Malaria Prevention

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QUESTION

What are the ways in which you can prevent yourself from being infected with malaria?

ANSWER

Malaria prevention consists of a combination of mosquito avoidance measures (since malaria is transmitted by infected mosquitoes) and chemoprophylaxis (medication to prevent the establishment of malaria in your body, if you do get bitten). Although very efficacious, none of the recommended interventions are 100% effective.

Mosquito Avoidance Measures

  • Because of the nocturnal feeding habits of Anopheles mosquitoes, malaria transmission occurs primarily between dusk and dawn.
  • Contact with mosquitoes can be reduced by remaining in well-screened areas, using mosquito bed nets (preferably insecticide-treated nets), using a pyrethroid-containing flying-insect spray in living and sleeping areas during evening and nighttime hours, and wearing clothes that cover most of the body.
  • All travelers should use an effective mosquito repellent.
  • The most effective repellent against a wide range of vectors is DEET (N,N-diethylmetatoluamide), an ingredient in many commercially available insect repellents. The actual concentration of DEET varies widely among repellents. DEET formulations as high as 50% are recommended for both adults and children older than 2 months of age (see the Protection Against Mosquitoes, Ticks, and Other Insects and Arthropods section later in this chapter). DEET should be applied to the exposed parts of the skin when mosquitoes are likely to be present.
  • In addition to using a topical insect repellent, a permethrin-containing product may be applied to bed nets and clothing for additional protection against mosquitoes.

Chemoprophylaxis

      • All currently recommended primary chemoprophylaxis regimens involve taking a medicine before travel, during travel, and for a period of time after leaving the malaria endemic area. Beginning the drug before travel allows the antimalarial agent to be in the blood before the traveler is exposed to malaria parasites.
      • Presumptive antirelapse therapy (also known as terminal prophylaxis) uses a medication towards the end of the exposure period (or immediately thereafter) to prevent relapses or delayed-onset clinical presentations of malaria caused by hypnozoites (dormant liver stages) of P. vivax or P. ovale. Because most malarious areas of the world (except the Caribbean) have at least one species of relapsing malaria, travelers to these areas have some risk for acquiring either P. vivax or P. ovale, although the actual risk for an individual traveler is difficult to define. Presumptive anti-relapse therapy is generally indicated only for persons who have had prolonged exposure in malaria-endemic areas (e.g., missionaries, volunteers).
      • In choosing an appropriate chemoprophylactic regimen before travel, the traveler and the health-care provider should consider several factors. The travel itinerary should be reviewed in detail and compared with the information on where malaria transmission occurs within a given country to determine whether the traveler will actually be traveling in a part of the country where malaria occurs and if significant antimalarial drug resistance has been reported in that location.
      • The resistance of P. falciparum to chloroquine has been confirmed in all areas with P. falciparum malaria except the Caribbean, Central America west of the Panama Canal, and some countries in the Middle East. In addition, resistance to sulfadoxine–pyrimethamine (e.g., Fansidar) is widespread in the Amazon River Basin area of South America, much of Southeast Asia, other parts of Asia, and in large parts of Africa. Resistance to mefloquine has been confirmed on the borders of Thailand with Burma (Myanmar) and Cambodia, in the western provinces of Cambodia, in the eastern states of Burma (Myanmar), on the border between Burma and China, along the borders of Laos and Burma, and the adjacent parts of the Thailand–Cambodia border, as well as in southern Vietnam.
      • Additional factors to consider are the patient’s other medical conditions, medications being taken (to assess potential drug–drug interactions), the cost of the medicines, and the potential side effects.

The medications recommended for chemoprophylaxis of malaria may also be available at overseas destinations. However, combinations of these medications and additional drugs that are not recommended may be commonly prescribed and used in other countries. Travelers should be strongly discouraged from obtaining chemoprophylactic medications while abroad. The quality of these products is not known, and they may not be protective and may be dangerous. These medications may have been produced by substandard manufacturing practices, may be counterfeit, or may contain contaminants. Additional information on this topic can be found in an FDA document

Purchasing Medications Outside the United States.

Prevention of Malaria

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QUESTION

What is the prevention of malaria?

ANSWER

Malaria prevention consists of a combination of mosquito avoidance measures and chemoprophylaxis. Although very efficacious, none of the recommended interventions are 100% effective.

Mosquito Avoidance Measures

  • Because of the nocturnal feeding habits of Anopheles mosquitoes, malaria transmission occurs primarily between dusk and dawn.
  • Contact with mosquitoes can be reduced by remaining in well-screened areas, using mosquito bed nets (preferably insecticide-treated nets), using a pyrethroid-containing flying-insect spray in living and sleeping areas during evening and nighttime hours, and wearing clothes that cover most of the body.
  • All travelers should use an effective mosquito repellent.
  • The most effective repellent against a wide range of vectors is DEET (N,N-diethylmetatoluamide), an ingredient in many commercially available insect repellents. The actual concentration of DEET varies widely among repellents. DEET formulations as high as 50% are recommended for both adults and children older than 2 months of age (see the Protection Against Mosquitoes, Ticks, and Other Insects and Arthropods section later in this chapter). DEET should be applied to the exposed parts of the skin when mosquitoes are likely to be present.
  • In addition to using a topical insect repellent, a permethrin-containing product may be applied to bed nets and clothing for additional protection against mosquitoes.

Read the full article about Malaria Prevention.

How Long Does it Take to Feel Ill from Malaria?

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QUESTION

How soon does a person usually to feel ill after malaria infection?

ANSWER

After being bitten by an infected mosquito, there is an “incubation period” before the person begins to suffer from symptoms of malaria. This time corresponds to the period the malaria parasite spends in the liver; it is once it enters the blood and begins to destroy red blood cells that initiate the onset of symptoms. The length of the incubation depends on a number of factors, including the type of malaria and whether the person has been taking anti-malarial preventative medication (prophylaxis), but the usual length of time is between 1-4 weeks.

Complete Course of Anti-Malarial Drugs

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QUESTION

Hi, I am in Goa and so far have not been bitten by anything. I am taking anti malaria tablets which I do not like. My question is this. If I do not receive any bites do I need to complete the course when I get home?

ANSWER

It is always better to complete the course of anti-malarials, just in case you actually did get bitten but just did not notice it. However, in some cases, the side-effects of anti-malarials can be uncomfortable and unpleasant, so I understand your dilemma. Just remember that there is always a risk of contracting malaria if you stop your anti-malarials early.

We at MALARIA.com are very interesting in learning about people’s experiences with anti-malarial drugs. Please take a few minutes to complete our Malaria Survey. All answers are anonymous and we will post the results on MALARIA.com.

US Army Doctor William Crawford Gorgas: Sent to Panama to fight Malaria

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QUESTION

What was the doctor’s name who was sent to Panama to fight Malaria when Panama Canal was being built?

ANSWER

I believe the person you are referring to is Dr. William Crawford Gorgas. Dr Gorgas was the chief sanitary officer for the Panama Canal project and had gained experience in controlling vector borne diseases while working in Havana, Cuba, where yellow fever was a problem.

It had also been shown a few years earlier, in 1898, that mosquitoes carried malaria as well. In Panama, Dr Gorgas focused his efforts on controlling mosquitoes, through drainage of standing water, adding larvicide and oil to remaining water and hand-collection of adult mosquitoes. In addition, Dr Gorgas screened all government buildings and workers’ quarters to prevent mosquitoes from entering, and gave workers prophylactic quinine. He was assisted in these endeavours by Dr Joseph Augustin LePrince and Dr Samuel Taylor Darling; together, their efforts led to the elimination of yellow fever from the canal zone and a great decrease in the number of malaria cases, though malaria continued to be a problem throughout the construction of the Panama Canal.

Malaria in Namibia or South Africa

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QUESTION

Is there a risk of catching malaria in Namibia or South Africa

ANSWER

Yes. According to the CDC, malaria is present in the following areas of Namibia: Kunene, Ohangwena, Okavango, Omaheke, Omusati, Oshana, Oshikoto, and Otjozondjupa and the Caprivi Strip. In addition, malaria is present in South Africa in northeastern KwaZulu-Natal Province as far south as the Tugela River, Limpopo (Northern) Province, and Mpumalanga Province. It is also present in Kruger National Park.

If you are visiting these areas, it is recommended you take prophylactic medication (such as doxycycline, mefloquine or atovaquone-proguanil) and sleep under a bednet. Other preventative measures against mosquito bites, such as wearing long-sleeved clothing and insecticide on exposed skin (especially in the evenings and at night) are also recommended.

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.

Repellent for Malaria Mosquitos

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QUESTION

My daughter is leaving for Africa for 5 weeks on a mission trip. Is there a repellent that can be used to ward off these infected mosquitos? Also what can she do to stay safe and protected?

ANSWER

There is no way of warding off only those mosquitoes that are infected with malaria. However, insect repellents which contain DEET (10% or higher) are the most effective against the species of Anopheles mosquito that carry malaria.

From personal experience, I can tell you that “natural” insect repellants that do not contain DEET are just not as effective against these mosquitoes. Your daughter can also spray her clothing with permethrin, which repells insects, and she should wear long-sleeved clothing in the evenings, early mornings and at night, when the malaria mosquitoes are most active. She should also try to sleep every night under a long-lasting insecticide treated bednet, which drastically reduces the number of bites.

In addition, your daughter should look into taking anti-malarial preventative medication, known as malaria prophylaxis. There are a number of different types; the two most commonly recommended for Africa are doxycycline (cheap, effective, but can cause sun sensitivity and so people taking it must be vigilant about using sun block! It also needs to be taken for four weeks after leaving the malarial area) and atovaquone-proguanil (sold as Malarone—this is effective, and has very few side effects, but is often very expensive. It only needs to be taken for a week after returning home), both of which are taken as a daily pill with food.

Malaria in Thailand: Phrae and Nan

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QUESTION

We are traveling in Phrae and Nan (in Thailand) in the period of December-Januar. Is there any risk for malaria. We are travelling with kids (9 months, 6 and 8 year) and want to avoid risky areas. Can we travel safely in that region? Thank you for your reply.

ANSWER

Thanks for your question. Phrae and Nan are two districts in northern Thailand—the latter shares a border with Laos. While most of the very touristy destinations in Thailand (i.e. Bangkok and the coastal regions) are considered to have very low levels of malaria, and perhaps no transmission at all, I’m afraid that the areas bordering Laos, Myanmar and Cambodia do have malaria and so if you visit, you should take appropriate preventative precautions.

It is worth noting that some parts of Thailand are known to have mefloquine (sold as Lariam) and chloroquine resistant strains of malaria, although I have just looked it up and it doesn’t appear that Phrae and Nan are within these regions. However, it would still be worth seeing a physician or visiting a travel clinic to get specific advice for your family, and particularly what anti-malarials are appropriate for your children—a lot of that will depend on personal preference, such as how frequently you are comfortable taking medication and also how much you are prepared to spend.

Some, such as Lariam, are also frequently associated with side effects, which may affect your decision. If you do take anti-malarials on your trip, please take the Malaria Medication Side-effects Survey: Treatment and Prophylaxis. We are trying to collect information from travellers to record people’s experiences with the different types available.

In addition to preventative anti-malaria medication (known as prophylaxis), there are other preventative measures you can take, such as sleeping under a long-lasting insecticide-treated bednet, wearing long-sleeved clothing (especially in the evenings and at night when malarial mosquitoes tend to bite) and using insect-repellent on any exposed skin. You can also spray clothing with permethrin, a chemical which repels insects and prevents them from biting through thin cloth.

Malaria Symptoms, Cures, and Prevention

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QUESTION

What is malaria cure, prevention, symptom and course?

ANSWER

I am not sure what you mean by “course” – however, links to information on malaria treatment, prevention and symptoms can be found on the main page of our website. For your convenience, I have provided them here:

As for malaria treatment, I have copied here an earlier answer in response to a question about malaria cures:

Malaria can be cured with a number of different medications, depending on then type of malaria and how far the disease has been progressed.

For standard, non-complicated Plasmodium falciparum malaria, the World Health Organisation recommends use of artemisinin-based combination therapies (ACTs), such as Coartem. This is due to increasing levels of resistance to chloroquine in many parts of the world. Indeed, even though chloroquine is still used in many places as first-line treatment against P. vivax, P. malariae, P. ovale and P. knowlesi uncomplicated malaria, there is some evidence that resistance to this treatment is also emerging, for example in P. vivax in parts of south-east Asia.

In cases where malaria infection has progressed to a stage where oral administration of medication is not possible, or where cerebral symptoms are suspected, the usual treatment option is intravenous quinine.

In addition, P. vivax and P. ovale malaria parasites are able to produce forms (called hypnozoites) which can become dormant in liver hepatocyte cells after the blood stages of the infection have been cleared. These dormant forms can become reactivated weeks or even months or years after the initial infection, which is called a “relapse” of the infection. One drug, called primaquine, is able to kill these liver stages, and so patients with either of these types of malaria should also discuss the possibility of taking primaquine.

Apart from these first-line treatments, there are other medications which are used against malaria, both prophylactically as well as for treatment. These include orally-administered quinine, pyrimethamine, mefloquine, proguanil, atovaquone and sulfonamides.