Malaria in Thailand

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QUESTION:

I am going to Thailand. Do I need to take Malaria medication there?

ANSWER:

Like many other countries, that depends on where in Thailand you are planning to go. The country on the whole has been successful in containing malaria, mostly through successful mosquito control initiatives and a great initiative of government-sponsored “malaria clinics”  dotted around the country, which diagnosed and treated thousands of people.

Now, malaria is more or less constrained to the border regions with Myanmar, Laos and Cambodia, and if you plan to travel to these areas, prophylaxis is recommended (malarone or doxycycline are best since the area has chloroquine-resistant strains of Plasmodium falciparum, the most quick-acting and dangerous form of malaria). There are a few cases of malaria from coastal areas every year, but bite prevention is probably sufficient to reduce the risk of infection – make sure to wear insect repellant, especially at night and dusk/dawn, and if possible sleep under an insecticide-treated bednet.

Finally, remember if you do take prophylaxis, and as per the manufacturer’s instructions, there is only a tiny risk of contracting malaria. But if you do find yourself with symptoms when you get back (see the ‘What are the symptoms of malaria?’ question in this Q&A forum for a description of the more common signs of malarial infection), it’s definitely worth getting checked out!

What Are the Symptoms of Malaria?

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QUESTION: What are the symptoms of Malaria?

ANSWER: Malaria can have many different symptoms, but the initial signs are similar to a flu-like illness, with high fever, chills, headache and muscle soreness or aches. A characteristic sign of malaria is cyclical fever, with peaks of severity every two or three days. Additionally, some people will experience nausea, coughing, vomiting and/or diarrhea.

Because these symptoms are quite generic of a wide variety of illnesses, if you live in a malaria-endemic region, it is crucial to be tested when you develop such symptoms, rather than assuming it’s just the flu and soldiering on! If you have recently traveled to a malarial area and start to experience these signs of infection, similarly you should inform your doctor of your travel history, as otherwise they might not recognize your symptoms as potentially that of malaria.

If treated rapidly and with the correct medication, malaria is almost always completely treatable; it is only if treatment is delayed that it becomes more serious, with long-lasting and potentially fatal consequences. Similarly, if you take sensible precautions while living or traveling in malarial areas, such as taking prophylaxis (and taking them as per the instructions, for the full required amount of time!), avoiding being bitten by mosquitoes and sleeping under an insecticide-treated bed-net, you vastly reduce your chances of getting infected in the first place.

It’s also worth noting that different species of Plasmodium, the parasite that causes malaria, cause slightly different manifestations of the disease, and also require different forms of treatment. Plasmodium falciparum has a unique way of affecting the red blood cells it infects, which eventually can result in loss of function of internal organs. ‘Cerebral malaria’ is a particularly deadly version of this, whereby the function of the brain is affected. The cycles of fever, mentioned above, are caused by synchronous rupturing of the red blood cells in the body by the malaria parasite; P. falciparum, P. vivax and P. ovale complete this cycle every 48 hours, resulting in fever cycles of roughly two days (though P. falciparum can be unpredictable); P. malariae, on the other hand, has a cycle lasting 72 hours, so three day cycles of fever are expected. Finally, although many types of malaria can be successfully treated with the drug chloroquine, some strains, and notably of P. falciparum, have become resistant to this treatment. In these cases, artemesinin-based treatment is recommended, usually in combination with other therapies (artemesinin-combination therapy, or ACT). P. vivax, in addition, requires an additional drug, called primaquine, which is used to treat lingering liver stages of the parasite, to prevent reoccurrence of the infection.

If anyone wants to add to the above account of symptoms and/treatment, please put your comments below! For example, has anyone had malaria first hand and wants to describe their experience?

— Claire, Editor