태국 말라리아 예방, Thailand, malaria

최근에 Chiang Mai를 방문한 후 모기에 물려서 말라리아가 걱정되어 내원한 환자가 있었습니다.

Chiang Mai는 말라리아 위험이 높지는 않습니다(Rare to few cases).

Areas with malaria: 
① Primarily in provinces that border Burma (Myanmar), Cambodia, and Laos and the provinces of Kalasin, Krabi (Plai Phraya district), Nakhon Si Thammarat, Narathiwat, Pattani, Phang Nga (including Phang Nga City), Rayong, Sakon Nakhon, Songkhla, Surat Thani, and Yala, especially the rural forest and forest fringe areas of these provinces. 

② Rare to few cases in other parts of Thailand, including other parts of Krabi Province and the cities of Bangkok, Chiang Mai, Chiang Rai, Koh Phangan, Koh Samui, and Phuket. 

③ None in the islands of Krabi Province (Koh Phi Phi, Koh Yao Noi, Koh Yao Yai, and Ko Lanta) and Pattaya City.

Estimated relative risk of malaria for US travelers: Low.

Drug resistance⁴: Chloroquine and mefloquine.

Malaria species: P. falciparum 50% (up to 75% in some areas), P. vivax 50% (up to 60% in some areas),  P. ovale and P. knowlesi rare.

Recommended chemoprophylaxis: 
① Provinces that border Burma (Myanmar), Cambodia, and Laos, the provinces of Kalasin, Plai Phraya district of Krabi, Nakhon Si Thammarat, Narathiwat, Pattani, Phang Nga (including Phang Nga City), Rayong, Sakon Nakhon, Songkhla, Surat Thani, and Yala: Atovaquone-proguanil or doxycycline. 

② All other areas of Thailand with malaria including the cities of Bangkok, Chiang Mai, Chiang Rai, Koh Phangan, Koh Samui, and Phuket: Mosquito avoidance only.

REF. https://wwwnc.cdc.gov/travel/yellowbook/2018/infectious-diseases-related-to-travel/yellow-fever-malaria-information-by-country/thailand#seldyfm879