Malaria Prevention for Travellers: The Complete UK Guide
Everything you need to know about antimalarial tablets, mosquito bite avoidance, malaria symptoms, and what to do if you feel unwell after returning from a high-risk destination.
Part of the Malaria Guides.
Key fact: No antimalarial tablet gives 100% protection, so tablets and bite avoidance are always used together. And if you develop a fever within 12 months of returning from a malaria-risk area, you need a same-day malaria test — tell the clinician where you have been.
Get Antimalarial Tablets Online
Access Doctor provides Malarone, Maloff Protect and doxycycline for malaria prevention following a GPhC-regulated online consultation with our pharmacist independent prescribers.
See antimalarial tablets →What is malaria? The risk to UK travellers
Malaria is a serious and potentially life-threatening tropical disease caused by Plasmodium parasites, transmitted through the bites of infected female Anopheles mosquitoes. According to the World Health Organization, there were an estimated 249 million malaria cases worldwide in 2022, making it one of the most significant health risks facing international travellers.
For UK travellers it is not an abstract threat. Around 1,500 to 2,000 cases of imported malaria are reported in the UK each year, and Plasmodium falciparum, the most dangerous species, accounts for most of the life-threatening cases in returning travellers.
249m
Estimated malaria cases worldwide in 2022 (WHO)
1,500+
Imported malaria cases reported in the UK each year
12 months
How long after travel a fever should prompt a malaria test
Malaria is found across sub-Saharan Africa, South and Southeast Asia, Central and South America, and parts of the Caribbean. Without prompt diagnosis and treatment, P. falciparum malaria can progress to severe anaemia, organ failure, cerebral malaria and death within 24 to 48 hours of symptoms starting.
Fever after travel is malaria until proven otherwise. If you develop a fever within 12 months of returning from a malaria-risk area, seek same-day medical attention and tell the clinician about your recent travel. Do not wait to see whether it settles on its own.
Which countries carry the highest risk?
Malaria risk varies with destination, altitude, season, and whether you are in a rural or urban area. The regions below carry the highest risk for UK travellers.
| Region | Main species | Risk level | Notes |
|---|---|---|---|
| Sub-Saharan Africa | P. falciparum | Very high | Highest transmission in the world; risk year-round in most areas |
| South Asia (India, Pakistan, Bangladesh) | P. vivax, P. falciparum | Moderate to high | Risk varies by region and season |
| Southeast Asia | P. vivax, P. falciparum | Low to moderate | Higher in rural and forested areas; drug-resistant strains present |
| Central and South America | P. vivax, P. falciparum | Low to moderate | Concentrated in the Amazon basin and jungle areas |
| Middle East | P. vivax | Low | Mainly Yemen; very low or absent in most tourist destinations |
| Caribbean | P. falciparum | Low | Haiti carries the greatest risk; most other islands are malaria-free |
Check your exact destination. Use the UKHSA country-by-country malaria recommendations, or get travel health advice from a pharmacist, GP or travel nurse at least four to six weeks before you go. Malaria risk changes, and so do the recommendations.
The ABCD of malaria prevention
UK travel medicine guidance uses a four-part framework. Following all four steps greatly reduces your risk of catching malaria, and makes sure it is treated quickly if you do.
Awareness of risk
Know whether your destination carries a malaria risk before you travel.
Bite prevention
Use DEET repellent, cover exposed skin and sleep under a treated net.
Chemoprophylaxis
Take the right antimalarial for your destination and finish the full course.
Diagnosis
Get tested promptly if you develop a fever, and do not delay treatment.
Mosquito bite avoidance
No antimalarial tablet provides complete protection, which is why bite avoidance must always be used alongside tablets. Mosquitoes in malaria areas can also carry dengue, chikungunya, Zika and other infections for which there is no preventive medicine, which makes physical protection even more important.
DEET insect repellent
Repellents containing DEET are the most effective option. UK guidance recommends 50% DEET, which gives the longest-lasting protection. Apply it to all exposed skin, particularly from dusk to dawn when the Anopheles mosquitoes that carry malaria are most active, and reapply after sweating or swimming. If you also need sunscreen, apply the sunscreen first and the repellent on top.
Repellents based on icaridin (also called picaridin) are an effective alternative for people whose skin is irritated by DEET.
Protective clothing
- wear long-sleeved tops and long, loose-fitting trousers, especially after sunset
- choose light-coloured clothing, which is less attractive to mosquitoes
- consider permethrin-treated clothing for long trips to high-risk areas
- tuck trousers into socks in forested or rural areas
Where you sleep
- choose accommodation with screens on windows and doors, and air conditioning where possible
- sleep under a mosquito net treated with permethrin, particularly in basic or remote accommodation
- use a plug-in insecticide vaporiser in the room
- check nets and screens for holes before use
DEET for children and in pregnancy. UK guidance advises that DEET repellents, up to 50%, can be used on babies older than two months, and during pregnancy and breastfeeding. Apply it to children yourself, avoid their hands, eyes and mouth, and wash it off when they come indoors. For babies under two months, rely on clothing, nets and screens.
Antimalarial tablets: which one is right for you?
Antimalarial tablets, also called chemoprophylaxis, are recommended for travel to moderate- and high-risk areas. Which one suits you depends on your destination, how long you are going for, your medical history and your other medicines. Three are most commonly used for UK travellers.
| Atovaquone/proguanil | Doxycycline | Mefloquine | |
|---|---|---|---|
| Start | 1 to 2 days before entering the risk area | 1 to 2 days before | 2 to 3 weeks before, to check for side effects |
| How often | One tablet daily | One capsule daily | One tablet weekly |
| After leaving the risk area | Continue for 7 days | Continue for 4 weeks | Continue for 4 weeks |
| Suits | Most destinations; ideal for short trips because of the short tail | Areas where resistance to other drugs is a concern; good value for longer trips | Some high-risk areas; weekly dosing can suit long trips |
| Common side effects | Headache, nausea, stomach pain, usually mild | Sensitivity to sunlight, nausea, heartburn if not taken with food and water | Sleep disturbance, vivid dreams, anxiety and mood changes |
| Not suitable for | Severe kidney impairment; not usually recommended in pregnancy | Children under 12, pregnancy | A history of depression, anxiety or other mental health conditions, epilepsy, or some heart conditions |
Atovaquone/proguanil is the most prescribed antimalarial in the UK, available as Malarone and as Maloff Protect. It works by stopping the parasite producing energy, and its once-daily dose and short course after travel make it the most convenient for most trips.
Doxycycline is an antibiotic that also stops the malaria parasite developing. It is effective and inexpensive, but the four-week course after travel and the risk of sunburn are the trade-offs. Take it upright, with a full glass of water and food, and not just before lying down.
Mefloquine (Lariam) is taken weekly, but it can cause neuropsychiatric side effects including anxiety, low mood, vivid dreams and, rarely, more serious reactions that can persist. It is started two to three weeks before travel so that any side effects show up before you leave, and it is not suitable for anyone with a history of mental health problems or seizures.
Finish the course. The tablets after you leave the risk area matter as much as the ones you take while you are there. They clear parasites that may already be developing in your liver or blood.
Malaria symptoms: what to look out for
Malaria symptoms can appear from seven days after exposure to several months after returning. P. falciparum usually causes symptoms within one to three months of travel, often within the first two weeks, while P. vivax and P. ovale can lie dormant in the liver and cause illness months or occasionally years later.
| Symptom | What it is like | What to do |
|---|---|---|
| Fever | Often the first and main symptom; may come and go in cycles | Same-day medical care |
| Chills and shivering | Intense shaking, often before a fever spike | Same-day medical care |
| Heavy sweating | Follows the fever as part of the classic cycle | Same-day medical care |
| Severe headache | Persistent and not eased by usual painkillers | Urgent |
| Nausea and vomiting | Common, and can stop tablets being kept down | Urgent |
| Muscle and joint aches | Widespread aches, similar to severe flu | Get advice; mention your travel |
| Tiredness | Exhaustion out of proportion to other symptoms | Get advice; mention your travel |
| Diarrhoea | Less common, but can occur, especially with P. falciparum | Get advice; mention your travel |
Signs of severe malaria: call 999 or go to A&E. Severe P. falciparum malaria can deteriorate within hours. Seek emergency care immediately for confusion, drowsiness, seizures, difficulty breathing, very pale skin, yellowing of the skin or eyes, or loss of consciousness after recent travel to a malaria-risk area.
Not everyone with malaria has the classic cycle of fevers. People who took antimalarials, in particular, can have milder or unusual symptoms. If you have been in a malaria-risk area in the past 12 months and develop any of these symptoms, get same-day medical advice whether or not you took tablets.
Advice for returning travellers
Complete your antimalarial course
One of the most common mistakes is stopping tablets on arrival home. Atovaquone/proguanil must be continued for 7 days after leaving the risk area, and doxycycline and mefloquine for 4 weeks. Stopping early significantly raises the risk of malaria from parasites that may already be in your body.
Stay alert for 12 months
P. falciparum malaria usually appears within three months of exposure, but the dormant forms of P. vivax and P. ovale can cause illness six to twelve months later, and occasionally longer. Mention your travel to any doctor you see in the year after a trip to a malaria-risk area.
If you feel unwell after travel
- contact your GP or NHS 111 straight away if you develop a fever
- tell the clinician you have recently been to a malaria-risk area, as this is critical information
- a malaria blood test should be done on the same day the fever starts
- do not accept that it is just a virus until malaria has been ruled out
- if you cannot reach a GP, go to an urgent treatment centre or A&E and state your travel history clearly
Travelling to a Malaria Area?
Our pharmacist independent prescribers check your destination, trip length, health and other medicines, and recommend the right antimalarial after a GPhC-regulated online consultation, with discreet delivery before you travel.
See antimalarial tablets →Frequently Asked Questions
What is the best antimalarial tablet for UK travellers?
The most commonly prescribed antimalarial in the UK is atovaquone/proguanil, sold as Malarone and Maloff Protect, because of its once-daily dose, short start before travel, short course afterwards and generally mild side effects. The best choice for you depends on your destination, trip length, medical history and other medicines.
How long before travel should I start antimalarial tablets?
It depends on the tablet. Atovaquone/proguanil and doxycycline are started one to two days before entering the risk area. Mefloquine is started two to three weeks before travel, so that any side effects show up before you leave.
Can I get antimalarial tablets without seeing a GP in person?
Yes. Access Doctor's pharmacist independent prescribers can prescribe antimalarial tablets such as Malarone and doxycycline following a short online consultation, which includes checks on your destination, health and other medicines.
Do antimalarial tablets protect me 100% against malaria?
No. No antimalarial gives complete protection, although they are highly effective when taken correctly and the full course is completed. That is why bite avoidance, including DEET repellent, covering up and sleeping under a treated net, must always be used alongside tablets.
Do I need malaria tablets if I am staying in a resort or city hotel?
Risk is generally lower in air-conditioned, well-screened hotels in cities, but it is not zero, particularly in sub-Saharan Africa. UK guidance recommends antimalarials for travel to high-risk areas regardless of the type of accommodation, and bite avoidance should be used everywhere. Always check advice for your specific destination.
Can I take antimalarials if I am pregnant?
Malaria is more likely and more dangerous in pregnancy, so travel to high-risk malaria areas is generally not advised while pregnant. If travel cannot be avoided, mefloquine is usually the preferred option where tablets are needed, while doxycycline should not be used and atovaquone/proguanil is not usually recommended. Discuss your situation with a GP, midwife or travel health specialist before travelling.
What strength of DEET should I use?
UK guidance recommends 50% DEET for the longest-lasting protection, and DEET up to 50% can be used by adults, by children and babies over two months, and during pregnancy and breastfeeding. Apply sunscreen first and repellent on top, and reapply after swimming or sweating.
How soon should I see a doctor if I feel unwell after returning?
If you develop a fever, get medical advice the same day. Do not wait overnight. Tell the doctor or nurse about your travel straight away, so that a malaria blood test can be done the same day. If you cannot reach your GP, call NHS 111 or go to an urgent treatment centre.
References
- UK Health Security Agency. Malaria prevention guidelines for travellers from the UK. gov.uk
- NHS. Malaria. nhs.uk
- World Health Organization. World Malaria Report 2023. who.int
- Joint Formulary Committee. British National Formulary: malaria, prophylaxis. bnf.nice.org.uk
Medical disclaimer: This article is for informational purposes only and does not constitute medical advice. Malaria recommendations vary by destination, individual health and changing resistance patterns. Always get personalised travel health advice from a pharmacist, GP or travel nurse before travelling to a malaria-risk area. In a medical emergency, call 999.