Understanding your risk, prophylaxis options, and how to protect yourself.
Malaria is a serious and potentially fatal disease caused by Plasmodium parasites, transmitted through the bite of infected Anopheles mosquitoes. Symptoms include fever, chills, headache, muscle pain, and fatigue. Without treatment, it can progress to severe illness and death within days.
There is no vaccine commercially available for travellers (though one exists for children in endemic areas). Prevention relies on antimalarial medication (prophylaxis) and mosquito bite avoidance.
The highest-risk destinations commonly visited by Australians include Papua New Guinea (risk throughout the country), East Africa (Kenya, Tanzania, Uganda), West Africa (Ghana), and parts of Southeast Asia (Myanmar, Cambodia). India, Indonesia (eastern regions), and the Amazon basin in South America also carry significant risk.
Many popular tourist areas in Southeast Asia — including Bangkok, Bali, Kuala Lumpur, and Singapore — have no or negligible malaria risk. Always check the specific risk for your itinerary, not just the country.
Three main antimalarial medications are prescribed in Australia:
Atovaquone/Proguanil (Malarone): Taken daily, starting 1-2 days before entering a risk area and continuing for 7 days after leaving. Fewest side effects for most people. Can be expensive for long trips.
Doxycycline: Taken daily, starting 1-2 days before and continuing for 4 weeks after leaving the risk area. More affordable for long trips. Can cause sun sensitivity and stomach upset. Not suitable during pregnancy or for children under 8.
Mefloquine (Lariam): Taken weekly, starting 2-3 weeks before and continuing for 4 weeks after. Convenient for long trips. Can cause vivid dreams, anxiety, and neuropsychiatric side effects in some people. Not suitable for everyone — discuss with your doctor.
Prophylaxis alone isn't enough. Combine medication with bite prevention: use DEET-based insect repellent (at least 20% concentration), sleep under insecticide-treated bed nets, wear long sleeves and pants at dusk and dawn (when Anopheles mosquitoes are most active), and use mosquito coils or plug-in repellents in your room.
If you develop fever, chills, or flu-like symptoms during or after travel to a malaria-risk area (even up to 12 months later), seek medical attention immediately. Tell the doctor about your travel history. A blood test can diagnose malaria quickly. Early treatment is critical — delays can be fatal.
Australian travellers have four main antimalarial prophylaxis options. Each suits different itineraries, durations, and tolerances:
Daily tablet, taken from 1–2 days before entering a malaria area until 7 days after leaving. Generally well-tolerated; the most common side effect is mild gastrointestinal upset, which improves if taken with food. Effective for short trips because the post-travel course is only a week. Resistance is rare. The most expensive option per day, but the shortest total course offsets this for trips under 3 weeks.
Daily tablet, taken from 1–2 days before until 4 weeks after leaving the area. Cheapest option per day. Side effects include photosensitivity (sunburn risk), gastrointestinal upset, and (in women) increased risk of vulvovaginal candidiasis. Take with a full glass of water and remain upright for 30 minutes to avoid oesophageal irritation. Not for children under 8 years or pregnant women. The 4-week post-travel course is significant — for short trips, total exposure to doxycycline often exceeds the trip duration.
Weekly tablet, started 2–3 weeks before travel and continued for 4 weeks after return. Convenience of weekly dosing is its main advantage. Significant neuropsychiatric side effects (vivid dreams, anxiety, depression, dizziness) limit use — the TGA requires a checklist of contraindications including history of depression, anxiety, psychiatric illness, and seizure disorders. Long history of use; effective except in known mefloquine-resistant areas (Cambodia–Thai border, parts of Myanmar).
Largely obsolete due to widespread P. falciparum resistance. Still effective in a small number of locations (Mexico, Central America north of the Panama Canal, parts of the Middle East, Hispaniola). Confirm current local resistance pattern before relying on it.
No prophylaxis is 100% effective. Bite avoidance is the foundation of malaria prevention and also reduces dengue, Zika, chikungunya, Japanese Encephalitis, and other vector-borne illness. Practical measures:
If you find yourself in a high-risk area without access to prophylaxis (e.g., extended trip, drug stocked-out, side effects), there is a "stand-by treatment" option: carrying a course of artemether-lumefantrine (Riamet) on prescription, with instructions to self-administer if symptoms develop and medical care is unavailable within 24 hours. This is a backup, not a primary strategy — discuss with a travel-medicine specialist before relying on it.
The classic presentation is fever (often cyclical), chills, sweats, headache, body aches, fatigue, nausea, and sometimes diarrhoea. P. falciparum can progress to severe malaria within 24–48 hours, with confusion, seizures, jaundice, severe anaemia, and shock. Any fever during or within 12 months of return from a malaria area requires immediate medical assessment, including a thick-and-thin blood film or rapid diagnostic test.
Pregnant women: See our pregnancy guide. Travel to malaria-endemic areas during pregnancy is generally not recommended; if unavoidable, mefloquine in second/third trimester is the typical choice. Malaria in pregnancy is more severe and dangerous to both mother and fetus.
Children: Atovaquone-proguanil from 5 kg body weight; mefloquine from 3 months; doxycycline only over 8 years.
People returning to home countries (visiting friends and relatives, VFR): Often skip prophylaxis under the belief that childhood exposure provides protection. This is a misconception — natural immunity wanes after years away from continuous exposure. VFR travellers have higher malaria rates than other Australian travellers.
Last updated: May 2026