla N, Devine GJ. A low-cost repellent for malaria vectors in the Americas: results of two field trials in Guatemala and Peru. Malar J. 2007;6:101.

U.S. Environmental Protection Agency. Pesticides: regulating pesticides— p -Menthane-3,8-diol (011550) fact sheet. http://www.epa.gov/oppbppd1/biopesticides/ingredients/factsheets/factsheet_011550.htm . Accessed July 1, 2011.

Pennetier C, Corbel V, Boko P, et al. Synergy between repellents and non-pyrethroid insecticides strongly extends the efficacy of treated nets against Anopheles gambiae . Malar J. 2007;6:38.

Kimani EW, Vulule JM, Kuria IW, Mugisha F. Use of insecticide-treated clothes for personal protection against malaria: a community trial. Malar J. 2006;5:63.

Centers for Disease Control and Prevention. Malaria—choosing a drug to prevent malaria. http://www.cdc.gov/malaria/travelers/drugs.html . Accessed August 15, 2010.

Gutman J, Green M, Durand S, et al. Mefloquine pharmacokinetics and mefloquineartesunate effectiveness in Peruvian patients with uncomplicated Plasmodium falciparum malaria. Malar J. 2009;8:58.

Nevin RL, Pietrusiak PP, Caci JB. Prevalence of contraindications to mefloquine use among USA military personnel deployed to Afghanistan. Malar J. 2008;7:30.

Hill DR, Baird JK, Parise ME, Lewis LS, Ryan ET, Magill AJ. Primaquine: report from CDC expert meeting on malaria chemoprophylaxis I. Am J Trop Med Hyg. 2006;75(3):402-415.

Baird JK, Hoffman SL. Primaquine therapy for malaria. Clin Infect Dis. 2004;39(9):1336-1345.

Centers for Disease Control and Prevention. Travelers' health—infectious diseases related to travel: malaria. http://wwwnc.cdc.gov/travel/yellowbook/2012/chapter-3-infectious-diseases-related-to-travel/malaria.htm . Acessed July 8, 2011.

Abdulla S, Oberholzer R, Juma O, et al. Safety and immunogenicity of RTS,S/AS02D malaria vaccine in infants. N Engl J Med. 2008;359(24):2533-2544.

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Major step in malaria prevention as three West African countries roll out vaccine

Cotonou/Freetown/Monrovia, 25 April 2024 – In a significant step forward for malaria prevention in Africa, three countries – Benin, Liberia and Sierra Leone – today launched a large-scale rollout of the life-saving malaria vaccine targeting millions of children across the three West African nations. The vaccine rollout, announced on World Malaria Day, seeks to further scale up vaccine deployment in the African region.

Today’s launch brings to eight the number of countries on the continent to offer the malaria vaccine as part of the childhood immunization programmes, extending access to more comprehensive malaria prevention. Several of the more than 30 countries in the African region that have expressed interest in the vaccine are scheduled to roll it out in the next year through support from Gavi, the Vaccine Alliance, as efforts continue to widen its deployment in the region in coordination with other prevention measures such as long-lasting insecticidal nets and seasonal malaria chemoprevention.

Benin, which received 215,900 doses, has added the malaria vaccine to its Expanded Programme on Immunization. The malaria vaccine should be provided in a schedule of 4 doses in children from around 5 months of age.

"The introduction of the malaria vaccine in the Expanded Programme on Immunization for our children is a major step forward in the fight against this scourge. I would like to reassure that the malaria vaccines are safe and effective and contribute to the protection of our children against this serious and fatal diseases," said Prof Benjamin Hounkpatin, Minister of Health of Benin .

In Liberia, the vaccine was launched in the southern Rivercess County and will be rolled out afterwards in five other counties which have high malaria burden. At least 45,000 children are expected to benefit from the 112,000 doses of the available vaccine.

"For far too long, malaria has stolen the laughter and dreams of our children. But today, with this vaccine and the unwavering commitment of our communities, healthcare workers and our partners, including Gavi, UNICEF and WHO, we break the chain. We have a powerful tool that will protect them from this devastating illness and related deaths, ensuring their right to health and a brighter future. Let's end malaria in Liberia and pave the way for a healthier, more just society," said Dr Louise Kpoto, Liberia’s Minister of Health .

Two safe and effective vaccines – RTS,S and R21 – recommended by World Health Organization (WHO), are a breakthrough for child health and malaria control. A pilot malaria vaccine programme in Ghana, Kenya and Malawi reached over 2 million children from 2019 to 2023, showing a significant reduction in malaria illness and a 13% drop in overall child mortality and substantial reductions in hospitalizations.

In Sierra Leone, the first doses were administered to children at a health centre in Western Area Rural where the authorities kicked off the rollout of 550,000 vaccine doses. The vaccine will then be delivered in health facilities nationwide.

"With the new, safe and efficacious malaria vaccine, we now have an additional tool to fight this disease. In combination with insecticide-treated nets, effective diagnosis and treatment, and indoor spraying, no child should die from malaria infection," said Dr Austin Demby, Minister of Health of Sierra Leone .

Malaria remains a huge health challenge in the African region, which is home to 11 countries that carry approximately 70% of the global burden of malaria. The region accounted for 94% of global malaria cases and 95% of all malaria deaths in 2022, according to the World Malaria Report .

"The African region is taking positive steps in scaling up the rollout of the malaria vaccine – a game-changer in our fight against this deadly disease," said Dr Matshidiso Moeti, WHO Regional Director for Africa . "Working with our partners, we’re committed to supporting the ongoing efforts to protect, save the lives of young children and lower the malaria burden in the region."

Aurélia Nguyen, Chief Programme Officer at Gavi, the Vaccine Alliance , noted: "Today we celebrate more children gaining access to a new life-saving tool to fight one of Africa’s deadliest diseases. This introduction of malaria vaccines into routine programmes in Benin, Liberia, and Sierra Leone alongside other proven interventions will help save lives and offer relief to families, communities and hard-pressed health systems."

Progress against malaria has stalled in these high-burden African countries since 2017 due to factors including climate change, humanitarian crises, low access to and insufficient quality of health services, gender-related barriers, biological threats such as insecticide and drug resistance and global economic crises. Fragile health systems and critical gaps in data and surveillance have compounded the challenge.

To put malaria progress back on track, WHO recommends robust commitment to malaria responses at all levels, particularly in high-burden countries; greater domestic and international funding; science and data-driven malaria responses; urgent action on the health impacts of climate change; harnessing research and innovation; as well as strong partnerships for coordinated responses. WHO is also calling attention to addressing delays in malaria programme implementation.

Notes to editors

Eight countries have so far rolled out the malaria vaccine as part of childhood immunization programmes in 2024: Benin, Burkina Faso, Cameroon, Ghana, Kenya, Liberia, Malawi, and Sierra Leone.

About Gavi, the Vaccine Alliance

Gavi, the Vaccine Alliance is a public-private partnership that helps vaccinate more than half the world’s children against some of the world’s deadliest diseases. The Vaccine Alliance brings together developing country and donor governments, the World Health Organization, UNICEF, the World Bank, the vaccine industry, technical agencies, civil society, the Bill & Melinda Gates Foundation and other private sector partners. View the full list of donor governments and other leading organisations that fund Gavi’s work here .

Since its inception in 2000, Gavi has helped to immunise a whole generation – over 1 billion children – and prevented more than 17.3 million future deaths, helping to halve child mortality in 78 lower-income countries. Gavi also plays a key role in improving global health security by supporting health systems as well as funding global stockpiles for Ebola, cholera, meningococcal and yellow fever vaccines. After two decades of progress, Gavi is now focused on protecting the next generation, above all the zero-dose children who have not received even a single vaccine shot. The Vaccine Alliance employs innovative finance and the latest technology – from drones to biometrics – to save lives, prevent outbreaks before they can spread and help countries on the road to self-sufficiency. Learn more at www.gavi.org and connect with us on Facebook and Twitter .

Dedicated to the well-being of all people and guided by science, the World Health Organization leads and champions global efforts to give everyone, everywhere an equal chance at a safe and healthy life. We are the UN agency for health that connects nations, partners and people on the front lines in 150+ locations – leading the world’s response to health emergencies, preventing disease, addressing the root causes of health issues and expanding access to medicines and health care. Our mission is to promote health, keep the world safe and serve the vulnerable.

Visit www.who.int and follow WHO on Twitter , Facebook , Instagram , LinkedIn , TikTok , Pinterest , Snapchat , YouTube .

About UNICEF

UNICEF works in some of the world’s toughest places, to reach the world’s most disadvantaged children. Across more than 190 countries and territories, we work for every child, everywhere, to build a better world for everyone.

For more information about UNICEF and its work, visit: www.unicef.org

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Guidelines for the Prevention of Malaria - 2017

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The first vaccine for malaria received major regulatory approval in 2015.

It didn’t become part of vaccination programs in africa until 2024., what if it had come faster, what if the shots had arrived 9 years ago, that’s how many children’s deaths could have been averted..

By Stephanie Nolen

Stephanie Nolen interviewed more than 30 scientists, health officials and other key players in the development of the malaria vaccines to report this article.

Nurses in countries from Sierra Leone to Cameroon are packing a new vaccine into the coolers they tote to villages for immunization clinics: a shot to protect against malaria, one of the deadliest diseases for children. Babies and toddlers in eight countries in the region recently started to get the vaccine as part of their routine childhood shots. Seven other African countries are eagerly awaiting its arrival.

This is a milestone in global health.

But it’s also a cautionary tale about a system that is ill equipped to deliver critical tools to the people who need them most. It took decades and at least a billion dollars to reach this point. Even now, only a fraction of the children whose lives are at risk will get the vaccine this year, or next year, or the year after. It’s been clear for some time what went wrong, but almost none of those issues have been fixed. That means that the next desperately needed vaccine stands every chance of running into those same problems. Take, for example, a new vaccine for tuberculosis that started clinical trials a few months ago. If it works as well as hoped, it could save at least a million lives a year. We’ll know by 2028 if it stops tuberculosis infections. But if it follows the same trajectory, it will be at least 2038 before it’s shipped to clinics.

“Children are receiving the vaccine, and for that, I am the happiest man in the world. But on the other hand, I cannot avoid being dismayed at this inexcusably long delay.”

— Dr. Joe Cohen, co-inventor of the first malaria vaccine

The U.S. Army started work on a malaria vaccine back in the 1980s, hoping to protect soldiers deployed to the tropics. It teamed up with the drug company GlaxoSmithKline, and together they produced promising prototypes. But the military lost interest after a few years, and that left GSK with a problem. The people who desperately needed a malaria vaccine were in villages in sub-Saharan Africa. They would not be able to pay for a product that would cost millions of dollars to develop. GSK needed an altruistically minded partner. It found one in the nonprofit global health agency PATH, and by the late 1990s they had a vaccine to test. The Bill & Melinda Gates Foundation put up more than $200 million to test it. The clinical trials were complex, because this was a whole new type of vaccine — the first ever against a parasite — delivered to children in places with limited health systems. The process took more than a decade. Finally, in 2014, results showed this vaccine cut severe malaria cases by about a third. This was a successful result, but not as much protection as scientists had hoped to see. Still, GSK and PATH planned a production facility to make millions of doses. Gavi, the organization that procures vaccines for low- and middle-income countries, with funds from donors, would buy them.

Then the Gates Foundation pulled its support.

There was a shake-up in the malaria division, and the leadership reoriented toward a new goal: eliminating the disease. The new malaria team said the vaccine didn’t work well enough to justify pouring millions more dollars into it. It would be better, they said, to wait for a more effective shot in the future, and in the meantime to fund other strategies, such as genetically modifying mosquitoes.

“If you go from very enthusiastic to very unenthusiastic and you’re the Gates Foundation, people pay attention.”

— Dr. Robert Newman, former director, Global Malaria Program, W.H.O.

The decision was driven by researchers who were looking at data. They didn’t factor in that the idea of a vaccine, even one with limited efficacy, would be so important to African parents — and African governments, which would come to see this as a classic example of a paternalistic donor ignoring their priorities. More than 300,000 children died of malaria that year. The foundation’s announcement shoved the vaccine into limbo — in ways the foundation today says it did not anticipate.

“In hindsight, we could have communicated more often and more clearly about our decisions and listened more clearly to what the impact of those might have been on other institutions and their decisions.”

— Dr. Chris Elias, president of global development at the Bill & Melinda Gates Foundation

GSK and PATH tried to push the vaccine forward. The company submitted a 250,000-page dossier to the European Medicines Agency, which can approve products not relevant in Europe but of humanitarian benefit. In 2015, the agency said the vaccine was safe (with some issues it wanted GSK to continue to study), and PATH began hunting for new financial partners to replace Gates.

Then came a second shock.

The World Health Organization evaluates new vaccines to decide what’s safe and well made, so that countries and Gavi know what to order. The malaria vaccine needed this sign-off, and since the European agency, a stringent regulator, had approved it, GSK and PATH assumed the W.H.O. would do so swiftly, too. Two groups met to consider the vaccine for the W.H.O.: an external advisory committee that evaluates vaccines, and a panel of malaria experts. The malaria specialists, who had seen African hospital wards full of children dying of the disease, said, “Yes, let’s go.”

But the vaccine experts said: No.

They argued that a small increase in cases of meningitis in children who got the shot hadn’t been sufficiently explained. If this small-chance issue turned out to be an actual problem, it could undermine African parents’ confidence in all childhood vaccines, with catastrophic consequences. Second, they feared that countries might struggle to deliver the vaccine. It came in four doses, none delivered on the usual childhood immunization schedules; the last dose came a year after the third, and without it, the vaccine offered little protection. In the end, there was a compromise: The W.H.O. announced what it called a pilot implementation, in Kenya, Malawi and Ghana, that would cost close to $100 million.

“I think that was the right thing. It meant a delay, which was unfortunate. But everyone, including GSK, knew a larger rollout was coming, and they should be ready. Did they act accordingly? I’m afraid not.”

— Dr. Pedro Alonso, former director, Global Malaria Program, W.H.O.

When GSK heard that instead of triumphantly shipping malaria shots to Africa, it would have to put the vaccine through another evaluation, executives ordered that the production facility and the vaccine ingredients be directed to more lucrative products.

“All the manufacturing plans that GSK had put in place were derailed. They stopped manufacturing because they did not want to continue to assume the risk of keeping a facility going for several years at huge expense for a vaccine that they weren’t sure was ever going to see the light of day.”

— Dr. Ashley Birkett, former director of the PATH Malaria Vaccine Initiative

Two years later, the W.H.O. had scraped together funding. GSK restarted a small production line to make enough of the vaccine for the study. At Gavi, however, board members representing Africa were demanding answers.

When was Africa going to get a vaccine for malaria?

Gavi turned to MedAccess, an organization that provides funding to reduce the financial risk for private companies working on medical products for low-income nations. With MedAccess’ support, Gavi offered a deal to protect GSK from financial risk, saying, in essence, we’ll fund you to start producing, and if the vaccine isn’t approved, we’ll cover the loss. GSK agreed and kept the production line open. In the end, the news was good. Data from the pilot showed no safety risk, and the W.H.O. approved the vaccine for Gavi to buy in bulk and ship to Africa. It was December 2021. But then GSK told Gavi that after all the agony of winning approval, it could produce only 12 million doses of its vaccine each year, tens of millions fewer than anxious countries were hoping for. Many people in the vaccine world believe that the issue was the chemical used to boost the strength of the immune response from vaccines, something called an adjuvant. It was made from the bark of a Chilean tree, and it has proved to be one of the more valuable substances the company ever produced.

When GSK said it would be limited in how much of its malaria vaccine it would make, angry collaborators at the W.H.O. and other agencies suggested it was because the company was keeping most of the adjuvant for more lucrative products such as its shingles vaccine, Shingrix, which sells for $350 per dose (compared with $10 for the malaria shot). GSK says that the adjuvant is not the constraint but that the factory that produces the vaccine is 50 years old and simply can’t make any more than those 12 million doses at present. The company says it will expand to an additional three million per year starting in 2026.

“The adjuvant is not the issue.”

— Dr. Thomas Breuer, chief of global health, GSK

The company has licensed the vaccine to Bharat Biotech, a drug maker in India, and is sharing the technology to produce it, but that process is complex; it will be at least five years until Bharat is making the vaccine on its own. In the meantime, GSK will upgrade its facility in Belgium later this year, and then make about 15 million doses a year until Bharat takes over. But until the end of 2025, there will be enough doses for only 4.5 million children, which could mean many more may fall ill and die.

Except: there is a second vaccine.

While this protracted process was playing out, a second malaria vaccine was moving through clinical trials. It was developed by researchers at the University of Oxford, who faced the familiar financial challenge. In 2021, the Serum Institute of India, the world’s biggest vaccine maker, put up the money to move the vaccine through a costly Phase 3 clinical trial. But there was still the question of production: it would cost millions of dollars to start mass-producing the vaccine, and the company had no guarantee of when, or even if, it would be able to sell it. The GSK experience had cast a chill over the whole field. The Oxford team submitted its clinical trial data for approval to the W.H.O. right around the time the GSK shot finally cleared the last hurdle. Because the two vaccines are based on essentially the same science, this one moved much more quickly through the process. And the Serum Institute bet big.

“We decided just to go ahead and make 25 million.”

— Adar Poonawalla, chief executive, Serum Institute of India

Those doses were made in time to be shipped in 2024, and the Serum Institute says it has the capacity to make 100 million doses per year. Even so, more than a decade after it was proved that a vaccine could protect children from malaria, only a fraction of the children at risk will get the shot this year or next. Gavi will ship about 11 million doses this year. The organization says that’s as much as countries rolling it out can handle right now. Policy Cures Research, a nonprofit that studies global health research investment, calculated that if the GSK vaccine had moved through the system as quickly as the Oxford-Serum shot did, the deaths of 590,000 children could already have been prevented . It’s an unsettled debate among experts, whether the W.H.O. pilot study was worth the years it added — was it better to err on the side of caution, because the stakes were so high for children’s health, or to gamble, given the scale of malaria’s devastation? When the W.H.O. decided on this delay, it seemed like the world might be winning the fight against malaria. The sense of urgency in the hunt for new tools was lower than it is today, when malaria deaths are climbing. And, in the Covid-19 era, regulators are more comfortable with emergency approval for vaccines than they were a decade ago.

The malaria vaccines we have now won’t be the last. There are 65 new candidate vaccines in the development pipeline. They will all face this question of how to raise funds for production before we know they work. Some of the lessons from the malaria experience have been applied to the tuberculosis vaccine, but it is made with the same GSK adjuvant and key questions about supply remain unresolved.

If the new tuberculosis vaccine proves effective, will it get to the people who need it any faster?

There is still no system that solves the fundamental problem of how to pay for at-risk production of a tool that is vitally important for the health of millions of people who can’t afford to pay for it. All the work on the tuberculosis vaccine is being bankrolled by philanthropies, which set their own agendas — not by the countries that need the vaccine.

“We will have scientific questions which may hold us up: You have to know that we may need to ride this out for longer than our wishful thinking would like. Who is going to pay for that and for how long?”

— Aurélia Nguyen, chief program officer, Gavi

Produced by Antonio de Luca

Stephanie Nolen is a global health reporter for The Times. More about Stephanie Nolen

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• Section 2 - Interactions Between Travel Vaccines & Drugs
• Section 2 - Travelers’ Diarrhea

Yellow Fever Vaccine & Malaria Prevention Information, by Country

Cdc yellow book 2024.

Author(s): Mark Gershman, Rhett Stoney (Yellow Fever) Holly Biggs, Kathrine Tan (Malaria)

The following pages present country-specific information on yellow fever (YF) vaccine requirements and recommendations, and malaria transmission information and prevention recommendations. Country-specific maps are included to aid in interpreting the information. The information in this chapter was accurate at the time of publication; however, it is subject to change at any time due to changes in disease transmission or, in the case of YF, changing entry requirements for travelers. Updated information reflecting changes since publication can be found in the online version of this book and on the Centers for Disease Control and Prevention (CDC) Travelers’ Health website. Recommendations for prevention of other travel-associated illnesses can also be found on the CDC Travelers’ Health website .

Yellow Fever Vaccine

Entry requirements.

Entry requirements for proof of YF vaccination under the International Health Regulations (IHR) differ from CDC’s YF vaccination recommendations. Under the IHR, countries are permitted to establish YF vaccine entry requirements to prevent the importation and transmission of YF virus within their boundaries. Certain countries require proof of vaccination from travelers arriving from all countries ( Table 5-25 ); some countries require proof of vaccination only for travelers above a certain age coming from countries with risk for YF virus transmission. The World Health Organization (WHO) defines areas with risk for YF virus transmission as countries or areas where YF virus activity has been reported currently or in the past, and where vectors and animal reservoirs exist.

Unless issued a medical waiver by a yellow fever vaccine provider, travelers must comply with entry requirements for proof of vaccination against YF.

WHO publishes a list of YF vaccine country entry requirements and recommendations for international travelers approximately annually. But because entry requirements are subject to change at any time, health care professionals and travelers should refer to the online version of this book and the CDC Travelers’ Health website for any updates before departure.

CDC Recommendations

CDC’s YF vaccine recommendations are guidance intended to protect travelers from acquiring YF virus infections during international travel. These recommendations are based on a classification system for destination-specific risk for YF virus transmission: endemic, transitional, low potential for exposure, and no risk ( Table 2-08 ). CDC recommends YF vaccination for travel to areas classified as having endemic or transitional risk (Maps 5-10 and 5-11 ). Because of changes in YF virus circulation, however, recommendations can change; therefore, before departure, travelers and clinicians should check CDC’s destination pages for up-to-date YF vaccine information.

Duration of Protection

In 2015, the US Advisory Committee on Immunization Practices published a recommendation that 1 dose of YF vaccine provides long-lasting protection and is adequate for most travelers. The recommendation also identifies specific groups of travelers who should receive additional doses, and others for whom additional doses should be considered (see Sec. 5, Part 2, Ch. 26, Yellow Fever ). In July 2016, WHO officially amended the IHR to stipulate that a completed International Certificate of Vaccination or Prophylaxis is valid for the lifetime of the vaccinee, and YF vaccine booster doses are not necessary. Moreover, countries cannot require proof of revaccination (booster) against YF as a condition of entry, even if the traveler’s last vaccination was >10 years ago.

Ultimately, when deciding whether to vaccinate travelers, clinicians should take into account destination-specific risks for YF virus infection, and individual risk factors (e.g., age, immune status) for serious YF vaccine–associated adverse events, in the context of the entry requirements. See Sec. 5, Part 2, Ch. 26, Yellow Fever , for a full discussion of YF disease and vaccination guidance.

Table 2-08 Yellow fever (YF) vaccine recommendation categories 1

Malaria prevention.

The following recommendations to protect travelers from malaria were developed using the best available data from multiple sources. Countries are not required to submit malaria surveillance data to CDC. On an ongoing basis, CDC actively solicits data from multiple sources, including WHO (main and regional offices); national malaria control programs; international organizations; CDC overseas offices; US military; academic, research, and aid organizations; and the published scientific literature. The reliability and accuracy of those data are also assessed.

If the information is available, trends in malaria incidence and other data are considered in the context of malaria control activities within a given country or other mitigating factors (e.g., natural disasters, wars, the coronavirus disease 2019 pandemic) that can affect the ability to control malaria or accurately count and report it. Factors such as the volume of travel to that country and the number of acquired cases reported in the US surveillance system are also examined. In developing its recommendations, CDC considers areas within countries where malaria transmission occurs, substantial occurrences of antimalarial drug resistance, the proportions of species present, and the available malaria prophylaxis options.

Clinicians should use these recommendations in conjunction with an individual risk assessment and consider not only the destination but also the detailed itinerary, including specific cities, types of accommodations, season, and style of travel, as well as special health conditions (e.g., pregnancy). Several medications are available for malaria prophylaxis. When deciding which drug to use, consider the itinerary and length of trip, travelers’ previous adverse reactions to antimalarials, drug allergies, medical history, and drug costs. For a thorough discussion of malaria and guidance for prophylaxis, see Sec. 5, Part 3, Ch. 16, Malaria .

Entry requirements : None

CDC recommendations : Recommended for travelers ≥9 months old going to Corrientes and Misiones Provinces. Generally not recommended for travel to Formosa Province or to designated areas of Chaco, Jujuy, and Salta Provinces. Not recommended for travel limited to provinces and areas not listed above.

No malaria transmission

Related Maps

Map 2-01 Yellow fever vaccine recommendations for Argentina & neighboring countries

Other Vaccines to Consider

See Health Information for Travelers to Argentina

Map 2-01 Yellow fever vaccine recommendations for Argentina & neighboring countries 1

View Larger

1 Current as of November 2022. This is an update of the 2010 map created by the Informal WHO Working Group on the Geographic Risk of Yellow Fever.

2 Refers to Plasmodium falciparum malaria, unless otherwise noted.

3 Tafenoquine can cause potentially life-threatening hemolysis in people with glucose-6-phosphate-dehydrogenase (G6PD) deficiency. Rule out G6PD deficiency with a quantitative laboratory test before prescribing tafenoquine to patients.

4 Mosquito avoidance includes applying topical mosquito repellant, sleeping under an insecticide-treated mosquito net, and wearing protective clothing (e.g., long pants and socks, long-sleeve shirt). For additional details on insect bite precautions, see Sec. 4, Ch. 6, Mosquitoes, Ticks & Other Arthropods.

5 Primaquine can cause potentially life-threatening hemolysis in people with G6PD deficiency. Rule out G6PD deficiency with a quantitative laboratory test before prescribing primaquine to patients.

6 P. knowlesi is a malaria species with a simian (macaque) host. Human cases have been reported from most countries in Southwest Asia and are associated with activities in forest or forest-fringe areas. P. knowlesi has no known resistance to antimalarials.

Yellow Fever Maps

2 In 2017, the Centers for Disease Control and Prevention (CDC) expanded its YF vaccination recommendations for travelers going to Brazil because of a large YF outbreak in multiple states in that country. Please refer to the CDC  Travelers’ Health website for more information and updated recommendations.

3 YF vaccination is generally not recommended for travel to areas where the potential for YF virus exposure is low. Vaccination might be considered, however, for a small subset of travelers going to these areas who are at increased risk for exposure to YF virus due to prolonged travel, heavy exposure to mosquitoes, or inability to avoid mosquito bites. Factors to consider when deciding whether to vaccinate a traveler include destination-specific and travel-associated risks for YF virus infection; individual, underlying risk factors for having a serious YF vaccine–associated adverse event; and destination entry requirements.

The following authors contributed to the previous version of this chapter: Mark D. Gershman, Emily S. Jentes, Rhett J. Stoney (Yellow Fever) Kathrine R. Tan, Paul M. Arguin (Malaria)

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