Malaria Prophylaxis: Necessary For Belize Travel?

Belize is a country in Central America with a tropical climate. It is a popular tourist destination, offering archaeological sites, rich culture, and natural wonders. When planning a trip to Belize, it is important to consider the necessary health precautions to ensure a safe and enjoyable journey. One common concern for travellers is whether malaria prophylaxis is required.

Malaria is a mosquito-borne disease that can pose a risk in certain parts of the world, including some regions in Belize. The need for malaria prophylaxis depends on the specific areas you plan to visit within the country and the time of year. While there is no malaria vaccine, anti-malarial drugs are available and are recommended for certain at-risk areas.

To determine if malaria prophylaxis is necessary for your trip to Belize, it is advisable to consult a healthcare professional or travel health specialist. They can provide personalised recommendations based on your itinerary, length of stay, and individual risk factors. Additionally, it is important to take general mosquito bite prevention measures, such as using insect repellent and wearing protective clothing, to lower the risk of not only malaria but also other mosquito-borne diseases present in Belize, such as Zika and dengue fever.

What anti-malarial drugs are recommended for Belize?

The CDC recommends that travellers to Belize take anti-malarial drugs as prophylaxis against malaria. The recommended anti-malarial drugs for Belize are chloroquine, Lariam (mefloquine), Malarone (atovaquone/proguanil), doxycycline, and primaquine.

Chloroquine is a good option for those travelling to areas with chloroquine-sensitive malaria. It is inexpensive and generally well-tolerated, with mild adverse reactions such as gastrointestinal disturbance, headache, dizziness, blurred vision, and itching.

Mefloquine is taken weekly and is a good choice for long trips. However, it may cause mild neuropsychiatric symptoms such as nausea, vomiting, dizziness, insomnia, and nightmares. It should not be taken by those with a history of seizures, psychiatric illness, cardiac conduction disorders, or an allergy to quinine or quinidine.

Atovaquone/proguanil is a good choice for shorter trips as it is only taken for 7 days after leaving a malaria-endemic area. It is also a good option for last-minute travellers as it can be started 1-2 days before travel. It is well-tolerated with mild side effects such as abdominal pain, nausea, vomiting, headache, diarrhoea, or dizziness.

Doxycycline is effective but may cause an exaggerated sunburn reaction, so it may not be suitable for the tropics. It is contraindicated in pregnant women and children under 8 years old.

Primaquine is one of the most effective drugs for preventing P. vivax malaria. It should be taken daily and is a good choice for shorter trips and last-minute travellers. However, it cannot be used by those with glucose-6-phosphate dehydrogenase (G6PD) deficiency, and a blood test is required before starting this medication.

It is important to note that no anti-malarial drug is 100% protective, and travellers should also take mosquito avoidance measures such as using insect repellent, wearing long sleeves and pants, and sleeping in a mosquito-free setting or under an insecticide-treated bed net.

Where is there no risk of malaria in Belize?

Belize was certified as a malaria-free country by the World Health Organization (WHO) in June 2023. The country had been working towards eliminating malaria for over 70 years. This certification means that there is no risk of malaria anywhere in Belize.

Belize's success in eliminating malaria is due to several factors, including strong surveillance, access to diagnosis, and effective vector control methods. Trained community health workers have also played a vital role in achieving timely diagnosis and treatment. Belize has invested in prevention to stop the re-establishment of malaria transmission.

While there is no risk of malaria in Belize, other insect-borne diseases are present, such as Zika, dengue fever, and chikungunya. Therefore, it is still important to take precautions against insect bites when visiting the country.

What are the recommended precautions to avoid mosquito bites?

The CDC recommends that travellers to Belize take precautions to avoid mosquito bites. This is because there is a risk of contracting Zika, dengue fever, chikungunya, and malaria in the country. Here are some recommended precautions:

• Wear long-sleeved shirts and long pants to cover your skin.
• Use insect repellents containing DEET, picaridin, or OLE on exposed skin. For children under two years old, do not use products containing DEET or picaridin.
• Apply permethrin-containing compounds to clothing, shoes, and bed nets.
• Sleep under an insecticide-treated mosquito net.
• Stay in accommodations with window screens and air conditioning.
• Remove standing water, where mosquitoes breed.

Additionally, it is important to be aware of the risk of malaria in Belize, especially in the districts of Cayo, Stann Creek, and Toledo. Antimalarial drugs are recommended for these areas. Speak with a healthcare provider or travel health specialist to determine the most appropriate antimalarial drug for your needs.

What other mosquito-borne illnesses are present in Belize?

Belize is a tropical hub for eco-tourism, and there are several mosquito-borne illnesses present in the country. Dengue fever is one of the most significant mosquito-borne illnesses in the tropics and subtropics, and Belize has an ongoing risk of dengue transmission. The mosquito that spreads dengue bites during the day and is more common in urban areas. Symptoms include fever, headache, severe joint, bone and muscular pain.

Zika is another mosquito-borne virus present in Belize. It can be transmitted by mosquitoes, as well as sexually, and can be passed from a pregnant woman to her fetus, causing severe birth defects.

Chikungunya is another virus transmitted by Aedes mosquitoes. Symptoms can include fever and severe joint pain, as well as headaches, muscle pain, nausea, fatigue and skin rashes.

In addition, there is a risk of malaria in Belize, although incidences have decreased dramatically since the 1980s due to government-led mosquito eradication programs.

What vaccines are recommended for travel to Belize?

The CDC, WHO, and other sources recommend that travellers to Belize be up to date with routine immunisations, including:

• COVID-19
• MMR (Measles, Mumps, and Rubella)
• Chickenpox (Varicella)
• Tdap (Tetanus, Diphtheria, and Pertussis)
• Polio
• Influenza

The CDC also recommends that all eligible travellers be up to date with their COVID-19 vaccines.

The following vaccines are also recommended for unvaccinated travellers to Belize:

• Hepatitis A
• Hepatitis B
• Typhoid
• Rabies

Additionally, the CDC suggests that travellers to Belize may want to consider the following vaccines:

• Chikungunya
• Pneumonia
• Meningitis
• Shingles

It is important to consult a healthcare professional to determine which vaccines are necessary for your specific travel plans and health status.

Frequently asked questions