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Malaria

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Areas affected by malaria (dark blue)

    This article is a travel topic

Malaria is a serious and sometimes fatal tropical disease. Four kinds of malaria parasites can infect humans: Plasmodium falciparum, P. vivax, P. ovale, and P. malariae; infection with P. falciparum, if not promptly and correctly treated, can be fatal in as little as one or two days.

Competent advice from an up-to-date source of information, such as the tropical diseases department of a major hospital, is essential.

Transmission

According to the CDC, Malaria is transmitted in large areas of Central and South America, the island of Hispaniola (includes Haiti and the Dominican Republic), Africa, Asia (including the Indian subcontinent, Southeast Asia and the Middle East), and a few areas of Eastern Europe and the South Pacific.

In general, the risk of contracting malaria is higher in rural areas and lower in urban areas. Often there is also a correlation to the mosquito population, with the rainy season creating stagnant pools of water where mosquitoes can breed.

Symptoms

Symptoms of malaria mimic common flu, with an infected person suffering fever, headache, and vomiting usually within 10 to 15 days after the mosquito bite. This means that you may become sick when you're already back at home, so be aware of that.

Malaria is life-threatening, and requires immediate treatment. No vaccine is currently available, but methods of prevention include avoiding mosquito bites and preventative drugs (prophylaxis). Note that some drugs are not effective for all areas. If a person who has visited a malaria risk zone contracts a fever within one year, their physician should be informed of the possibility of malaria. Less serious forms (such as P. vivax) can mimic symptoms of the flu. Physicians who rarely, if ever, examine malaria patients may need to be reminded of this fact. The standard laboratory test for malaria is a thick and thin blood smear on a glass slide viewed under the microscope. Self-test kits are highly unreliable.

Prophylaxis

Any malaria prophylaxis must be taken before, during, and (especially) after traveling to a malaria-risk zone. Anti-malarial drugs are highly effective in preventing malaria. Different drugs are recommended for travel to different areas due to malarial strains resistant to certain drugs. Talk to a specialist doctor or verify the information with a reliable source. As with all drugs, anti-malarials may cause side-effects. Seldom will malaria be the sole health concern, and the physician will need to assess all the health risks the traveler will face. Obtain medications from a reliable source, either at home before you leave or from a reliable chemist in a high-end or tourist area. Sometimes, the pills sold might be placebos.

Pregnant women should be especially careful, as some anti-malarials must not be taken during pregnancy, and malaria during pregnancy is usually more severe and is always considered to be a serious emergency. As with most prophylaxis, anti-malarials are not 100% effective; however studies have shown that when taken as directed, the most common drugs (e.g. doxycycline, Malarone) are ~98%~99% effective. The choice of a malaria prophylaxis should be made carefully with one's physician, taking into account drug resistance in the traveler's destination; possible side effects, interactions, and contraindications; and finally the preferred frequency per dose (daily, weekly, etc.)

As well as prophylactic medications, there are important anti-mosquito measures that should be used. Avoiding mosquito bites by using repellent containing DEET, netting, screens, long clothing, and avoid being exposed around dusk. Air-conditioning and fans can also help indoors. For those sensitive to DEET, or dislike its smell, repellents containing Picaridin (e.g. Natrapel) are available in limited areas. Concentrations of 20% have been shown to be as effective as DEET.

The most common anti-malarials include:

  • Doxycycline is highly effective and can be very inexpensive. Possible disadvantages include increased sun sensitivity (sunburning easier), and nausea and stomach pain; some sources caution that it may reduce the effectiveness of birth control pills.
  • Lariam (mefloquine), or it's generic Mefliam, is highly effective, has a simple weekly dose and can be taken for extended periods. It does have a number of contra-indications and must be prescribed by a doctor, and has also been known to have very rare but severe neurological side effects. More common side effects include nausea, stomach cramps and lucid dreams. Not to be used if you plan on scuba diving or high altitude climbing. Your doctor may advise that you start using it several weeks before leaving, in order to check for possible side effects. There are resistant mosquitoes in Southeast Asia, and West and East Africa. Find out the latest information on this drug from a professional before purchase.
  • Malarone (atovaquone + proguanil) is highly effective, has a very low incidence of side effects, and only needs to be taken for one week after leaving the risk area; however it is the most expensive.
  • Chloroquine (Daramal / Nivaquine / Promal) in combination with proguanil (Paludrine) may sometimes be recommended, and is generally well tolerated. Problems include people having difficulty adhering to the prescribed regime due to its complexity, and widespread resistance.

There has been some debate recently over whether pre-travel malaria prophylaxis is being started early enough. For example, mefloquine is normally taken one week prior to travel. Some feel this is inadequate if the person is unfortunate enough to be exposed to malaria shortly upon arrival. Those who have concerns may wish to discuss with their physician the option of doubling the time period (not the dosage) that their malaria prophylaxis will be taken prior to travel. In addition to providing better protection, there will be more time to switch to another anti-malaria medication, if necessary.

Aspirin must never be taken as an antipyretic (fever reducer) when malaria or dengue fever is a possibility. (Continuing daily low-dose 81 mg aspirin therapy during and after third-world travel should be discussed with your physician.) Acetaminophen (paracetamol) and ibuprofen are considered safe alternatives provided all of their precautions are observed. Malaria, dengue fever, and typhoid fever all tend to have somewhat similar symptoms at first and should not be self-diagnosed.

Travel

Travel to rural areas always involves more potential exposure to malaria than in the larger cities. (This is in contrast to dengue fever where cities present the greater risk.) For example, the capital cities of the Philippines, Thailand and Sri Lanka are essentially malaria-free. However, malaria is present in many other places (especially rural areas) of these countries. By contrast, in West Africa, Ghana and Nigeria have malaria throughout the entire country. However, the risk will always be lower in the larger cities. Travelers should never assume that their choice of malaria prophylaxis is available in the country that they will be visiting. Many third-world countries stock only chloroquine and possibly doxycycline. Quinine might also be available, but is not recommended as a prophylactic anti-malarial.

Find out more

  • WHO - Malaria. [1] World wide information on malaria.
  • MAP (Malaria Atlas Project), [2]
  • MARA (Mapping Malaria Risk in Africa), [3], a malaria atlas for Africa
  • South African Department of Health, [4]
  • Scottish National Health Service, [5] Interactive World map showing malarial hotspots
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