Risk of multi-drug-resistant malaria is high throughout the states of the Amazon Basin, including cities and towns (main cities in brackets): Acre (Rio Branco), Amapá (Macapá), Amazonas (Manaus), the northwestern part of Maranhão (outskirts of São Luís), northern part of Mato Grosso (outskirts of Cuiabá), Pará (outskirts of Belém, Marabá, and Santarém), Rondônia (Porto Velho), Roraima (Boa Vista), and the western part of Tocantins.
High malaria transmission occurs along the trans-Amazon highway, the highway from Santarém to Cuiabá and in the valleys of the Araguaia, Xingu, Jamanxim and Tapajos rivers. Localized malaria outbreaks due to migration from the Amazon region have been reported in other parts of Brazil. Risk is also present in some rural, forested areas of the states of Bahia, Espirito Santo, Minas Gerais, Rio de Janeiro, and São Paulo.
Note: Persons on cruises on the Amazon and its tributaries, or travelling overland throughout the Amazon Basin, must follow antimalarial medication guidelines. There is no malaria transmission at Iguazú Falls.
Risk is present in the country; areas of risk are specified:
High risk months for Malaria are: January to December
Incidence of Plasmodium falciparum Malaria: 11%
Areas with drug resistant Malaria: Multidrug resistant P. falciparum malaria is present in all malarious areas of Brazil. Chloroquine resistant P. vivax malaria has also been reported. The antimalarial medications listed below are effective for this country.
All malaria infections are serious illnesses and must be treated as a medical emergency. In offering guidance on the choice of antimalarial drugs, the main concern is to provide protection against Plasmodium falciparum malaria, the most dangerous and often fatal form of the illness.
Regardless of the medication which has been taken, it is of utmost importance for travellers and their physician to consider fever and flu-like symptoms appearing 7 days up to several months after leaving a malarious area as a malaria breakthrough. Early diagnosis is essential for successful treatment.
In addition to the suggested antimalarial medication, use a mosquito bed net and effective repellents to avoid the bite of the nocturnal Anopheles mosquito.
Brand names: Malarone, Malanil and others; generics available.
TAKE 1 TABLET DAILY (ATOVAQUONE 250 mg + PROGUANIL 100 mg).
START 1-2 DAYS BEFORE ENTERING THE MALARIOUS AREA, CONTINUE DAILY DURING YOUR STAY AND CONTINUE FOR 7 DAYS AFTER LEAVING.
Note: Take at the same time every day with food or milk.
Brand names: Vibramycin and others; generics available.
TAKE 1 TABLET DAILY OF 100 mg.
START 1 DAY BEFORE ENTERING MALARIOUS AREA, CONTINUE DAILY DURING YOUR STAY AND CONTINUE FOR 4 WEEKS AFTER LEAVING.
Note: When taking this drug, avoid exposure to direct sunlight and use sunscreen with protection against long range ultraviolet radiation (UVA) to minimize risk of photosensitive reaction. Take with large amounts of water to prevent esophageal and stomach irritation.
Brand names: Lariam, Mephaquin, Mefliam and others; generics available.
TAKE 1 TABLET OF 250 mg (228 mg base) ONCE A WEEK.
START 1-2 WEEKS BEFORE ENTERING THE MALARIOUS AREA, CONTINUE WEEKLY DURING YOUR STAY AND CONTINUE FOR 4 WEEKS AFTER LEAVING.
Note: Side effects include nausea and headache, including neurological side effects such as dizziness, ringing of the ears, and loss of balance. Psychiatric side effects include anxiety, depression, mistrustfulness, and hallucinations. Neurological side effects can occur any time during use and can last for long periods of time or become permanent even after the drug is stopped. Seek medical advice if any neurological or psychiatric side effects occur.