Will malaria come back?

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QUESTION:

As a result of a blood test I have just been informed that at some time I have had malaria. Though I have no idea when this was. I once was ill for 4 days with what I thought was flu and that is the only occasion I can remember. Therefore I have never been treated for malaria. Could you please tell me if there is any chance the disease will come back.

ANSWER:

That will depend on the type of malaria you had. I presume you found out you were infected through a blood test – it is likely a test that looked for antibodies to malaria in your blood. These tests can sometimes differentiate between the different species of malaria, and so it is definitely worth asking the clinic or doctor that performed the test if they can give you this information. Your location, or places where you have travelled in the last 4 years, may also assist in determining which type of malaria you had. Given that you barely registered being sick, I would suspect that you probably didn’t have Plasmodium falciparum, which is usually the most severe kind; it also cannot survive dormant in your system for long periods of time, so if you happened to have this kind, you wouldn’t need to worry about it coming back (though of course you can still be re-infected by all types of malaria, so prevention is still important!).

However, the other three main types of malaria can linger in a patient’s body. P. malariae is the least acute of all the malaria species, and can survive for a long time in the bloodstream, meaning that some people can have the infection for long periods of time without really feeling sick. If the blood test you took looked directly for parasites in your blood, and you tested positive, it is likely you have this kind. Like all uncomplicated cases of malaria, it is easily treatable, and once cured, you won’t have worry about it coming back (again, you do still need to watch out for being bitten by mosquitoes and getting re-infected though!).

The final two types of malaria are P. vivax and P. ovale. These persist in the body in a slightly different way than P. malariae – these have a special life stage which can lie dormant in the liver. Months or even years later, these dormant stages can re-activate and enter the blood stream, causing the patient to feel symptoms again, such as fever and nausea. Therefore, if you find you tested positive for one of these two forms, it is very important to ask your doctor about receiving medication (called primaquine) that will specifically target the liver stages of the parasites, to ensure you don’t get a recurrence of the infection later on.

As I’ve mentioned a couple of times earlier in this response, a key thing to be aware of is that even if you don’t have a recurring form of malaria, or treat it successfully, you will still be susceptible to re-infection if you are bitten by an infected mosquito. As such, if you live in or travel to a region known to have malaria transmission, it is crucial to take steps to prevent infection. For example, sleeping under a long-lasting insecticide treated bednet greatly reduces your risk of being bitten by the mosquitoes that carry malaria; similarly, wearing long-sleeved clothing and insect repellent, especially at night when malaria mosquitoes are most active, is recommended. Finally, medication is available that can be taken to prevent malaria (these are called prophylactics). As they can be expensive and are not recommended to be taken over long periods of time, these tend to be used primarily by people travelling to malarial areas rather than residents. There are several different forms of these prophylactics available commercially; the one to use will depend on several factors, including where you are travelling to.

Malaria on Bougainville Island, Papua New Guinea

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QUESTION:

Is there malaria on Bougainville Island?

ANSWER:

Yes, Bougainville Island (an autonomous region of Papua New Guinea) is considered a malaria transmission zone, and precautions against malaria are advised when visiting. These include sleeping under an insecticide treated bednet, wearing long-sleeved clothing and insect repellent in the evenings and talking with your doctor about potentially also taking anti-malaria medication (called prophylaxis) as a further step to prevent infection.

Breaking the Promise of Bednets? Let’s Not Jump to Conclusions…

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Review of Trape et al., (2011), Malaria morbidity and pyrethroid resistance after the introduction of insecticide-treated bednets and artemisinin-based combination therapies: a longitudinal study, The Lancet Infectious Diseases, published online August 18th.

Jean-François Trape and colleagues have been causing quite a media stir with the article they recently published in The Lancet Infectious Diseases, an offshoot of the eminent medical journal. The research consisted of a longitudinal study, following the inhabitants of a village in Senegal for almost four years, recording all instances of malaria and treating cases with artemisinin-based combination therapies (ACTs), the WHO-recommended front-line medication for uncomplicated malaria cases. In addition, 18 months into the study, the villagers were provided with long-lasting insecticide treated bednets (LLINs); concurrently, throughout the study period Anopheles mosquitoes, the vectors of malaria, were collected from the village area and tested for resistance to the insecticides used in these LLINs.

The scientists noted an immediate decrease in the monthly incidence of malaria in the initial period following the introduction of LLINs, but then recorded a substantial, and statistically significant, increase in re-infections in the final three months of the study. Moreover, when broken down into age groups, this rebound of malaria cases was most notable in children aged 10-14 years, which is unusual given that normally younger children are considered most susceptible to malaria infection. Perhaps most concerning of all, more than a third of mosquitoes tested at the end of the study were resistant to the insecticide in the LLINs, and the prevalence of a gene known to correlate with resistance had increased from 8% to 48% over the four-year period.

This research is clearly highly important, timely, and worthy of deeper consideration. While LLINs have been shown to be highly effective in earlier studies to prevent malaria infection, fewer studies have focused on the long-term consequences of these interventions, which are being rolled out at great speed throughout malaria endemic areas. Clearly, insight into the effects on mosquitoes, as well as re-infection rates, is warranted. However, a few gentle caveats should also be made.

For one, although the observation of reduced immunity being responsible for higher rebound rates is of great interest, and a sound conclusion from the evidence, it requires much further testing before a causal relationship can be proven. Secondly, the authors compare a rebound period of three months, at the end of the study, with the preceding two years of LLIN use as well as the initial LLIN-free 18 months, in order to draw their conclusions about re-infection rates.

Malaria is highly seasonal; while this is acknowledged by the authors (one of the figures includes rainfall in the graph of Anopheles biting rates), it is unclear whether this was included as a covariate in the statistical analysis, and therefore controlled for as a variable. As it happens, that final three month period occurred during a season of high rainfall, usually associated with high numbers of mosquitoes and subsequently high biting rates. Similarly, the authors do not account for the possibility of other environmental factors influencing the rate of malaria during this final, and very short, time period. Had they compared time periods of equal length, and incorporating all seasons, it might be easier to ascertain whether the increase they observe is a true trend or a statistical artifact of sampling bias.

However, I am getting slightly off the point with technical grievances. The methods the authors use are sound; their conclusions valid, if perhaps in need of further justification. My main concern with the impact of this paper lies in its misinterpretation by the media. Already, I have seen one newspaper report (The Independent on Sunday August 21st, 2011 “Twenty Holiday Myths Exposed”) which erroneously stated “Research published last week suggested mosquito nets were not as effective as previously believed.”

I can only assume they are referring to the Trape paper; this is patently not the conclusion the scientists come to. Rather, they state that in one area of high malaria endemicity, bednets may reduce immunity, leaving people more vulnerable later, and secondly, that LLINs may result in increased resistance to insecticides in mosquitoes.

The authors make no statement about the efficacy of bednets in preventing infection. Moreover, the use of bednets in a highly endemic area, where people have no other option for malaria prevention, is a very different situation than what travelers face, visiting a malarial area for a matter of days or weeks, armed in conjunction with prophylactic medication and insect repellant sprays. The Independent‘s ignorant throw-away statement may encourage travelers to forsake bednets, which still are a key way of preventing malaria infection, thus leaving themselves at greater risk. I am sure Trape and his colleagues did not intend for this to be a consequence of their research.

Are there dietary restrictions for malaria?

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QUESTION:

What are the dietary restrictions of malaria?

ANSWER:

There are no dietary restrictions, as such, when infected with malaria. A person who is suffering from malaria will have high fevers and potentially nausea, which might decrease the appetite—it is crucially important to try to stay hydrated  by drinking lots of fluids and trying to eat when possible. Certain drinks, such as bitter lemon and tonic water, contain quinine, which has long been used as a natural remedy against malaria, and can help prevent infection with certain types of malaria, though it is far more effective to use other preventive actions, such as sleeping under an insecticide-treated bednet and/or taking prophylactic medication when in a malarial area.

What is malaria?

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QUESTION:

What is malaria?

ANSWER:

Malaria is a disease caused by parasites of the genus Plasmodium. Transmitted by mosquitoes, there are several different kinds of malaria distributed throughout the tropical and sub-tropical regions of the world, causing somewhere between 300-500 million cases of disease each year, and as many as 1 million deaths. In fact, malaria is one of the biggest killers of children under the age of five in sub-Saharan Africa, one of the regions of the world where the burden from malaria is the highest. Malaria is usually an acute disease, manifesting itself with severe fever, chills, headache and often nausea as well. Some types of malaria can have relapsing episodes over a time period of many years.

Having said this, malaria is easily preventable, through avoiding mosquito bites by wearing appropriate clothing and sleeping under insecticide-treated bednets, or through taking preventative medication (called prophylaxis). Malaria is also treatable once symptoms appear, through ingesting safe, effective and relatively cheap drugs. With such control measures at hand, you may ask why malaria is still such a huge problem in our world; the answer is that delivering control strategies and treatment to populations most at risk is difficult, and often countries with high malaria burdens don’t have efficient and effective health systems in place to coordinate control efforts.

International non-governmental organisations such as the World Health Organisation, as well as a multitude of non-profit organisations such as the Malaria Consortium and Malaria No More, work tirelessly to bring malaria control and treatment to the places that need it most, with the aim to eradicate malaria as a disease of public health importance.

 

Is malaria contagious?

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QUESTION:

Is malaria contagious?

ANSWER:

No, malaria isn’t directly contagious from one person to another. It has to be transmitted by the bite of a mosquito, which means that if someone near you has malaria, those mosquitoes that bite him are carrying the disease! So, the best way to avoid getting infected is to make sure neither you nor your brother are bitten by mosquitoes. The best way to prevent biting is by wearing long sleeved shirts and long trousers, especially during dusk, dawn and at night, when mosquitoes are most active. Similarly, you should try to sleep under an insecticide-treated bednet. These have been proven to reduce biting from mosquitoes, and therefore the transmission of malaria.

What is malaria, and how can it be cured?

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QUESTION:

What is malaria? How could we cure it?

ANSWER:

Malaria is a disease caused by parasites of the genus Plasmodium. Transmitted by mosquitoes, there are several different kinds of malaria distributed throughout the tropical and sub-tropical regions of the world, causing somewhere between 300-500 million cases of disease each year, and as many as 1 million deaths. In fact, malaria is one of the biggest killers of children under the age of five in sub-Saharan Africa, one of the regions of the world where the burden from malaria is the highest. Malaria is usually an acute disease, manifesting itself with severe fever, chills, headache and often nausea as well. Some types of malaria can have relapsing episodes over a time period of many years.

Having said this, malaria is easily preventable, through avoiding mosquito bites by wearing appropriate clothing and sleeping under insecticide-treated bednets, or through taking preventative medication (called prophylaxis). Malaria is also treatable once symptoms appear, through ingesting safe, effective and relatively cheap drugs. With such control measures at hand, you may ask why malaria is still such a huge problem in our world; the answer is that delivering control strategies and treatment to populations most at risk is difficult, and often countries with high malaria burdens don’t have efficient and effective health systems in place to coordinate control efforts.

International non-governmental organisations such as the World Health Organisation, as well as a multitude of non-profit organisations such as the Malaria Consortium and Malaria No More, work tirelessly to bring malaria control and treatment to the places that need it most, with the aim to eradicate malaria as a disease of public health importance. There are also many research groups around the world that are striving to create new, more effective medications and drugs. For some time now, there has also been work in progress trying to develop a vaccine against malaria; at this point, there has been little applied success, but with further research and efforts, an immunization against Plasmodium may be forthcoming in the future.


Can malaria kill you?

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QUESTION:

Can malaria kill you?

ANSWER:

YES! Malaria, especially of the kind caused by Plasmodium falciparum parasites, can be an extremely severe illness and even deadly. Somewhere between 700,000 and 1 million people die of malaria every year, and the majority of these are children under the age of five years old, which is the age group most susceptible to severe malaria attacks. Pregnant women are also at elevated risk, due to their compromised immune systems. Therefore, preventing malaria in young children and pregnant women is the single most effective way to reduce the number of malaria fatalities; in highly endemic areas, this is usually achieved through the distribution of insecticide-treated bednets, to sleep under at night to reduce mosquito bites, or preventative medication such as intermittent preventive therapy (IPT).

Given the seriousness of malaria, it is prudent to check with a doctor or go to hospital if you live in a malaria endemic area and come down with symptoms of the disease such as high fever, chills and nausea. The majority of malaria cases are easily treated with oral medication, given swift and accurate diagnosis.

What is malaria?

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QUESTION:

What is malaria?

ANSWER:

To answer your question, I have copied below the answer to an earlier post, published on the 1st of May, 2011, which also asked “What is malaria?”:

Malaria is a disease caused by parasites of the genus Plasmodium. Transmitted by mosquitoes, there are several different kinds of malaria distributed throughout the tropical and sub-tropical regions of the world, causing somewhere between 300-500 million cases of disease each year, and as many as 1 million deaths. In fact, malaria is one of the biggest killers of children under the age of five in sub-Saharan Africa, one of the regions of the world where the burden from malaria is the highest. Malaria is usually an acute disease, manifesting itself with severe fever, chills, headache and often nausea as well. Some types of malaria can have relapsing episodes over a time period of many years.

Having said this, malaria is easily preventable, through avoiding mosquito bites by wearing appropriate clothing and sleeping under insecticide-treated bednets, or through taking preventative medication (called prophylaxis). Malaria is also treatable once symptoms appear, through ingesting safe, effective and relatively cheap drugs. With such control measures at hand, you may ask why malaria is still such a huge problem in our world; the answer is that delivering control strategies and treatment to populations most at risk is difficult, and often countries with high malaria burdens don’t have efficient and effective health systems in place to coordinate control efforts.

International non-governmental organisations such as the World Health Organisation, as well as a multitude of non-profit organisations such as the Malaria Consortium and Malaria No More, work tirelessly to bring malaria control and treatment to the places that need it most, with the aim to eradicate malaria as a disease of public health importance.

 

What is malaria?

by

QUESTION:

What is malaria?

ANSWER:

Malaria is a disease caused by parasites of the genus Plasmodium. Transmitted by mosquitoes, there are several different kinds of malaria distributed throughout the tropical and sub-tropical regions of the world, causing somewhere between 300-500 million cases of disease each year, and as many as 1 million deaths. In fact, malaria is one of the biggest killers of children under the age of five in sub-Saharan Africa, one of the regions of the world where the burden from malaria is the highest. Malaria is usually an acute disease, manifesting itself with severe fever, chills, headache and often nausea as well. Some types of malaria can have relapsing episodes over a time period of many years.

Having said this, malaria is easily preventable, through avoiding mosquito bites by wearing appropriate clothing and sleeping under insecticide-treated bednets, or through taking preventative medication (called prophylaxis). Malaria is also treatable once symptoms appear, through ingesting safe, effective and relatively cheap drugs. With such control measures at hand, you may ask why malaria is still such a huge problem in our world; the answer is that delivering control strategies and treatment to populations most at risk is difficult, and often countries with high malaria burdens don’t have efficient and effective health systems in place to coordinate control efforts.

International non-governmental organisations such as the World Health Organisation, as well as a multitude of non-profit organisations such as the Malaria Consortium and Malaria No More, work tirelessly to bring malaria control and treatment to the places that need it most, with the aim to eradicate malaria as a disease of public health importance.