Malaria is an infectious disease common to tropical and subtropical countries and poses a major health risk to travellers. Although residents of malarial areas have some immunity to the disease, visitors to affected countries have no immunity to the malaria parasite and must take precautions against it.
What Countries Have Malaria?
Malaria is found in over 100 countries, placing about half the world’s population (3.3 billion people) at risk, according to the Centers for Disease Control and Prevention. Countries in Africa, Asia, Central and South America, the Caribbean, Middle East and Oceania are notably affected. Travellers to sub-Saharan Africa and parts of Oceania, where the rate of malaria transmission is high, have the greatest risk of infection.
In some countries, malaria is widespread. Other countries have only isolated 'pockets' of malaria. Your risk of becoming infected is influenced by air temperature, humidity, rainfall, altitude, population size, local malaria control efforts and seasonal variations (if it is cold or dry the risk may decrease). There may be certain times during the year when travel to certain areas is not advised.
The risk of malaria infection also depends on whether you are visiting a rural or urban area (the risk can be higher in rural areas), and whether your accommodation is in the open air or well screened with air conditioning. A long stay that includes backpacking through the jungle may pose a greater risk of disease than a short stay in an air-conditioned hotel in the same country.
The following information is correct at the time of writing (2012), but malaria risk levels can change. If you are planning a tropical holiday in the sun, visiting family abroad or taking a business trip to an unfamiliar country, check with your doctor or travel clinic to see if you need to take precautions.
African Countries with Malaria
There is a high risk of malaria throughout the following African countries:
Angola, Benin, Burkina Faso, Burundi, Cameroon, Central African Republic, Chad, Comoros, Congo, Cote d’Ivoire, Democratic Republic of the Congo, Djibouti, Equatorial Guinea, Gabon, Gambia, Ghana, Guinea, Guinea-Bissau, Liberia, Madagascar, Malawi, Mali, Mayotte, Mozambique, Niger, Nigeria, Rwanda, Sao Tome and Principe, Senegal, Sierra Leone, Somalia, South Sudan, Sudan, United Republic of Tanzania, Togo, Uganda and Zambia.
High-risk parts of Africa include:
- Botswana – northern parts
- Eritrea – entire country apart from Asmara
- Ethiopia – areas below 2,500m
- Kenya – whole country except for Nairobi and the highlands
- Mauritania – southern areas
- Namibia – northern third of the country
- South Africa – very far north eastern areas
- Swaziland – eastern regions
- Zimbabwe – Zambezi Valley and areas below 1,200m
Countries in Africa that do not have malaria include Egypt, Lesotho, Libya, Mauritius, Morocco, Reunion, Saint Helena, Seychelles, Tunisia and Western Sahara.
Countries in Central America have low or variable risk of malaria, apart from Panama, where there is a high risk of infection in eastern provinces.
With the exception of Chile, the Falkland Islands and Uruguay, all countries in South America have low, variable or high-risk malarial areas. High risk areas include:
- Bolivia – all areas below 2,500m
- Brazil – forested areas of Amazonia below 900m and some urban areas
- Colombia – rural areas below 1,700m
- Ecuador – all areas below 1,500m
- French Guiana – high risk throughout, particularly in areas bordering Brazil and Suriname
- Guyana – high risk throughout, apart from coastal areas
- Peru – north eastern areas, including Iquitos
- Suriname – most areas are high risk, but coastal areas, including Paramaribo, are not
- Venezuela – areas south of the Orinoco river
- Central Asia
The risk of malaria in Afghanistan is low at altitudes above 2,000m, but high throughout April to December in areas below 2,000m. All areas of Pakistan are high risk, apart from the Himalayas in the far north, which are low risk. There is a very small risk of malaria in areas of Kyrgyzstan that border other countries with the disease. Tajikistan has mostly low risk areas with variable risk in others. Malaria rarely occurs in Uzbekistan and there is none in Kazakhstan or Turkmenistan.
Most East Asian countries have high-risk malaria areas as well as low risk regions. High-risk areas include:
- Bangladesh – south eastern areas
- Bhutan – southern districts
- Cambodia – everywhere except areas around Tonle Sap Lake and the capital city Phnom Penh
- China – there is a risk of serious malaria in Hainan Island and Yunnan Province
- India – Assam
- Indonesia – high risk everywhere apart from areas of Bali and Java
- Laos – entire country
- Malaysia – areas in both east and west Malaysia
- Myanmar (formerly Burma) – altitudes below 1,000m
- Nepal – low-lying southern areas
- Philippines – rural areas below 600m
- Thailand – areas along some international borders and forested areas
- East Timor – high risk throughout
- Vietnam – rural areas
There is no malaria in Brunei Darussalam, Hong Kong, Japan, Macao, Maldives, Mongolia or Singapore.
Most countries in the Caribbean are malaria-free, apart from the entire country of Haiti and western areas of the Dominican Republic, which are high risk areas.
There is no malaria in Anguilla, Antigua and Barbuda, Netherlands Antilles, Bahamas, Barbados, British Virgin Islands, Cayman Islands, Cuba, Dominica, Grenada, Guadeloupe, Jamaica, Martinique, Monserrat, Puerto Rico, Saint Kitts and Nevis, Saint Lucia, Saint Vincent and the Grenadines, Trinidad and Tobago, Turks and Caicos or the US Virgin Islands.
There are high and low risk malaria areas in the Middle East. High-risk areas include:
- Iran – southern rural areas including Kerman
- Saudi Arabia – south western areas
- Yemen – areas below 2,000m
There is no malaria in Abu Dhabi, Bahrain, Dubai, Israel, Jordan, Kuwait, Lebanon, Qatar, Syria or the United Arab Emirates.
Most of Oceania is malaria free, apart from Vanuatu, the Solomon Islands and most of Papua New Guinea (areas below 1,800m), where there is a high risk of infection.
There is no malaria in American Samoa, Australia, Christmas Island, Cook Islands, Federated States of Micronesia, Fiji, French Polynesia, Guam, Kiribati, Marshall Islands, Nauru, New Caledonia, New Zealand, Niue, Northern Mariana Islands, Palau, Pitcairn, Samoa, Tasmania, Tokelau, Tonga or Tuvalu.
Mexico is the only part of North America where malaria occurs. While there is low to no risk throughout most of the country, there is variable risk in non-tourist, rural areas of Chiapas and Oaxaca.
There is no malaria in Alaska, Bermuda, Canada, Greenland, Hawaii, Maui, Oahu, Saint Pierre and Miquelon or the United States of America.
Most of Europe is malaria free, with the exception of Armenia, Azerbaijan, Georgia, Greece and Turkey, where there is low risk of disease transmission.
- Armenia – low risk throughout, but precautions are necessary in some parts of the Ararat Valley
- Azerbaijan – variable risk in rural areas below 1,500m, between the Kura and Arax rivers, low risk elsewhere
- Georgia – there is a risk of malaria transmission in the south east near the Azerbaijan border
- Greece – rare cases reported in Lakonia and some other non-tourist areas
- Turkey – variable risk in the south east
There is no malaria in Albania, Austria, Belarus, Belgium, Bosnia Herzegovina, Bulgaria, Croatia, Cyprus, Czech Republic, Denmark, Estonia, Faroe Islands, Finland, France, Germany, Gibraltar, Hungary, Iceland, Republic of Ireland, Italy, Latvia, Liechtenstein, Lithuania, Luxembourg, Portugal, Republic of Macedonia, Malta, Republic of Moldova, Monaco, Montenegro, Netherlands, Norway, Poland, Romania, Russian Federation, San Marino, Serbia, Slovakia, Slovenia, Spain, Sweden, Switzerland or the Ukraine.