VACCINATION REQUIREMENTS AND MALARIA
CHEMOPROPHYLAXIS FOR UN STAFF AND HUMANITARIAN
WORKERS TRAVELLING TO CENTRAL ASIA
UPDATE NO 1 October 2001
Routine vaccinations recommended - check vaccination history to ensure
immunisations are up to date
 Diphtheria
 Tetanus
 Polio
 Hepatitis A
 Hepatitis B
 Typhoid fever IM
Recommendations on additional vaccines
 Meningococcal disease
Meningococcal vaccine is recommended.
The tetravalent vaccine (A,C,Y & W135) can be used if available (one case of
serogroup W135 disease has been confirmed in Pakistan following the Haj this year).
If tetravalent vaccine is not available, bivalent (A&C) vaccine should be adequate as
over recent years documented outbreaks of meningococcal disease in Central Asia
have been associated with serogroup A.
 Rabies
Rabies vaccine is recommended.
2,000 – 10,000 cases reported in Pakistan annually. Potential for delay in accessing
health care in event of exposure due to security situation puts UN workers at high
risk. Important to consider stockpiles of post exposure therapy and evacuation plan.
 Measles
Majority of adult population have protective immunity due to measles infection or
vaccination in childhood. Check vaccination history - if no history of measles
infection or measles vaccination, measles vaccine may be given.
 Cholera
Cholera vaccine is NOT recommended.
Priority is prevention measures - safe water, cooked food
Cholera season in Central Asia is from March to October
In event of a confirmed cholera epidemic, the recommendations regarding oral
cholera vaccine will be reconsidered.
Note: A yellow fever vaccination certificate is required from travellers coming
from infected areas.
 Malaria chemoprophylaxis
Pakistan, Afghanistan, Iran – chloroquine plus proguanil
Tajikistan – chloroquine
Uzbekistan, Turkmenistan – prophylaxis not recommended
If more than one country is visited: follow the advice for the most endemic country.
Update no 1 October 2001
Combine with protection against mosquito bites, especially between dusk and dawn.
Malaria Chemoprophylaxis:
Afghanistan
Season: May – November in areas below 1500 m
Recommended: Chloroquine 300mg weekly in combination
with proguanil 200 mg daily. Alternatively, chloroquine can be
taken as 600mg per week, divided over 6 daily doses, in
combination with daily proguanil1.
Iran
Limited risk–exclusively in the benign (P. vivax) form–exists in
some areas north of the Zagros mountains and in western and
south-western regions during the summer months. Malaria risk
in the malignant (P. falciparum) form exists from March
through November in rural areas of the provinces of
Hormozgan, Kerman (tropical part) and Sistan-Baluchestan.
Recommended in P.falciparum risk areas: chloroquine 300mg
weekly in combination with proguanil 200 mg daily.
Alternatively, chloroquine can be taken as 600mg per week,
divided over 6 daily doses, in combination with daily
proguanil.
Pakistan
Season: mainly from April to December. Year-round
transmission in the southern part of the country
Recommended: chloroquine 300mg weekly in combination
with proguanil 200 mg daily. Alternatively, chloroquine can be
taken as 600mg per week, divided over 6 daily doses, in
combination with daily proguanil.
Tajikistan
Season: May - October. Malaria risk exists particularly in the
southern part of the country (Khatlon region) and to a lesser
extent in some central, western and northern areas.
Recommended: Chloroquine 300mg weekly. Alternatively,
chloroquine can be taken as 600mg per week, divided over 6
daily doses.
Turkmenistan
No malaria chemoprophylaxis necessary.
Uzbekistan
No malaria chemoprophylaxis necessary.
Alternative chemoprophylaxis options: mefloquine (250mg weekly) or doxycycline
(100 mg daily)
Chloroquine and mefloquine should be started at least a week before arrival or before
the beginning of the transmission season; proguanil and doxycycline should be started
1
In several countries a combination tablet containing 100mg chloroquine base plus 200 mg proguanil
hydrochloride (common trade name: Savarine) is available, which may improve compliance.
Update no 1 October 2001
the day before. The drugs should be continued for 4 weeks after departure from the
endemic area.
Malaria Emergency Standby Treatment:
Chemoprophylaxis can not offer 100% protection. In case of a breakthrough,
suspected malaria infections can be treated with quinine, given as 8 mg base/kg
bodyweight 3 times daily for 7 days, or with mefloquine, taken as 15 mg base/kg
bodyweight in a single dose, i.e., 4 tablets for an adult (only when not taking
mefloquine prophylaxis). Urgent medical attention should be sought to confirm the
diagnosis and adjust the treatment, and to exclude other causes of fever.
Source: International Travel and Health 2001 – vaccination requirements and health advice. WHO
Geneva, 2001. http://www.who.int/ith
Update no 1 October 2001
Updates of this protocol may become necessary in case of epidemics, and when new data on drug
resistance and transmission become available.
Update no 1 October 2001