Do you need anti-malaria (antimalarial) tablets for travel to Vanuatu?

Antimalarial Tablets for Vanuatu

Yes, you need antimalarial tablets for travel to Vanuatu as transmission of chloroquine-resistant falciparum malaria is intense in this region. 1

Malaria Risk in Vanuatu

• Vanuatu is located in Oceania where malaria transmission is intense with chloroquine-resistant Plasmodium falciparum present 1
• An epidemic of P. falciparum malaria was reported in Vanuatu starting in 1980, possibly due to increasing chloroquine resistance 2
• Malaria remains one of the main diseases of public health importance in Vanuatu 2
• Recent evidence shows P. vivax resurgence in Vanuatu, highlighting ongoing transmission risks 3

Recommended Antimalarial Prophylaxis

First-line Option:

• Mefloquine is recommended as the first-line prophylactic agent for areas with chloroquine-resistant P. falciparum such as Vanuatu 1
• Dosage: 250 mg once weekly for adults 1
• Begin taking mefloquine 1-2 weeks before travel, continue during travel, and for 4 weeks after leaving Vanuatu 1

Alternative Options (if mefloquine is contraindicated):

1. Doxycycline:

   • 100 mg daily for adults 1
   • Begin 1-2 days before travel, continue during travel, and for 4 weeks after leaving Vanuatu 1
   • Caution: May cause photosensitivity; avoid excessive sun exposure 1
   • Not suitable for children under 8 years or pregnant women 1

2. Chloroquine plus Proguanil:

   • Chloroquine 300 mg base weekly plus proguanil 200 mg daily 1
   • Less effective than mefloquine in areas with high chloroquine resistance but still provides substantial protection 1
   • Proguanil dosage needs adjustment in renal impairment 1

Important Considerations

• Compliance is essential - most malaria deaths occur in travelers who do not fully comply with prophylaxis regimens 1
• Begin antimalarial medication before travel to establish the habit and ensure adequate blood levels 1
• Continue prophylaxis for 4 weeks after leaving Vanuatu (except for mefloquine which requires two tablets after the end of exposure) 1
• Even with prophylaxis, breakthrough infections can occur; seek immediate medical attention for any fever within a year of return 1, 4

Additional Protective Measures

• Use insect repellents containing DEET on exposed skin 1
• Sleep under insecticide-treated bed nets 5
• Wear clothing that covers most of the body, especially between dusk and dawn 1
• Use pyrethrum-containing flying-insect spray in living and sleeping areas 1
• Consider permethrin treatment for clothing for additional protection 1

Special Populations

• Pregnant women: Should ideally avoid travel to malaria-endemic areas; if travel is necessary, chloroquine and proguanil have a long history of safe use during pregnancy 1
• Asplenic travelers: At particular risk of severe malaria and need meticulous precautions 1
• Children: Require adjusted dosages based on weight 1
• Travelers with renal impairment: May need dose adjustments, particularly for proguanil 1

Common Pitfalls to Avoid

• Not taking prophylaxis because of perceived low risk - approximately 71.7% of US residents diagnosed with malaria had not taken chemoprophylaxis during travel 4
• Discontinuing prophylaxis too early after return 1
• Relying solely on mosquito avoidance measures without chemoprophylaxis 1
• Not seeking prompt medical attention for febrile illness after travel 1, 4

Remember that P. vivax malaria can cause relapses months after the initial infection due to dormant liver stages, making proper prophylaxis and follow-up essential 6.