Draft

Malaria Guidance
MV Explorer/Semester at Sea
Spring 2013 Voyage – January 9 – April 25, 2013

Malaria Prophylaxis should be considered for the countries on the itinerary with identified malaria risk.
We encourage prophylaxis with specific recommendations as follows:
Mexico – No malaria risk along the United States-Mexico border area, including Ensenada.
Hawaii – No malaria risk

Japan – No malaria risk
China - No malaria risk in Shanghai or Hong Kong. Risk only if traveling away from the ship to rural
areas noted below where prophylaxis should be considered.
Viet Nam – No malaria risk in Ho Chi Minh City. Risk only if traveling away form ship to rural areas
noted below where prophylaxis should be considered. If traveling to a risk area, begin doxycycline 100 mg.
daily each morning at the same time starting on 2/10 or 2/11 and continuing during visit and for 4 weeks
thereafter, until 3/17

Singapore – No malaria risk.
Burma (Myanmar) – No malaria risk in Rangoon (Yangon). Risk only if traveling away from ship to
rural areas noted below where prophylaxis should be considered. If already taking doxycycline and
traveling to risk areas, continue until 3/29. If not previously taking doxycycline and traveling to risk
areas, begin doxycycline 100 mg. daily each morning at the same time starting on 2/23 or 2/24 and
continue during visit and for 4 weeks thereafter, until 3/29.
India – Malaria risk in all areas, except areas > 2,000 m (6,562 ft) noted below. For those already taking
doxycycline, continue until 4/8. For those just starting, begin doxycycline 100 mg. daily each morning at
the same time starting on 3/4 or 3/5 and continuing during visit and for 4 weeks thereafter, until 4/8.

Mauritius – No malaria risk.
South Africa - No malaria risk in Cape Town area. For those already taking doxycycline and traveling to
risk areas noted below and including Kruger National Park, continue until 4/27. For those just starting
doxycycline for travel to South Africa risk areas, begin 100 mg. daily each morning at the same time
starting on 3/23 or 3/24 and continuing during visit and for 4 weeks thereafter, until 4/27.

Ghana – Malaria risk in all areas. For those already taking doxycycline, continue until 5/8. For those just
starting doxycycline for Ghana, begin doxycycline 100 mg. daily each morning at the same time starting
4/4 or 4/5 and continuing during the visit and for 4 weeks thereafter until 5/8.
Morocco – No malaria risk.

Spain – No malaria risk.
MHG Medical Consulting Services 1600 SE 17 Street, Suite 410, Fort Lauderdale, FL 33316
Regardless of use of prophylactic medication, the following general mosquito avoidance
precautions should be advised:
Avoid contact with mosquitoes as possible, especially between dusk and dawn, since malaria mosquitoes bite primarily at night. Other types of mosquitoes that transmit dengue fever and yellow fever bite primarily during the day and should also be avoided. Wear clothes that minimize exposed skin (long sleeves, long pants). Consider use of clothes treated with a permethrin-containing product. Sleep in enclosed or screened area or use permethrin treated mosquito net if in exposed area. Apply insect repellent such as DEET spray to exposed skin areas. Pyrethroid-containing insect spray can be used in living and sleeping areas especially during Alternate Prophylactic Treatment – Spring 2013
For anyone allergic to doxycycline, unusual photosensitivity, or other contraindication,
atovaquone/proguanil (Malarone) is the preferred alternate with one tablet daily beginning as noted
above, and continuing 7 days post last exposure. Mefloquine (Larium) is not recommended due to
possible psychiatric disturbance and resistance in some areas. Chloroquine is not an acceptable
alternate in any areas due to resistance.

*Guidance on the three available options for chemoprophylaxis:
Atovaquone/proguanil (Malarone)
Adult dose is one 250 mg atovaquone/100 mg proguanil fixed dose tablet beginning 1-2 days prior, daily
at same time during, and for 7 days post exposure.
Doxycycline
Adult dose is 100 mg daily, beginning 1-2 days prior, daily at same time during, and for 4 weeks post
exposure.
Mefloquine (Lariam)
Adult dose is one 228 mg base tablet beginning 1-2 weeks prior, weekly on same day during, and for 4
weeks post exposure.

*For countries on the itinerary with malaria risk:
In most areas the three options above can be considered, with exceptions noted below. There are some
limited areas of mefloquine resistance in Viet Nam, Burma, and China along the Burma border.
Ghana – All areas have risk. May use any of the three options.
South Africa – Present in Kruger National Park for which prophylaxis with any of the three options may
be used. Other areas with risk are Mpumalanga and Limpopo Provinces and NE KwaZulu-Natal south to
Tugela River. No risk in Cape Town.

India – All areas have risk except none at heights >2,000 m. (6,561 ft.) in Himchal Pradesh, Jammu and
Kashmir, and Sikkim. Present in Delhi and Bombay (Mumbai). May use any of the three options.

Viet Nam – Malaria is found in rural areas except Red River Delta and coast north of Nha Trang. Rare in
Mekong Delta. No risk in Ho Chi Minh City (Saigon). Use doxycycline or atovaquone/proguanil, since
mefloquine resistance is found in southern areas.
China – No malaria risk in Hong Kong or Shanghai. Found in some rural areas. Recommend mosquito
avoidance and consider prophylaxis for river cruises that travel in rural endemic areas. May use
any of three options except along the China-Burma border where mefloquine resistance is found.
Burma (Myanmar) –Malaria risk in rural areas throughout the country at altitudes <1000 m (<3,281
ft). None in the cities of Mandalay and Rangoon (Yangon). Use doxycycline or atovaquone/proguanil, since some mefloquine resistance in the provinces of Bago, Kachin, Kayah, Kayin, Shan, and Tanintharyi. MHG Medical Consulting Services 1600 SE 17 Street, Suite 410, Fort Lauderdale, FL 33316

Source: http://www.semesteratsea.org/wp-content/uploads/2012/08/Malaria-Guidance-Spring-2013.pdf