The following recommendations to protect travelers from malaria were developed by 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, such as the International Society of Travel Medicine; CDC overseas staff; US military; academic, research, and aid organizations; and published records from the medical 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 such as natural disasters, wars, and other events that may 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. Based on all those considerations, recommendations are developed to try to accurately describe areas of the country where transmission occurs, substantial occurrences of antimalarial drug resistance, the proportions of species present, and the recommended prophylaxis options.
These recommendations should be used in conjunction with an individual risk assessment, taking into account not only the destination country but also the detailed itinerary including specific cities, types of accommodation, season, and style of travel, as well as special health conditions such as pregnancy.
Several medications are available for malaria prophylaxis. When deciding which drug to use, clinicians should consider the specific itinerary, length of trip, drug costs, previous adverse reactions to anti-malaria, drug allergies, and medical history.
For a thorough discussion of malaria and guidance for prophylaxis, see Chapter 4, Malaria.