Malaria
Malaria
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Despite being preventable and curable, malaria is officially the world’s biggest killer. In 2006 there were 247 million cases of malaria resulting in nearly one million deaths, with a child dying of malaria every thirty seconds. The greatest incidence of the disease is in developing or lower-income countries, particularly in sub-Saharan Africa. However, Asia, Latin America, the Middle East and parts of Europe are also affected. In 2006, malaria was present in 109 countries and territories and travellers from non-malarious countries are most at risk when visiting these endemic areas or malaria ‘hot-spots’.
Malaria is caused by a parasite called Plasmodium and is transmitted to humans through the bites of infected mosquitoes. Just one bite is enough to cause infection. There are four types of human malaria:
1. Plasmodium falciparum
2. Plasmodium vivax
3. Plasmodium malariae
4. Plasmodium ovale
Plasmodium falciparum and Plasmodium vivax are the most common. Plasmodium falciparum is the most deadly. Travellers will be susceptible to different infections depending on the areas to be visited and should always check for up to date information on their destinations prior to travel as the type of anti-malaria medication will vary according to the countries to be visited, time of year and local factors such as rainfall patterns. For current information on malaria and other travel health updates you should visit one of the following websites:
Prevention of Malaria
The most severe form of malaria, Plasmodium falciparum, is on the increase in the UK and an average of nine people in the UK die every year from malaria. The chance of catching malaria can be reduced substantially by taking precautions to avoid being bitten and antimalarial tablets to prevent possible infection. You should ideally seek information on travel health, including malaria prevention and other measures such as vaccination against a range of diseases, eight weeks before travel in order to be fully protected, although some antimalarials can be started just one or two days before travel. Treatment with the antimalarials should continue for one week after leaving the endemic area.
Avoidance of Bites
As well as causing an irritating local reaction and spreading malaria, mosquito bites spread other infections such as yellow fever, dengue and Japanese B encephalitis. Mosquitoes can bite at any time of day but most bites occur between dusk and dawn. The following precautions will help you to minimise the chance of being bitten:
1. Keep your arms and legs covered if you are out after sunset.
2. Use an insect repellent. Repellents containing DEET (Diethyl toluaminde) are most effective.
3. Mosquitoes may bite through thin clothing, so spray the repellent onto your clothes as well as exposed skin.
4. Spraying insecticides in the room after sunset, burning pyrethroid coils and heating insecticide impregnated tablets all help to control mosquitoes.
5. If sleeping in an unscreened room, or out of doors, use an insecticide impregnated mosquito net.
None of these precautions offers total protection and should be used in addition to taking antimalarials.
Antimalarials
Travellers should always seek up to date advice from a doctor, pharmacist or travel clinic on which antimalarial is suitable for their particular travel itinerary as resistance will make some treatments ineffective. Medications currently licensed in the UK for the prevention of malaria include chloroquine, proguanil, mefloquine, doxycycline and a combination product atovaquone plus proguanil (Malarone). If you are taking any prescribed medication you should consult your doctor or pharmacist before taking any antimalarial because of the risk of interactions. All antimalarials vary in the dosage and range of side effects but the following points apply to all antimalarials:
1. It is important to take the appropriate antimalarial for the endemic area to be visited. This helps to reduce the development of resistance whilst ensuring effective cover for the traveller.
2. Follow the dosage instructions precisely and start the course prior to entering the endemic area according to the doctor or travel health advisor.
3. Take all doses regularly, preferably with or after food.
4. It is extremely important to continue taking the antimalarials after leaving the endemic area. For some antimalarials this will be for four weeks, for Malarone (atovaquone plus proguanil) this is for seven days.
For more information on Malarone click here.
Precautions
Travellers should note that there is increasing resistance to insecticides and repellents amongst mosquitoes and no regimen provides 100% protection. If you develop a fever or feel ill while abroad, you should consult a doctor. If malarial symptoms develop up to one year after travel to an affected area, you must consult a doctor and inform them or your symptoms and that you have been to a malarious area.
Symptoms of Malaria
Malaria symptoms are ‘flu like and include headaches, tiredness, nausea, fever and chills lasting 24 hours. In some cases, there can be heavy sweating and breathing problems. Unlike normal ‘flu symptoms however, malaria is characterised by the symptoms occurring every 2-4 days. The first signs of malaria usually appear one week to 2 months after being bitten by an infected mosquito in an endemic area. Travellers must therefore report any such symptoms which occur up to six months after returning home.
Fake Antimalarials – Warning
Travellers should be aware that fake antimalarial tablets are often sold abroad. These tablets will offer no protection to you against malaria and may even do you harm. Always make sure you obtain your antimalarials from a reputable source in the UK before you travel.