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Sierra Leone
Health Overview
Key Health Risks
Health Risk Callout
Other Health Risks
Regional Information
Vaccine and Malaria Prevention
- Risk Level: High
- Areas: All areas of Sierra Leone
- Recommended Drug: Atovaquone-proguanil (Malarone); doxycycline; mefloquine; tafenoquine (G6PD testing required)
- Drug Resistance: Yes
P. falciparum malaria with chloroquine resistance is present throughout all of Sierra Leone year-round. Transmission is intense even in Freetown. All travelers require prophylaxis. Fever within 12 months of return requires urgent malaria evaluation.
Physician Note
Sierra Leone has a specific clinical profile that every traveler here needs to understand. The most important fact: yellow fever is required at the border and they check. I have seen travelers denied entry or held at the airport for missing documentation.
Make sure your patients have the card, not just a vague memory of having gotten the vaccine. Lassa fever is the other under-discussed risk here — Sierra Leone is one of the historically endemic countries, and the mechanism is rodent contact (specifically the multimammate rat) and their excreta. Practical prevention: do not leave food uncovered in rooms, do not sleep on the ground, and avoid rural areas if your team has any immunocompromised members.
On malaria: chloroquine resistance is complete and atovaquone-proguanil is my first choice for most travelers. The healthcare system is fragile — this is a country still rebuilding from Ebola. Choithrams in Freetown is the reference hospital for the expat community, but their capacity for complex cases is limited.
Have an evacuation plan to Dakar or Accra before you land. Be sure to consult your Dr. prior to travel to discuss
Pre-Departure Checklist
8+ Weeks
- Be sure to consult your Dr. prior to travel to discuss
- CDC recommends Yellow fever vaccine (required at border — carry card
- 10-day lead required)
- Hepatitis A complete series
- Typhoid
- Polio booster
- Begin malaria prophylaxis discussion
- Initiate rabies pre-exposure series if rural or animal exposure anticipated
- Cholera vaccine if staying in areas with active transmission.
2-4 Weeks
- Confirm medevac insurance with named provider
- Assemble travel medical kit with DEET repellent, oral rehydration salts, ciprofloxacin or azithromycin for traveler's diarrhea, and wound care supplies
- Pay $25 airport security fee online at securipass.sl before travel.
Day Of
- Start atovaquone-proguanil or doxycycline per schedule
- Carry yellow fever card at border
- Note emergency number 900 and nearest hospital address
- Bring full supply of all medications.
Trip Type Guidance
Beach travel: The peninsula beaches south of Freetown (Tokeh, River No. 2) are accessible in the dry season with appropriate caution. Do not swim alone and be aware of strong currents. Mission travel: Sierra Leone has substantial faith-based and humanitarian mission activity. Teams need full prophylaxis, yellow fever cards (border required), and a clear medevac plan.
