1. Areas below 1800m (high risk) and Zanzibar:
Recommended adult regimen:
Mefloquine 250mg weekly. Begin 2-3 weeks before travel to affected area and continue for four weeks after leaving.
Doxycycline 100mg daily. Begin one to two days before travel to affected area and continue for four weeks after leaving.
Atovaquone 250mg plus proguanil 100mg daily (Malarone). Begin one to two days before travel to affected area and continue for seven days after leaving.
Healthcare professionals only may check with the National Travel Health Network and Centre (NaTHNaC) on 0845 6026712 (Mon, Fri, 9.00-11.00am & 1.00-2.00pm; Tue, Wed, Thur, 9.00-11.00am & 1.00-3.30pm; closed on Bank Holidays).
2. Areas >1800m
There is no risk of malaria. Advise mosquito bite avoidance.
Travellers should be up to date with routinely recommended vaccinations according to the routine UK immunisation programme.
Vaccination recommended for travellers whose activities put them at increased risk, including those visiting friends and relatives, those in contact with an infected person, young children, long-stay travellers, and those visiting areas of poor sanitation.
Vaccination recommended for all previously unvaccinated travellers. Hepatitis A vaccine is well tolerated and affords long-lasting protection.
Vaccination recommended for travellers whose activities or medical history put them at increased risk, including those who may have unprotected sex, those who may be exposed to contaminated needles (eg, through injecting drug use or receiving medical or dental care), those who may be exposed to blood or body fluids through their work (eg, health workers), long-stay travellers, those who are participating in contact sports and families adopting children from this country.
Vaccination recommended for travellers whose activities or medical condition put them at increased risk, including healthcare workers, travellers visiting friends and relatives, those who live or travel 'rough' such as backpackers, long-stay travellers who have close contact with the local population, those with complement disorders and those who do not have a functioning spleen.
Vaccination recommended for travellers whose activities put them at increased risk, including those at risk due to their work (eg, health workers or those working with animals), those travelling to areas where access to post-exposure treatment and medical care is limited, those planning higher risk activities such as running or cycling, and long-stay travellers.
Vaccination recommended for travellers whose activities or medical history put them at increased risk, including aid workers and travellers those going to areas of cholera outbreaks who have limited access to safe water and medical care.
Vaccination is generally not recommended but could be considered for a small subset of travellers (aged over 9 months) who are at increased risk because of:
- Prolonged travel
- Heavy exposure to mosquito bites
- Inability to avoid insect bites.
International Certificate of Vaccination or Prophylaxis (ICVP) required if arriving from a country with a risk of yellow fever transmission or having transited for more than 12 hours through an airport of a risk country.
- applies to travellers from 12 months of age.
If a receiving country requires an ICVP as a condition of entry, and the individual should not receive the vaccine on medical grounds, a letter of medical exemption can be considered.
Travellers should have completed a primary vaccination course according to the UK schedule. If travelling to a country where medical facilities may be limited, a booster dose of a tetanus-containing vaccine is recommended if the last dose was more than ten years ago even if five doses of vaccine have been given previously.
Vaccination recommended for travellers at increased risk of developing severe disease and/or of exposure to TB, including unvaccinated children under 16 years of age who are going to live for more than 3 months in this country and unvaccinated, tuberculin skin test negative individuals under 35 years of age at risk because of their work (eg, healthcare workers, prison staff and vets).