El Tigre Journeys
in the heart of the Amazon

Health and Wellness
for travelers to the Peruvian Amazon
From the CDC Travel Page
Division of Quarantine, National Center for Infectious Diseases
Centers for Disease Control and Prevention, Atlanta, Georgia U.S.A.
updated October 10, 2001


Malaria
Health Information for International Travel, 2001–2002

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 personal 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
Bolivia: Risk in areas below 2,500 meters (8,202 feet) in the following departments: Beni, Cochabamba, Chuquisaca, La Paz, Pando, Santa Cruz, and Tarija. Brazil: Risk in states of Acre, Rondonia, Amapa, Amazonas, Roraima, and Tocantins. Risk in parts of the states of Maranhao (western part), Mato Grosso (northern part), and Para (except Belem City). There is also transmission in urban areas, including large cities such as Porto Velho, Boa Vista, Macapa, Manaus, Santarem, and Maraba. The coastal states from the "horn" south to the Uruguay border, including Iguassu Falls, are not risk areas. Colombia: Risk in all rural areas below 1,600 meters (5,249 feet). No risk in Bogota and vicinity. Ecuador: risk in all areas, except no risk at altitudes higher than 1,500 meters (4,921 feet). No risk in Guayaquil, Quito, the central highland tourist areas, and the Galapagos Islands. French Guiana: Risk in all areas. Guyana: Risk in all areas of the interior. Sporadic cases have also been reported along the coastal region. Paraguay: Risk in 3 departments: Alto Parana, Caaguazu, and Canendiyu. Peru: Risk in all departments except Arequipa, Moquegua, Puno, and Tacna. Travelers who visit the city of Lima or the highland tourist areas (Cuzco, Machu Picchu, Lake Titicaca) are not at risk. Suriname: Risk exists in rural areas, except no risk in the Paramaribo District and the coastal area north of 5° N. Venezuela: Risk in rural areas of the following states: Apure, Amazonas, Barinas, Bolivar, Sucre, Tachira, and Delta Amacuro.

Prevention
Travelers to risk areas in Perú below should take one of the following drugs: mefloquine (brand name Lariam®), doxycycline, or Malarone™.

Mefloquine (brand name Lariam®)
Directions for use

Mefloquine side effects
Most travelers who take mefloquine have few, if any, side effects. The most commonly reported minor side effects include nausea, dizziness, difficulty sleeping, and vivid dreams. Mefloquine has very rarely been reported to cause serious side effects, such as seizures, hallucinations, and severe anxiety. Minor side effects usually do not require stopping the drug. Travelers who have serious side effects should see a health care provider.

Do NOT take mefloquine if you have

Alternatives for travelers who cannot or choose not to take mefloquine include doxycycline or Malarone™.

Doxycycline
Directions for use

Doxycycline side effects and warnings Do NOT take doxycycline if you are pregnant.
Do NOT give doxycycline to children under the age of 8; teeth may be permanently stained.

Alternatives for travelers who cannot or choose not to take doxycycline include mefloquine or Malarone™.

Malarone™
Malarone is a new antimalarial drug in the United States. Malarone is a combination of two drugs (atovaquone and proguanil) and is an effective alternative for travelers who cannot or choose not to take doxycycline or mefloquine.

Directions for use

Malarone Side Effects and Warnings
Although side effects are rare, abdominal pain, nausea, vomiting, and headache can occur.

Malarone should not be taken by patients with severe renal impairment.
Pregnant women or women breast-feeding infants weighing less than 11 kg (24 lbs) should not take Malarone to prevent malaria.

Chloroquine (brand name Aralen®) is the recommended drug for travelers to malaria-risk areas in:

Directions for use 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.

For additional information on malaria, please see the following:

For information about other travel health risks, precautions, and vaccination recommendations, please see Health Information for Travelers to Tropical South America.

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:

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.

For more travel health information:

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