Europe - Travel Vaccines and Malaria Prophylaxis

The UK Global Health Insurance Card (GHIC) has replaced the European Health Insurance Card (EHIC)

The UK Global Health Insurance Card (GHIC) lets you get necessary state healthcare in the European Economic Area (EEA),
and some other countries, on the same basis as a resident of that country. This may be free or it may require a payment
equivalent to that which a local resident would pay.

The UK GHIC replaced the existing EHIC in 2021 when the UK left the EU. If you have an existing EHIC you can continue
to use it until the expiry date on the card. Once it expires, you'll need to apply for a UK GHIC to replace it.
You can apply for a new card up to 9 months before your current card expires.

A UK GHIC is free and lasts for up to 5 years. Apply for your new card through the NHS website.
Avoid unofficial websites – they may charge you a fee to apply.

NOTE: The UK GHIC is not a replacement for travel insurance.
You are advised to have private travel and medical insurance for the duration of your trip.

Disease Risks in Europe, including Cyprus and countries of the former USSR

Albania, Andorra, Armenia, Austria, Azerbaijan, Belarus, Belgium, Bosnia and Herzegovina, Bulgaria, Croatia, Cyprus, Czech Republic, Denmark (with the Faroe Islands), Estonia, Finland, France, Georgia, Germany, Gibraltar, Greece, Hungary, Iceland, Ireland, Italy, Kazakhstan, Kyrgyzstan, Latvia, Liechtenstein, Lithuania, Luxembourg, Macedonia, Malta, Moldova, Monaco, Netherlands, Norway, Poland, Portugal (with the Azores and Madeira), Romania, Russia, San Marino, Slovakia, Slovenia, Spain (with the Canary Islands), Sweden, Switzerland, Tajikistan, Turkmenistan, Ukraine, Uzbekistan, Yugoslavia (including Kosovo, Montenegro and Serbia.

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YEL	Yellow Fever
HEP A	Hepatitis A
TYP	Typhoid
TET	Tetanus
POL	Polio
MEN	Meningitis
ENC	Jap. B Encephalitis
DIP	Diphtheria
RAB	Rabies
HEP B	Hepatitis B

M	Vaccination is mandatory and a certificate of vaccination is required for entry.
C	A certificate of vaccination may be required if entering from an endemic country, (except for children <1 year old).
R	Vaccination is recommended for the country but no evidence is required for entry.
L	Long Term. Vaccination recommended for travellers staying in endemic areas for 3 months or more. Except Japanese B Encephalitis if longer than 1 month.

COUNTRY

MALARIA
REGIMEN

YEL

HEP
A

TYP

TET

POL

MEN

ENC

DIP

RAB

HEP
B

Albania
No malaria risk

Andorra
No malaria risk

Austria
No malaria risk

Belarus
No malaria risk

Belgium
No malaria risk

Bosnia & Herzegovina
No malaria risk

Bulgaria
No malaria risk

Croatia
No malaria risk

Cyprus
No malaria risk

Czech Republic
No malaria risk

Denmark
No malaria risk

Estonia
No malaria risk

Finland
No malaria risk

France
No malaria risk

COUNTRY

MALARIA
REGIMEN

YEL

HEP
A

TYP

TET

POL

MEN

ENC

DIP

RAB

HEP
B

Germany
No malaria risk

Greece
No malaria risk

Hungary
No malaria risk

Iceland
No malaria risk

Ireland
No malaria risk

Italy
No malaria risk

Latvia
No malaria risk

Liechtenstein
No malaria risk

Lithuania
No malaria risk

Luxembourg
No malaria risk

Macedonia
No malaria risk

Malta
No malaria risk

Moldova
No malaria risk

Monaco
No malaria risk

COUNTRY

MALARIA
REGIMEN

YEL

HEP
A

TYP

TET

POL

MEN

ENC

DIP

RAB

HEP
B

Netherlands
No malaria risk

Norway
No malaria risk

Poland
No malaria risk

Portugal
(including Madeira & Azores)
No malaria risk

Romania
No malaria risk

Russia
No malaria risk

San Marino
No malaria risk

Slovakia
No malaria risk

Slovenia
No malaria risk

Spain
(including Canary Islands)
No malaria risk

Sweden
No malaria risk

Switzerland
No malaria risk

Ukraine
No malaria risk

Yugoslavia (former) - including: Bosnia and Herzegovina, Croatia, Macedonia, Montenegro, Serbia, and Slovenia.
No malaria risk

YEL	Yellow Fever
HEP A	Hepatitis A
TYP	Typhoid
TET	Tetanus
POL	Polio
MEN	Meningitis
ENC	Jap. B Encephalitis
DIP	Diphtheria
RAB	Rabies
HEP B	Hepatitis B

M	Vaccination is mandatory and a certificate of vaccination is required for entry.
C	A certificate of vaccination may be required if entering from an endemic country, (except for children <1 year old).
R	Vaccination is recommended for the country but no evidence is required for entry.
L	Long Term. Vaccination recommended for travellers staying in endemic areas for 3 months or more. Except Japanese B Encephalitis if longer than 1 month.

The information supplied here is derived from a number of reliable sources and is compared and compiled into the alphabetical lists found on this web site.

Countries requiring malaria prophylaxis should be regarded as being at risk all year round and you should also assume that the whole country is at risk unless otherwise indicated. The malaria regimen is the recommended regimen for a country. Use of the incorrect regimen may not provide adequate cover.

When there are two different regimens for the same country, they are area specific. Read the text to find out which regimen is suitable for the area you require.

Where regimen 1 is indicated there is Chloroquine resistance in that region and it is very likely to be the Falciparum malaria which is the most serious form of the disease. In this instance it is vitally important that travellers take adequate prophylaxis.

Remember:- No prophylaxis is 100% effective but not taking anti-malarials where they are indicated will put you at greater risk should you get the disease. Remember - Malaria is a killer!

The Different Drug Regimens
Regimen 1	Mefloquine one 250mg tablet weekly. OR Doxycycline one 100mg capsule daily. OR Malarone one tablet daily.
Regimen 2	Chloroquine 300mg weekly (2x150mg tablets). PLUS Proguanil 200mg daily (2x100mg tablets).
Regimen 3	Chloroquine 300mg weekly (2x150mg tablets) OR Proguanil 200mg daily (2x100mg tablets).
Regimen 4	No prophylactic tablets required but anti mosquito measures should be strictly observed: Avoid mosquito bites by covering up with clothing such as long sleeves and long trousers especially after sunset, using insect repellents on exposed skin and, when necessary, sleeping under a mosquito net.
.

Proguanil	100mg tablets are supplied as Paludrine Tablets
Chloroquine	150mg tablets are supplied as Nivaquine or Avloclor Tablets
Mefloquine	250mg tablets are supplied as Lariam Tablets
Malarone	is a combination of Atovaquone 250mg and Proguanil 100mg

Length of Prophylaxis
Chloroquine, Proguanil & Maloprim	Start one week before travel, throughout your stay in an endemic area and continue for four weeks after return.
Mefloquine (Lariam)	Start two and a half weeks before travel, throughout your stay in an endemic area and continue for four weeks after return.
Doxycycline	Start two days before travel, throughout your stay in an endemic area and continue for four weeks after return.
Malarone	Start two days before travel, throughout your stay in an endemic area and continue for one week after return.
IMPORTANT! Take the tablets absolutely regularly, preferably with or after a meal.

Long Term Use of Anti-Malaria Drugs
Chloroquine	May be taken for periods exceeding five years.
Paludrine	May be taken for periods exceeding five years.
Maloprim	Can be taken for periods up to one year.
Mefloquine	Can be taken for periods up to one year.
Doxycycline	Can be taken for periods up to six months.
Malarone	Can be used for travel periods up to one year.

Compatibility of Anti-Malaria Drugs
	Pregnancy	Breast Feeding	Epilepsy	Psoriasis	Altitude	Scuba Diving
Chloroquine	OK	OK	NO	NO	OK	OK
Paludrine	OK	OK	OK	OK	OK	OK
Mefloquine	OK*	NO	NO	OK	NO	NO
Doxycycline	NO	NO	OK	OK	OK	OK
Malarone	NO	NO	OK	OK	OK	OK
* These drugs are not suitable during the first trimester of pregnancy.

Childrens' Dosages: Calculate the dose by weight rather than by age if possible
Age/Weight	Chloroquine (once weekly)	Proguanil (once daily)	Mefloquine (once weekly)	Doxycycline (once daily)	Malarone (once daily)
0 - 12 weeks under 6kg	1/4 tablet	1/4 tablet	-	-	-
3 - 12 months 6 - 10kg	1/2 tablet	1/2 tablet	1/4 tablet	-	-
1 - 3 years 10 - 16kg	3/4 tablet	3/4 tablet	1/4 tablet	-	1 child's tablet
4 - 7 years 16 - 25kg	1 tablet	1 tablet	1/2 tablet	-	1 child's tablet
8 - 12 years 25 - 45 Kg	11/2 tablets	11/2 tablets	3/4 tablet	-	2 child's tablets
13 years and over 45kg and over	2 tablets	2 tablets	1 tablet	1 capsule	1 adult tablet
The above dosages are based upon the guidelines issued by the Advisory Committee on Malaria Prevention.

Adult Dosages
Regimen	Dose for Chemoprophylaxis	Usual amount per tablet (mg)
Areas without drug resistance:
Chloroquine Proguanil	2 tablets weekly 2 tablets daily	150mg (base) 100mg
Areas of little chloroquine resistance (poorly effective where marked resistance):
Chloroquine plus Proguanil	2 tablets weekly 2 tablets daily	150mg (base) 100mg
Areas of chloroquine resistant P. falciparum:
Mefloquine Doxycycline Malarone (atovaquone & proguanil)	1 tablet weekly 1 tablet/capsule daily 1 tablet daily	250mg (228 in USA) 100mg 250mg atovaquone & 100mg proguanil

Please read the Malaria Page for more information