Malaria in São Toméand Príncipe: What You Need to Know

Malaria is present in São Tomé and Príncipe. The parasite Plasmodium falciparum, which can cause severe illness, is the primary species reported in the country. Prevention matters wherever you stay, including São Tomé City and Príncipe.

The country has made substantial progress in malaria control, but malaria has not been eliminated. The US Centers for Disease Control and Prevention (CDC) recommends prescription malaria prevention medication for travellers to all areas of São Tomé and Príncipe. The UK National Travel Health Network and Centre (NaTHNaC) also recommends antimalarial tablets for travel to the country.

Malaria Risk Across São Tomé and Príncipe

Exposure to mosquitoes can vary with the season, your activities, accommodation and surroundings. A screened, air-conditioned hotel room may reduce bites; an evening outdoors or a stay in accommodation without screens can increase exposure.

São Tomé has varied landscapes, from the drier north to wetter forested areas in the south. These differences can influence mosquito habitats, but they do not establish that any particular visitor area is malaria-free. Take prescribed medication and use bite protection throughout your trip.

Preventive Medication: What Doctors Prescribe

A travel health professional can recommend a suitable prescription based on your health, age, other medicines, pregnancy status and itinerary.

Obtain your medication before departure rather than relying on finding it locally. Take it exactly as prescribed, including the course required after you leave. No preventive medication provides complete protection, so mosquito bite prevention remains important.

Atovaquone/proguanil (Malarone)

Usually taken once daily. It is generally started one to two days before entering a malaria-risk area, taken daily during exposure and continued for seven days after leaving. It is often convenient for shorter trips, although it can be more expensive than some alternatives. It is not suitable for everyone.

Doxycycline

A daily antibiotic that may be a more affordable option. It is generally started one to two days before entering a malaria-risk area and continued daily for four weeks after leaving.

Doxycycline can increase sensitivity to sunlight. Discuss sun protection and any other precautions with your prescriber.

Mefloquine

A weekly option for some travellers. It must be started before travel and continued after leaving, according to the prescriber’s instructions. It can cause neuropsychiatric side effects and is unsuitable for people with certain medical histories. Discuss its benefits and risks with your clinician.

Practical Mosquito Bite Prevention

• ✦Protect yourself from dusk to dawn. Mosquitoes that transmit malaria predominantly bite at night.
• ✦Cover exposed skin. Wear loose, lightweight long sleeves, trousers and socks when outdoors in the evening.
• ✦Use an effective repellent. Apply a product containing DEET or picaridin/icaridin to exposed skin, following the product label.
• ✦Protect your sleeping space. Choose air-conditioned or well-screened accommodation, or sleep under a properly used mosquito net, preferably insecticide-treated.
• ✦Use daytime protection too. Mosquitoes that spread dengue can bite during the day, so use repellent and other bite precautions throughout the day as well.

Symptoms & What to Do if You Get a Fever

Malaria often begins with a fever and flu-like symptoms. These can include chills, sweats, headache, muscle aches, fatigue, nausea, vomiting or diarrhoea. Symptoms commonly start one week or more after infection, but can appear much later.

Malaria can become severe quickly, but prompt testing and treatment can be lifesaving. Do not wait for a particular set of symptoms or assume that taking prevention tablets rules malaria out.

Sources

1. CDC: São Tomé and Príncipe traveller advicehttps://wwwnc.cdc.gov/travel/destinations/traveler/none/Sao-tome-and-principe
2. NaTHNaC: São Tomé and Príncipe travel health advicehttps://travelhealthpro.org.uk/country/190/sao-tome-and-principe
3. CDC: Malaria symptomshttps://www.cdc.gov/malaria/symptoms/index.html
4. CDC: Malaria prevention and medication guidancehttps://www.cdc.gov/yellow-book/hcp/travel-associated-infections-diseases/malaria.html
5. WHO: Malaria control in São Tomé and Príncipehttps://www.afro.who.int/countries/sao-tome-and-principe/photo-story/sao-tome-and-principe-committed-eliminate-malaria