A number of international travellers die from malaria every year because:
- they were not aware of, or underestimated, the danger of contracting malaria abroad
- the disease, especially malignant tertian (falciparum) malaria, can simulate various diseases, and diagnosis and adequate treatment are delayed;
- they did not tell their doctor that they had recently been to a tropical country.
In many malarias countries the main towns are often free of the disease, although this is not necessarily true of their outskirts. There is usually much less risk of malaria at altitudes greater than 1500m, but the disease can occur in certain climatic conditions as high as 3000m or above. The degree of risk of infection also may vary with the season of the year.
If there is any doubt about the need to take preventive measures against malaria, a precautionary attitude should be adopted and the traveller should be advised to comply with the recommendations.
There are three things travellers should always do:
- inquire beforehand about malaria risk and prophylactic measures appropriate for the specific area they wish to visit (physician health authorities, specialized institutions, travel agents, airline offices etc.);
- protect themselves against mosquito bites (as described below);
- be aware that in spite of all their precautions they may still contract malaria.
- Mosquito bites. This should constitute the traveller's first line of defence against malaria. Travellers can protect themselves quite effectively against insect bites and in this way prevent infection; sufficiently thick long-sleeved clothing when outdoors after sunset avoiding dark colours; insect repellent on the parts of skin remaining exposed (repellent should include either N, N-diethyl-M-toluamide (deet) or dimethyl phthalate; properly screened rooms (air-conditioned); anti-mosquito spray; sleeping under mosquito net (increased protection by impregnating with permethrin or deltamethrin); plug-in insecticide dispensers; burning mosquito coils
- Although chemoprophylaxis National advisory bodies differ in their specific recommendations. The advice given here reflects the current opinion of the WHO malaria action programme with due consideration given to varying experts views; it is not intended to supplant the advice of national authorities. The traveller should consult his or her physician, who will advise on the appropriate prophylactic drug and its dosage. In Timatic, the recommended type of prevention is referred to as :
- Type I (very limited risk of malaria transmission) - Mosquito bite prevention only.
- Type II (risk of P. vivax malaria or fully chloroquine-sensitive P. Falciparum only) Mosquito bite prevention plus chloroquine chemoprophylaxis.
- Type III (risk of malaria transmission and memerging chloroquine resistance) Mosquito bite prevention plus chloroquine+proguanil chemoprophylaxis.
- Type IV (high risk of falciparum malaria plus drug resistance, or moderate/low risk falciparum malaria but high drug resistance) Mosquito bite prevention plus either mefloquine, doxycycline or atovaquone/proguanil (take one that no resistance is reported for in the specific areas to be visited).
No prophylactic regimen is 100% protective against infection, but even if it fails to prevent the disease it may, nevertheless, render the infection milder and less life threatening.
A disease starting less than seven days after the first exposure is most probably not malaria. As the most important survival factor in persons with malignant malaria is early diagnosis and treatment, a traveller who develops fever seven days or more after the first possible exposure to malaria should seek prompt medical attention. Malaria should be considered in all unexplained fevers in travellers who have been exposed. There are situations in which no safe and effective phophylactic drug regimen is available, and the traveller will have to rely on protection against mosquito bites, prompt medical attention, and perhaps self-treatment.
Areas with malaria risk
The presence of malaria risk in a tropical or subtropical country is indicated on the country sections under Health. The existing malaria form: malignant (p.falciparum) or benign (p.vivax), as well as resistance of the falciparum parasite to chloroquine or sulfadoxine/pyrimethamine are also stated. The information given is taken from the WHO International Travel and Health 2005 edition. For those advising travellers, this booklet is available from WHO, Distribution and Sales, CH 1211, Geneva 27. This booklet also covers health hazards other than malaria to which travellers may be exposed and indicates the areas in which these are most likely to occur and recommends certain precautions which the wise traveller should take when visiting unfamiliar places.
- In order to avoid difficulties with customs or security authorities, those using medicines (especially if drugs contain or have been derived from opium) are advised to hold a medical attestation (preferably in English)
- Merchant Seamen
- Merchant Seamen may be holders of a document adopted by the ILO member states (ILO = International Labour Organization:
- The Seafarer's National Identity Document issued pursuant to ILO Convention 108 (see separate ILO section)
- Seaman Book issued pursuant to ILO Convention 22 (see separate ILO section)
The Seafarer's National Identity Document/Seaman Book, stating identity of holder, is accepted in lieu of a passport if this is stated under the "Passport" section of the country(ies) concerned.
Seamen must travel on duty and a hold Letter of Guarantee from their shipping company. The Letter of Guarantee should state the following: full name of seaman, date/place/country of birth, and in case of joining ship: name of ship, sailing date of ship, statement that seaman is a crew member of that ship; or - in case of disembarking ship, statement that seaman is proceeding to airport for e.g. repatriation and holds tickets with reserved seats and all documents required for country of destination.
Note: If no information exists on merchant seamen, the normal (transit) visa regulations apply.
- Some countries accept military identity documents as passport-replacing documents, whether issued to military and civilian personnel, other staff or family members.
Additionally, specific requirements may be applicable depending on the service, such as, holder must:
- be travelling on duty;
- wear uniform;
- hold additional leave/travel/move orders, etc.
- Minors are not allowed to travel on a passport in which they are registered if they are not accompanied by the holder(s) of that passport.
Minors must also comply with the regulations for entrance in, transit through and departure from a country.
When their names are registered in, and they travel on the passport of (one of) their parents or guardians, the (transit) visas or other endorsements in that passport must indicate that they are also valid for the child(ren) travelling on that passport.
Children not being of same nationality as their parents should carry their own passport and corresponding visas.
Passport, Visa , Health Glossary
The used terms of this website explained