When it comes to travel in Southeast Asia, few things are as divisive as whether you should take malaria tablets. Of course, everyone wants to stay safe but with nasty side effects resulting from some of the prescribed drugs, many travellers argue that the negatives of the medication far outweigh the risk of contracting malaria.
I know you’ve already trawled Google and are just looking for a simple yes or no answer. Sadly though, the issue is far too complicated for black and white. It depends on where exactly that you are going and how long for. (Not to mention, how you weigh up the risks versus the costs!) There is a lot to consider. Don’t worry though, we are going to help you!
We here at South East Asia Backpacker have compiled our years of travel experience and reached out to the valued members of our community to bring you the most comprehensive answer to the million-dollar question. But first, let’s dive into a bit more about malaria, including what it is and where it is found.
So what actually is malaria?
Trust me when I say, you don’t want to get malaria. Just ask this girl. The CDC defines malaria as ‘a serious and sometimes fatal disease caused by a parasite that commonly infects a certain type of mosquito which feeds on humans’. Somewhat scarily, you only need to be bitten once to contract the disease!
Symptoms of malaria
As well as being potentially fatal, malaria comes with all sorts of horrible symptoms. They include:
- Fever of 38C or above
- Muscle pain
- Feeling hot
How is it spread?
Okay, so we know that malaria is spread by infected mosquitos. But how do these mosquitos get infected in the first place? Malaria is caused by a kind of parasite which lives inside the mosquito. It is this parasite that causes malaria disease.
Malaria is not a contagious disease and cannot be spread from person to person. It is mainly spread by the female mosquitos which usually bite in the evenings and at night. When you are bitten by an infected mosquito, the parasite passes into your bloodstream, causing malaria.
What areas in Southeast Asia are affected by malaria?
It is important that you know that malaria is not present everywhere across Southeast Asia. Depending on which areas you visit, you may not be advised to take antimalarials. However, there are areas across Southeast Asia where you could be at risk of contracting malaria. In order to decide whether you need to take malaria tablets, we strongly recommend you go to a health professional and advise them of your travel plans. They will be able to tell you exactly where there is malaria risk at that point in time.
There is also a lot of information regarding specific destinations online. To see an up to date and detailed map of malaria risk areas for your country of choice, we recommend the Fit for Travel destinations page, which we used to help us write this guide and create the map below.
Southeast Asia Malaria Map
Below is a map of Southeast Asia showing areas that are low risk (where anti-malarials are not usually advised) and areas that are medium to high risk (where anti-malarials are usually advised for ALL travellers.)
Please note, travellers who are deemed ‘higher risk’* may need to take anti-malarials in low risk areas too. Travellers considered to be at higher risk include those visiting rural areas longer-term or those with pre-existing medical conditions. We advise that you discuss with a medical professional to determine if you may be considered higher risk.
Disclaimer – This map was put together by the Southeast Asia Backpacker Team (not health professionals) and is meant as a rough guide only to help travellers to see at a glance where they may need to investigate the risk of malaria further. We advise that you check the Fit for Travel website for up to date information and discuss your specific travel plans with a medical professional.
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Country by Country Guide to Malaria in Southeast Asia
Below we have tried to highlight some of the most popular destinations for travellers to Southeast Asia and whether or not you are at risk of malaria in these places.
Much of Cambodia is classed as low risk for malaria. Anti-malaria tablets could be recommended for certain travellers who are considered to be at a higher risk*. However, In the northeast of the country, in areas such as Stung Treng and Senmonorom, antimalarials are advised. There is no risk in Phnom Penh, Siem Reap or around Tonlé Sap Lake. Other traveller favourites such as Kampot, Kep, Koh Rong and the islands are also considered no risk areas.
There is a malaria risk present throughout the year around most of the country. As you would expect, the risk is higher in rural areas including East Bus Tengarra (including Komodo Island), North Maluku, Maluku, Papua and West Papua. Popular traveller hotspot Flores is classed as a high risk area and travellers are advised to use antimalarials there.
Only travellers considered high risk* will usually be advised to take antimalarials for the following areas: Jambo, Bengkulu, North Sumatra, West Nusa Tenggara, Lombok, South East and North Sulawesi. This is also the case for Indonesian Borneo, for example, Kalimantan. In the main cities, urban areas and the tourist resorts, there is low to no risk. This includes Bali, Java and the Jakarta municipality.
Antimalarials are recommended in the south of the country, in areas such as Pakse, Salavan and Champasak, as well as the backpacker favourite; 4000 islands.Vientiane, Xam Nua and Ban Houayxay present no risk of malaria. The rest of the country, including Luang Prabang, is low risk, however, travellers who are considered to be at a higher risk* could be recommended antimalarials.
West Malaysia presents low to no risk. This includes places like Kuala Lumpur, Penang and Malacca. Travellers to the East, for example, Sabah and Sarawak, may be required to take antimalarials if they are deemed at higher risk*.
Antimalarial tablets are recommended for travellers visiting the north-west of the country, e.g. Myitkyina and Hakha. They are also recommended for visitors to the south, e.g. Dawei. Mandalay and Yangon currently present no malaria risk. In the rest of the country, antimalarials are advised for travellers at higher risk*.
Malaria risk throughout the year is low, especially in areas below 600 m. Risk is higher in areas such as Palawan and Tawi Tawi, although antimalarials are still not usually advised for most travellers. Only those deemed to be at higher risk* could be advised to take anti-malaria tablets.
Anti-malarial tablets are not advised for travellers heading to Singapore.
Thailand is generally low risk and therefore antimalarials do not need to be taken in most of the country. However, there are a few hotspots that travellers should be aware of. Malaria risk is found mainly towards the international borders, along parts of the southern border with Malaysia and especially along the border with Myanmar. There is low to no risk in pretty much all of the tourist areas and main cities including, Bangkok, Koh Samui, Chiang Mai, Chiang Rai and Phuket.
The whole of Vietnam is considered low risk to no risk for malaria. Places which have no risk of malaria include Hanoi, Mekong Delta, Ho Chi Minh City and Phu Quoc Island. Antimalarials are not advised for travellers heading to these areas. Other areas such as Dar Nong, Gi Lai and Kon Tum are also low risk but anti-malaria pills could be advised for travellers considered to be at higher risk*.
But what if I don’t know where I am going?!
It is the classic backpacker catch 22. The reason so many of us love backpacking is the ability to travel without fixed plans. However, the lack of schedule can act as a severe roadblock for travellers trying to organise their trips.
If you don’t know where you are going to visit, it can be hard to determine whether you will need to take anti-malaria medication. Generally, if you stick to the tourist areas (the beach towns and the cities), you probably won’t need to take antimalarials. However, if you decide to go to a high risk area or somewhere off the beaten track with poor medical access, it is better to have some just in case.
Different kinds of malaria tablets
Now you’ve determined where you are going to visit, it is time to consider the different range of malaria tablets available. Sadly, there is no ‘one size fits all’ kind of tablet so you will need to discuss the best choice for you with your doctor or medical advisor. There are four types of antimalarials that are readily available:
- Atovaquone/Proguanil (commonly sold under the name of Malarone)
Possible side-effects: nausea, vomiting, abdominal pain, headache, diarrhoea, loss of appetite, dizziness, itching, upset stomach, unusual dreams, sleeping problems.
“My friend and I are on Malarone. I’ve been fine but she started having really messed up dreams so has stopped taking them except in high risk areas. We did a tour when we first came out and most people the tour we’re having messed up dreams. I am on other medication which has a side effect of making me sleep so that’s probably why I’m fine.” – Jess.
- Chloroquine (commonly sold under the name of Avloclor)
Possible side-effects: nausea, vomiting, abdominal pain, headache, diarrhoea, loss of hair colour, itching, dizziness, skin rashes.
Possible side-effects: loss of appetite, rash, sensitivity to the sun (you will burn very easily!), hives, nausea, vomiting, temporary discolouring of teeth.
“I used Doxy without any problems. After looking at the potential side effects of Malarone and Mefloquine and getting advice from a doctor qualified in tropical medicine, I opted for Doxy.” – Heather.
“If you take Doxy, be so careful in the sun! That’s what I used in parts of Asia.” – Emma
- Mefloquine (commonly sold under the brand name of Lariam)
Possible side-effects: headaches, ringing in your ears, problems with coordination, loss of balance, anxiety, depression, hallucinations, confusion.
Standby Emergency Antimalarials You could be advised to take emergency antimalarials on your trip. These are usually prescribed if there is a risk of you becoming infected with the disease in a remote area with little or no access to medical care. If at any point you do need to take your standby emergency antimalarials, you will still need to seek medical attention as soon as possible to ensure that your treatment has been effective. There are also a few key things you should know about antimalarials:
- They do not protect you from catching malaria. They do, however, stop the symptoms from developing and the infection from taking hold. Despite this, they are never 100% effective and you will still need to seek medical attention if you think you have contracted the disease. Malaria nearly always begins with a fever.
- Preventative antimalarials come with a strict schedule. Usually, you will need to start taking them 2 weeks before you travel to an affected area, during your time there and 2 weeks after you leave the affected area. Failure to adhere to the advised duration and dosage can make them less effective.
- Some of the pills can have nasty side effects.
- Some mosquitos are anti-malarial resistant. Certain antimalarials will be ineffective in specific areas. Your health advisor will discuss this with you when deciding what type of anti-malarial that you need.
- Many factors go into deciding which antimalarials are right for you. The areas you are visiting, family history, any other medication being taken and your current vulnerability to sunburn will all be considered.
Should you take malaria tablets?
Deciding whether you need to take malaria tablets is hugely personal. They can be expensive to buy and may not be needed by all travellers to South East Asia. To help you make your decision, let’s see what some members of our community had to say.
The case for taking anti-malaria tablets
Of course, the positive of taking anti-malaria tablets is that you will be protected from malaria manifesting and taking hold. Therefore, even though the parasite is still transmitted, it can no longer establish the infection. This can be a lifesaver!
Here are some thoughts from the South East Asia Backpacker Community…
“15 years ago, on a 12 month trip, I stopped taking my anti- malaria tablets because they made me feel so sick and my hair started falling out (yes…they are evil!) We then went to east Flores. I was very careful and only got a couple of bites but….I got malaria!! In a tiny town with only very basic medical facilities. The wonderful local doctor there saved my life!! I was very lucky and had managed to contract a non-recurring strain. My advice is…do your research and if you’re going to a high risk area, as we did, then consider using them.” – Vivienne.
“I’m currently taking Malarone and have had no side effects. Most of the countries you are visiting have malaria in, at least, some parts. (The really touristy areas usually don’t have malaria just FYI). In general, it is less likely you will get malaria in SEA than in a place like subsahara Africa but the strains of malaria in SEA are usually more resistant to treatment and can be very dangerous if contracted, even with proper medical treatment. I think of it as a sort of extension of travel insurance… most likely, nothing will happen and you’ll be fine without taking them but there’s always a chance something happens.” – John.
“It’s one of those dilemmas, you’ll only wish you’d taken them if you get malaria!” – Daniel.
The case against taking anti-malaria tablets:
We know the side-effects of these drugs can be pretty horrible. During my visit to South East Asia, I took doxycycline and they made me really nauseous. The only way I could get through the first two hours after taking them was by going back to bed! There is also the cost to consider.
Antimalarials can be expensive depending on where you buy them. Much of Southeast Asia is classified as low-risk areas so anti-malaria tablets are not required in these places anyway. Most of the preventative antimalarials work by being administered over a strict time frame. You must remember to take the pills before entering a malaria zone and also after you leave. If you do not adhere to this, the tablets could be ineffective.
And some more thoughts from the South East Asia Backpacker Community...
“Never taken them. I’m from the USA where they wanna jab you with anything and everything they can profit from. I refused it all! Been living in southern Thailand for almost a decade and healthy as an ox.” –Jay.
“Nope, never taken them. Aside from the financial cost of them – which is neither here nor there, in my opinion, when it comes to your health – I believe the risk of getting sick from the tablets themselves is far higher than actually contracting malaria!” – Lisa.
Where can I get malaria tablets?
Malaria tablets are available from your local health professional and usually come with a cost. In the UK and the US, they can be expensive but it is also possible to buy them in South East Asia. Antimalarials are much cheaper to buy in places like Bangkok, however, you will need to make sure you know which type you want to purchase.
Alternative ways to prevent malaria
Regardless of whether you decide to take antimalarials or not, you should still practice bite avoidance. As well as helping to keep you safe from malaria, this will also help you defend against Dengue Fever, another nasty tropical disease.
Use a mosquito net
It is easy and not that expensive to find travel mosquito nets. Many of these come with a hanging kit so you can easily set it up, no matter where you are. Mosquito nets are even more effective when impregnated with pyrethroid insecticide. If your net does not come with these added chemicals, you can spray your own repellent on it to ensure this level of protection (DEET is recommended).
Although the mosquitos which carry malaria tend to bite between dusk and dawn, the Dengue carrying mosquitoes can strike at any time. Whenever you can, wear loose clothing that covers your bare skin.
Use a DEET based insect repellent
DEET is the most effective defence against mosquitoes. Although it is a powerful chemical to apply to your skin, research shows that if used in accordance with the manufacturer’s instructions, there is a low risk of adverse effects resulting from the use of DEET. DEET based insect repellents come in different concentrations which affect the duration of protection.
- 20% DEET covers you for between 1-3 hours
- 30% DEET covers you up to 6 hours
- 50% DEET up to 12 hours
- Concentrations above 50% DEET should not be used on the skin as they do not increase the duration of protection. They can, however, be used on clothing.
There is much debate as to chemical-free insect repellents and their effectiveness. According to the Fit for Travel NHS website, none of the following is recommended as a form of insect bite avoidance.
- Herbal remedies
- Tree tree oil
- Vitamin B1 and B12
- Garlic and yeast extract
So should I take antimalarials, yes or no?
As you can see, deciding whether or not to take antimalarials is a complex issue. We here at South East Asia Backpacker are not doctors and can only offer advice based on our own experience and those of our community. But for those of you looking for a simple answer…
If you are heading to very remote areas with a malaria risk, it is advised to take the antimalarials. If you are sticking to the main tourist track, you probably don’t need them.
Regardless of your decision to take or not take antimalarials, always practice bite avoidance. Sadly, there is more than just malaria to worry about and you must make sure that you are properly vaccinated before you embark upon your trip.
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