Is malaria a problem for a tourist in Guyana?

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QUESTION

Is malaria a problem for a tourist to Guyana?

ANSWER

Yes, malaria is something you should be aware of when travelling to Guyana. Transmission occurs in all areas under 900m in Guyana, including Georgetown. If you are visiting these areas, you should consider taking prophylactic medication to prevent malaria, such as atovaquone-proguanil (sold as Malarone), doxycycline or mefloquine (Lariam). You should also consider other preventative measures while you are there, such as sleeping under a bednet, wearing long-sleeved clothing (especially in the evenings and at night) and covering exposed skin with insect repellent.

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.

How is Malaria Treated

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QUESTION

How is malaria treated today?

ANSWER

Several different medications exist which are used for the treatment of malaria. The exact drug and method of treatment depends somewhat on the type of malaria the patient is infected with.

In most cases of non-complicated (i.e. when the patient is stable and conscious) malaria, the World Health Organisation recommends an orally-administered (in the form of solid pills) artemisinin-based combination therapy (ACT), such as Coartem (a combination of artemether and lumefantrine). Other types of medication include atovaquone-proguanil (Malarone) and sulfadoxine-pyrimethamine (Fansidar). In some locations, where chloroquine-resistance is not a problem, chloroquine can also be used as a treatment. For complicated malaria, where the patient is in a more severe state, intravenously administered quinine is usually the first-line treatment.

If diagnosed early and the patient is given appropriate medication, virtually all cases of uncomplicated malaria can be effectively treated.

Cure for Malaria

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QUESTION

Is there a cure for Malaria?

ANSWER

Yes. Several different medications exist which are used for the treatment of malaria. The exact drug and method of treatment depends somewhat on the type of malaria the patient is infected with. In most cases of non-complicated (i.e. when the patient is stable and conscious) malaria, the World Health Organisation recommends an orally-administered (in the form of solid pills) artemisinin-based combination therapy (ACT), such as Coartem (a combination of artemether and lumefantrine). Other types of medication include atovaquone-proguanil (Malarone) and sulfadoxine-pyrimethamine (Fansidar). In some locations, where chloroquine-resistance is not a problem, chloroquine can also be used as a treatment. For complicated malaria, where the patient is in a more severe state, intravenously administered quinine is usually the first-line treatment.

If diagnosed early and the patient is given appropriate medication, virtually all cases of uncomplicated malaria can be effectively treated.

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 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.

 

Which Anti Malarial for South-East Asia?

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QUESTION

We are in our 70s and will be on a cruise from Siem Reap to Ho Chi Minh. Which anti malarial would be most effective for these areas?

ANSWER

The main thing to consider when travelling to south-east Asia is that there are areas where some of the malaria is resistant to mefloquine (commonly sold as Lariam), and therefore this drug is not appropriate as an anti-malarial in these regions.

Chloroquine resistance is also rife throughout the region, although this drug is rarely used as a malaria prophylactic drug. However, apart from this, the choice of anti-malarial depends to a large extent on personal preferences.

The two main types recommended by the CDC for travel to south-east Asia are atovaquone-proguanil (marketed commonly as Malarone) and doxycycline. The former is associated with very few side effects, is taken once a day, and needs to be taken for a week after returning from the malarial area. However it is also very pricey! Doxycycline, on the other hand, is very cheap, but many people experience high sun sensitivity which can lead to severe sun burn if sufficient care is not taken. It also has to be taken for a full four weeks after returning from the malarial area.

Malaria Treatment

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Malaria can be a severe, potentially fatal disease (especially when caused by Plasmodium falciparum) and treatment should be initiated as soon as possible.

Patients who have severe P. falciparum malaria or who cannot take oral medications should be given the treatment by continuous intravenous infusion.

Most drugs used in treatment are active against the parasite forms in the blood (the form that causes disease) and include:

  • chloroquine
  • atovaquone-proguanil (Malarone®)
  • artemether-lumefantrine (Coartem®)
  • mefloquine (Lariam®)
  • quinine
  • quinidine
  • doxycycline (used in combination with quinine)
  • clindamycin (used in combination with quinine)
  • artesunate (not licensed for use in the United States, but available through the CDC malaria hotline)

In addition, primaquine is active against the dormant parasite liver forms (hypnozoites) and prevents relapses. Primaquine should not be taken by pregnant women or by people who are deficient in G6PD (glucose-6-phosphate dehydrogenase). Patients should not take primaquine until a screening test has excluded G6PD deficiency.

How to treat a patient with malaria depends on:

  • The type (species) of the infecting parasite
  • The area where the infection was acquired and its drug-resistance status
  • The clinical status of the patient
  • Any accompanying illness or condition
  • Pregnancy
  • Drug allergies, or other medications taken by the patient

If you have or suspect you have malaria, you should contact your doctor immediately.

Source: Centers for Disease Control (CDC)