Malaria Information for Travelers to Mexico and Central America

Transmission and Symptoms
Malaria is a serious disease transmitted to humans by the bite of an infected female Anopheles mosquito. Symptoms may include fever and flu-like illness, including chills, headache, muscle aches, and fatigue. Malaria may cause anemia and jaundice. P. falciparum infections, if not promptly treated, may cause kidney failure, coma, and death. Malaria can often be prevented by using antimalarial drugs and by using protection measures to prevent mosquito bites. However, in spite of all protective measures, travelers may still develop malaria.
Malaria symptoms will occur at least 7 to 9 days after being bitten by an infected mosquito. Fever in the first week of travel in a malaria-risk area is unlikely to be malaria; however, any fever should be promptly evaluated.
Travelers who become ill with a fever or flu-like illness while traveling in a malaria risk area and up to 1 year after returning home should seek prompt medical attention and should tell the physician their travel history.
Malaria Risk by Country
Belize: All, except no risk in Belize City. Costa Rica: Risk in the provinces of Alajuela, Limon, Guanacaste, and Heredia. No risk in Limon City. El Salvador: Rural areas of the departments of Santa Ana, Ahuachapan, and La Union. Guatemala: Rural only, except no risk at altitudes higher than 1,500 meters (4,921 feet). Honduras: Rural areas only, including Roatan and other Bay Islands. Mexico: Risk in all rural areas, including resorts in the rural areas, of the following states: Campeche, Chiapas, Guerrero, Michoacan, Nayarit, Oaxaca, Quintana Roo, Sinaloa, and Tabasco. In addition, risk exists in Jalisco State (in its mountainous northern area only). Risk also exists in an area between 24° north and 28° north latitude and 106° west and 110° west longitude. This area is rarely visited by tourists and includes parts of the states of Sonora, Chihuahua, and Durango. No malaria risk along the United States-Mexico border. No malaria risk in the major resorts along the Pacific and Gulf coasts, although tourists should use insect repellent and other anti-mosquito measures. Nicaragua: Rural areas only; however, risk exists in the outskirts of Managua. Panama: Risk in rural areas of three provinces: Bocas del Toro, Darien, and San Blas. No risk in Panama City or in the former Canal Zone.
Chloroquine (brand name Aralen®) is the recommended drug for most travelers to risk areas in

* Belize 
* Costa Rica
* El Salvador
* Guatemala
* Honduras
* Mexico
* Nicaragua
* Panama, in the Bocas del Toro Province (other provinces, see below)

Directions for use

* The adult dosage is 500 mg (salt) chloroquine phosphate once a week.
* Take the first dose of chloroquine 1 week before arrival in the malaria-risk area.
* Take chloroquine once a week, on the same day of the week, while in the malaria-risk area.
* Take chloroquine once a week for 4 weeks after leaving the malaria-risk area.
* Chloroquine should be taken on a full stomach to lessen nausea.

Chloroquine side effects
Although side effects are rare, nausea and vomiting, headache, dizziness, blurred vision, and itching can occur. Chloroquine may worsen the symptoms of psoriasis.
Travelers to the Darien and San Blas provinces, including the San Blas Islands, of Panama should take one of the following antimalarials: mefloquine (Lariam®), doxycycline, or Malarone™.
Mefloquine (brand name Lariam®)

Preventing Insect Bites
Protect yourself from mosquito bites. Prevent mosquito bites by wearing long-sleeved shirts and long pants; apply insect repellent to exposed skin. Mosquitoes that transmit malaria bite between dusk and dawn. Use insect repellents that contain DEET.
When using repellent with DEET, follow these precautions:

* Always use according to label directions.
* Use only when outdoors and wash skin after coming indoors.
* Do not breathe in, swallow, or get into the eyes.
* Do not put on wounds or broken skin.
* Use a concentration of 30% to 35%.

Travelers who will not be staying in well-screened or air-conditioned rooms should use a pyrethroid-containing flying-insect spray in living and sleeping areas during evening and nighttime hours. In addition, travelers should take additional precautions, including sleeping under mosquito netting (bed nets). Bed nets sprayed with the insecticide permethrin are more effective. In the United States, permethrin is available as a spray or liquid to treat clothes and bed nets. Bed nets may be purchased that have already been treated with permethrin. Permethrin or another insecticide, deltamethrin, may be purchased overseas to treat nets and clothes.
Lan Sluder/Belize First