Malaria Prevention

  • Joseph Torresi
  • Sarah McGuinness
  • Karin Leder
  • Daniel O’Brien
  • Tilman Ruff
  • Mike Starr
  • Katherine Gibney


Malaria, a potentially life-threatening parasitic infection transmitted by mosquitoes, continues to be a major global health problem. Malaria remains the most common cause of fever in returned travellers, with an estimated 10,000 cases of travel-associated malaria occuring globally every year. Young children, pregnant women and asplenic individuals are particularly vulnerable to severe malaria, and malaria acquisition is more common among visiting friends and relatives (VFR) travellers, long-term travellers and expatriates. In this chapter, we discuss the global epidemiology of malaria and preventive measures that can be employed to reduce the risk of malaria acquisition by travellers. We include detail on the drugs available for malaria chemoprophylaxis and the different preventive strategies that can be employed, and we provide advice on how to choose the appropriate strategy and drug for the individual traveller.

Key Reading

  1. American Academy of Pediatrics. Follow safety precautions when using DEET on children. <> updated June 2003. Accessed May 2011.
  2. Antibiotic Writing Group. Therapeutic guidelines: antibiotic. 15th ed. Melbourne: Therapeutic Guidelines Ltd; 2014.Google Scholar
  3. Baird JK. Tafenoquine for travelers’ malaria: evidence, rationale and recommendations. J Travel Med. 2018;25(1):1–13.CrossRefGoogle Scholar
  4. Baird JK, Lacy MD, Basri H, Barcus MJ, et al. Randomized, parallel placebo-controlled trial of primaquine for malaria prophylaxis in Papua, Indonesia. Clin Infect Dis. 2001;33:1990–7.CrossRefGoogle Scholar
  5. Bannister B, Hatz C, Toovey S, Price R, Zuckerman JN. The role of standby emergency medication for falciparum malaria: current opinion. Trav Med Infect Dis March. 2004;2:119–26.CrossRefGoogle Scholar
  6. Berman J. Toxicity of commonly-used antimalarial drugs. Travel Med Infect Dis. 2004;2:171–84.CrossRefGoogle Scholar
  7. Boubaker R, Herard Fossati A, Meige P, Mialet C, Ngarambe Buffat C, Rochat J, et al. Malaria prevention strategies and recommendations, from chemoprophylaxis to stand-by emergency treatment: a 10-year prospective study in a Swiss Travel Clinic. J Travel Med. 2017;24(5)Google Scholar
  8. Centers for Disease Control and Prevention (CDC). Travelers’ Health Yellow Book. <>.
  9. Chen LH, Wilson ME, Schlagenhauf P. Controversies and misconceptions in malaria chemoprophylaxis for travelers. JAMA. 2007;297:2251–63.CrossRefGoogle Scholar
  10. Chiodini P, Patel D, Whitty C. Lalloo D on behalf of the Public Health England Advisory Committee for Malaria Prevention for UK Travellers (ACMP). Guidelines for malaria prevention in travellers from the United Kingdom 2017. London: Public Health England; 2017. Accessed 6 Aug 2018.Google Scholar
  11. Chu CS, Freedman DO. Tafenoquine and G6PD: a primer for clinicians. J Travel Med. 2019;26(4).Google Scholar
  12. Croft AM. Malaria: prevention in travelers (non-drug interventions). BMJ Clin Evid. 2014;11:903.Google Scholar
  13. Deye GA, Miller RS, Miller L, Salas CJ, Tosh D, Macareo L, et al. Prolonged protection provided by a single dose of atovaquone-proguanil for the chemoprophylaxis of Plasmodium falciparum malaria in a human challenge model. Clin Infect Dis. 2012;54(2):232–9.CrossRefGoogle Scholar
  14. Dow GS, Liu J, Lin G, Hetzell B, Thieling S, McCarthy WF, et al. Summary of anti-malarial prophylactic efficacy of tafenoquine from three placebo-controlled studies of residents of malaria-endemic countries. Malar J. 2015;14:473.CrossRefGoogle Scholar
  15. Dow GS, McCarthy WF, Reid M, Smith B, Tang D, Shanks GD. A retrospective analysis of the protective efficacy of tafenoquine and mefloquine as prophylactic anti-malarials in non-immune individuals during deployment to a malaria-endemic area. Malar J. 2014;13:49.CrossRefGoogle Scholar
  16. Elliott JH, O’Brien D, Leder K, Kitchener S, et al. Imported Plasmodium vivax malaria: demographic and clinical features in non-immune travelers. J Travel Med. 2004;11:213–9.CrossRefGoogle Scholar
  17. Freedman DO. Malaria prevention in short-term travelers. New Engl J Med. 2008;359:603–12.CrossRefGoogle Scholar
  18. Gaillard T, Madamet M, Pradines B. Tetracyclines in malaria. Malar J. 2015;14:445.CrossRefGoogle Scholar
  19. Genton B, D’Acremont V. Malaria prevention in travelers. Infect Dis Clin North Am. 2012;26(3):637–54.CrossRefGoogle Scholar
  20. Goodyer LI, Croft AM, Frances SP, Hill N, Moore SJ, Onyango SP, et al. Expert review of the evidence base for arthropod bite avoidance. J Travel Med. 2010;17(3):182–92.CrossRefGoogle Scholar
  21. Hill DR, Baird JK, Parise ME, Lewis LS, et al. Primaquine: report from CDC expert meeting on malaria chemoprophylaxis. Am J Trop Med Hyg. 2006;75:402–15.CrossRefGoogle Scholar
  22. Krause G, Schöneberg I, Altmann D, Stark K. Chemoprophylaxis and malaria death rates. Emerg Infect Dis. 2006;12:447–51.CrossRefGoogle Scholar
  23. Lange WR, Frankenfield DL, Moriarty-Sheehan M, Contoreggi CS, Frame JD. No evidence for chloroquine-associated retinopathy among missionaries on long-term malaria chemoprophylaxis. Am J Trop Med Hyg. 1994;51(4):389–92.CrossRefGoogle Scholar
  24. Lachish T, Bar-Meir M, Eisenberg N, Schwartz E. Effectiveness of twice a week prophylaxis with atovaquone–proguanil (malarone) in long-term travellers to West Africa. J Travel Med. 2016;23(6):1–5.CrossRefGoogle Scholar
  25. Leder K, Torresi J, Libman MD, Cramer JP, et al. GeoSentinel surveillance of illness in returned travelers. Ann Intern Med. 2013;158:456–68.CrossRefGoogle Scholar
  26. Leder K, Black J, O’Brien D, Greenwood Z, et al. Malaria in travelers: a review of the GeoSentinel Surveillance Network. Clin Infect Dis. 2004;39:1104–12.CrossRefGoogle Scholar
  27. Lobel HO, Miani M, Eng T, Bernard KW, et al. Long-term malaria prophylaxis with weekly mefloquine. Lancet. 1993;341:848–51.CrossRefGoogle Scholar
  28. Luthi B, Schlagenhauf P. Risk factors associated with malaria deaths in travellers: a literature review. Travel Med Infect Dis. 2015;13(1):48–60.CrossRefGoogle Scholar
  29. McGready R, Ashley EA, Nosten F. Malaria and the pregnant traveller. Travel Med Infect Dis. 2004;2:127–42.CrossRefGoogle Scholar
  30. Murray CK, Gasser RA, Magill AJ, Miller RS. Update on rapid diagnostic testing for malaria. Clin Microbiol Rev. 2008;21(1):97–110.CrossRefGoogle Scholar
  31. Mueller I, Galinski MR, Baird JK, Carlton JM, et al. Key gaps in the knowledge of Plasmodium vivax, a neglected human malaria parasite. Lancet Infect Dis. 2009;9(9):555–66.CrossRefGoogle Scholar
  32. Pavli A, Maltezou HC. Malaria and travellers visiting friends and relatives. Travel Med Infect Dis. 2010;8:161–8.CrossRefGoogle Scholar
  33. Robinson P, Jenney AW, Tachado M, Yung A, et al. Imported malaria treated in Melbourne, Australia: epidemiology and clinical features in 246 patients. J Travel Med. 2001;8:76–81.CrossRefGoogle Scholar
  34. Schlagenhauf P, Petersen E. Malaria chemoprophylaxis: strategies for risk groups. Clin Microbiol Rev. 2008;21(3):466–72.CrossRefGoogle Scholar
  35. Staines HM, Burrow R, Teo BH et al. Clinical implications of Plasmodium resistance to atovaquone/proguanil: a systematic review and meta-analysis. J Antimicrob Chemother. 2017. [Epub ahead of print].Google Scholar
  36. Stanczyk NM, Behrens RH, Chen-Hussey V, et al. Mosquito repellents for travellers. BMJ. 2015;350:h99.CrossRefGoogle Scholar
  37. Tan KR, Magill AJ, Parise ME, Arguin PM. Doxycycline for malaria chemoprophylaxis and treatment: report from the CDC expert meeting on malaria chemoprophylaxis. Am J Trop Med Hyg. 2011;84(4):517–31.CrossRefGoogle Scholar
  38. The Royal Children’s Hospital Melbourne. Insect repellents—guidelines for safe use. Updated May 2018. 2018. Accessed 11 July 2018.
  39. Wittes R, Saginur R. Adverse reaction to mefloquine associated with ethanol ingestion. Can Med Assoc J. 1995;152:515–7.Google Scholar
  40. World Health Organization. WHO International Travel and Health.; for country list <>.
  41. World Health Organization (WHO). World malaria report 2017. Geneva: World Health Organization. License: CC BY-NC-SA 3.0 IGO. Accessed 11 July 2018.

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • Joseph Torresi
    • 1
    • 2
    • 3
    • 4
  • Sarah McGuinness
    • 5
    • 6
  • Karin Leder
    • 7
    • 8
  • Daniel O’Brien
    • 9
    • 10
  • Tilman Ruff
    • 11
    • 12
  • Mike Starr
    • 13
  • Katherine Gibney
    • 14
  1. 1.Professor of Medicine, Infectious Diseases Physician University of Melbourne, Department of Microbiology and ImmunologyThe Peter Doherty Institute for Infection and Immunity, The University of MelbourneMelbourneAustralia
  2. 2.Knox Private HospitalMelbourneAustralia
  3. 3.Epworth Eastern HospitalMelbourneAustralia
  4. 4.Austin HospitalMelbourneAustralia
  5. 5.Infectious Diseases Physician, Department of Infectious DiseasesThe Alfred Hospital and Monash UniversityMelbourneAustralia
  6. 6.Lecturer, Infectious Disease Epidemiology UnitSchool of Public Health and Preventive Medicine, Monash UniversityMelbourneAustralia
  7. 7.Professor of Medicine, Infectious Diseases Physician, Head of Infectious Disease EpidemiologySchool of Public Health and Preventive Medicine, Monash UniversityMelbourneAustralia
  8. 8.Head of Travel Medicine and Immigrant Health, Victorian Infectious Disease ServiceRoyal Melbourne Hospital Peter Doherty, Institute for Infection and ImmunityMelbourneAustralia
  9. 9.Associate Professor, Victorian Infectious Diseases ServiceRoyal Melbourne HospitalMelbourneAustralia
  10. 10.Department of Infectious DiseasesUniversity Hospital GeelongGeelongAustralia
  11. 11.Associate Professor, Nossal Institute for Global HealthSchool of Population and Global Health, The University of MelbourneMelbourneAustralia
  12. 12.International Medical Advisor, Australian Red Cross (1996–2019)Founding Head of Travel Medicine at Fairfield and Royal Melbourne HospitalsMelbourneAustralia
  13. 13.Paediatrician, Infectious Diseases Physician, Consultant in Emergency Medicine, Director of Paediatric Education, Royal Children’s Hospital Melbourne, Honorary Clinical Associate Professor, University of MelbourneMelbourneAustralia
  14. 14.Infectious Diseases Physician, Public Health Physician and Senior Research FellowThe Austin Hospital, The Royal Melbourne Hospital, and The University of Melbourne, at The Peter Doherty Institute for Infection and ImmunityMelbourneAustralia

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