Paludrine/Avloclor Anti Malaria Travel Pack

by

QUESTION

Is this anti malaria travel pack suitable for Borneo?

ANSWER

This kit is NOT appropriate for preventing malaria in Borneo. Avloclor contain chloroquine phosphate, and some types of malaria present in Borneo are resistant to chloroquine.

The CDC recommends that travelers to Malaysian or Indonesian Borneo should use atovaquone-proguanil (Paludrine contains proguanil, but the drug Malarone contains the combination of proguanil and atovaquone in one pill), mefloquine (sold under the brand name Lariam) or doxycycline.

Each of these different types of prophylaxis (preventative medication) has its advantages and disadvantages: Malarone is very expensive but many people consider it to have the fewest side effects; Lariam has been associated with severe side effects and is not recommended for people with a history of mental illness, but only needs to be taken once a week (the others require a daily pill); and doxycycline is cheap but may produce sun sensitivity.

When you return from your trip, please take a moment to share your experiences with anti-malarial medication by taking our malaria survey. We will compile all the results and post them on MALARIA.com, so visitors to the site can be informed about the preferences and side effects experienced by other members of the public who have used different forms of prophylaxis.

Malaria Prophylaxis in Pakistan

by

QUESTION

Do I need antimalarials if i am returning to my home country in pakistan after two years?

ANSWER

That depends on where you will be going in Pakistan and how long you are planning on staying. Malaria is a risk at all areas under 2,500m of altitude. However, antimalarials are not recommended to be taken on a long-term basis, so if you are relocating home permanently and will be in an area at risk of malaria transmission, you should look into other preventative measures. This includes sleeping under a long-lasting insecticide-treated bednet at night, which prevents infected mosquitoes from biting you, and also potentially spraying indoors to kill mosquitoes. Making sure all rooms are well-screened can also keep mosquitoes out, and wearing long-sleeved clothing and insect repellent on exposed skin will further reduce bites. If you suspect you might have malaria (for example if you experience high fever, particularly coming in cycles interspersed with chills), you should immediately visit a doctor or clinic to test for malaria, so you can receive prompt and accurate treatment.

If you are staying in Pakistan for a short period of time (< 6 weeks) you could certainly consider taking an anti-malarial drug to prevent malaria. Doxycycline, mefloquine (sold as Lariam) and atovaquone-proguanil (sold as Malarone) are all recommended as appropriate prophylactic medications against malaria in Pakistan.

Is malaria a problem for a tourist in Guyana?

by

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

by

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.

Are Anti-malaria pills necessary if no mosquito bites?

by

QUESTION

We had a weekend in the Kruger Park and all of us took anti malaria pills beforehand. None of us was bitten or even saw a mosquito, do we need to carry on taking them for so long?

ANSWER

Since you say “so long”, I assume you are either taking doxycycline or Lariam, both of which are taken for four weeks after leaving the malarial area. Unless you are experiencing severe side effects, it is always recommended to continue taking prophylactic medication for the full course, the reason being that the malaria parasite has a latent period of up to a few weeks, and the prophylactics only kill the parasite after this latent stage. Even though you didn’t see any mosquitoes, the possibility remains that you got bitten and did not notice – ultimately, you can weigh up the slight inconvenience of taking the pills for a while longer versus the slight risk, but enormous inconvenience of getting malaria!

Since you have taken malaria prophylactics, please take a moment to fill out the Malaria Medication Side-effects Survey: Treatment and Prophylaxis!

Thank you!

Post-infection Malaria Medication

by

QUESTION

My daughter has recently returned from a trip to Borneo. Even with aggressive preventive anti-mosquito behaviour (long sleeves/pants, deet applications and mosquito netting) but not anti-malarial medication, she received over 30 bites. She is now exhibiting some symptoms (body aches, headache and severe fatigue). She has an appointment at the doctors in 2 days time. Is there some kind of post-trip medication (like doxycycline) she can take as a precaution even if the malarial test comes back negative at this early of a time. Thanks.

ANSWER

The important thing to note here is that if your daughter has symptoms of malaria, then she should be diagnosed and, if positive, treated with medication aimed at curing active malaria. Doxycycline is NOT a drug used for the treatment of malaria, so there is no point taking it if she is already exhibiting symptoms.

Furthermore, some types of malaria found in Borneo (notably P. falciparum and P. knowlesi) can become more severe very quickly – 2 days may be too long to wait. If you live in an area where malaria transmission occurs, you may be able to buy a self-testing kit (also known as a rapid diagnostic test, or RDT) for malaria in a local pharmacy. Otherwise, if your daughter’s symptoms get worse, you should take her to an emergency room and explain her travel history and subsequent risk of having malaria.

There is no substitute for taking prophylactic malaria medicine; it might be that if your daughter had started taking prophylactic medicine as soon as she started receiving multiple mosquito bites, then she may have been protected to some degree. However, malaria has a latent period, and so she would have had to continue taking the medication for a period of time after returning home as well – with doxycycline, this means taking the drug for a further four weeks.

Malaria in Haiti

by

QUESTION

I just recently returned from Senegal, 60 days ago, in which I had taken Malaria medicine; Chloroquine. I am heading to Haiti in 5 days, and wondering if I am in need of taking Malaria medicine again, or was the time frame close enough that it would be fine to go without.

ANSWER

You are only protected against malaria while you are taking the anti-malarial prophylactic medicine. All of Haiti is considered at risk for malaria, and so you should talke anti-malarial medication throughout the duration of your stay, plus the required time afterwards (depending on which type of prophylactic medication you take). Chloroquine is considered suitable as an anti-malarial for Haiti, as is atovaquone-proguanil (Malarone), doxycycline and mefloquine (Lariam).

Prevention of Malaria

by

QUESTION

How do I prevent malaria?

ANSWER

There are a number of ways to prevent malaria. These can be placed into two categories: medication and vector protection.

For medication, there are drugs you can take to prevent the malaria parasite from developing after someone is bitten by an infected mosquito. These drugs are known as “chemoprophylaxis”. There are several different kinds, such as doxycycline, mefloquine (marketed as Lariam), atovaquone-proguanil (marketed as Malarone) and chloroquine – the type you use depends on the type of malaria present in the area. For example, in much of Africa and India, malaria is resistant to chloroquine, so this cannot be used as a prophylactic. In parts of Thailand, resistance to mefloquine has emerged. However, if the appropriate type of prophylaxis is used, it is very effective against malaria. The problem is that these drugs have not been tested for long-term use, can be expensive and may have side-effects. Therefore they are of limited use for people who live in areas where malaria is endemic, and are more appropriate for travellers who are in malarial areas for short amounts of time. However, anti-malarial medication may be used in a very specific way for people at particularly high-risk for malaria, such as pregnant women and young children. In these cases, the high-risk individuals receive a dose or series of doses of malaria medication in order to prevent malaria. This form of prevention is known as intermittent preventive therapy (IPT).

Vector prevention involves protecting oneself against getting bitten by mosquitoes. This can involve wearing long-sleeved clothing in the evenings and at night, when malaria mosquitoes are most active, or wearing insect repellent on exposed skin. Indoor residual spraying, whereby repellent and insecticides are sprayed inside the house, can also be used to bring down the number of mosquitoes. Another very effective technique for preventing malaria is to sleep under a long-lasting insecticide-treated bednet. The mesh acts as a barrier against the mosquitoes, and the insecticide impregnated in the mesh further repells the mosquitoes and prevents them from biting through the mesh.

Lariam Side Effects

by

QUESTION

My son is playing tennis in Rwanda, Africa. He feels terrible and I suspect it may be the Lariam. He has a fever and has been seeing stuff like snakes, etc. I am very worried as there is no doctor nearby. Is there anything to do to help him? The last Lariam he took was on Saturday.

ANSWER

Certainly Lariam is associated with some severe side effects, which include hallucinations such as that which you describe. Unfortunately, the best way to deal with the side effects of Lariam is to stop taking the drug.

If your son decides to do this, I strongly suggest he looks into taking a different malaria prophylactic for the remainder of his trip in Rwanda—doxycycline is readily available from most pharmacies in the region and is very modestly priced. Your son will probably need to take one tablet (100mg) every day (if he is under 8 years old the dosing is slightly different) and should be continued for 4 weeks after he leaves the malarial area. Side effects to look out for include severe sun sensitivity, so he should be diligent with sun block if he starts taking doxycycline.

A more expensive alternative is Malarone, which is also harder to find in Africa, but which has milder side effects and only needs to be taken for a week after returning home.

We are always very interested in our readers’ experiences with malaria preventative drugs and treatment, and we actually have a survey about malaria prophylaxis up on our home page at the moment&mdsh;please have your son take our Malaria Survey when he gets a chance.

Malaria Prevention

by

QUESTION

what is the prevention of malaria?

ANSWER

There are many ways in which to prevent malaria. I’ll break them down into three categories: 1) medical prevention, 2) protection from getting mosquito bites and 3) vector control.

1) Medical prevention

Malaria can be prevented using certain medications. Taking drugs to prevent a disease is known as “chemoprophylaxis”, and so these drugs are often referred to as “malaria prophylactics”. There are several different types of malaria prophylactic: the most common ones are chloroquine, a mix of atovaquone and proguanil (marketed as Malarone), mefloquine (marketed as Lariam) and doxycycline. The mode of taking these medications vary (Lariam is taken once a week, for example, whereas the others are usually taken once every day), and they also have different restrictions and side effects. Chloroquine is not effective in areas where local forms of malaria have become resistant, for example, and Lariam is not recommended for people with a history of mental instability, as it is known to cause hallucinations and otherwise impair consciousness. Here on Malaria.com, we are actually currently running a survey on side effects of malaria prophylactic drugs, so if you have ever taken medication to prevent malaria, please take the survey: Malaria Medication Side-effects Survey: Treatment and Prophylaxis

It is worth noting that these drugs have not been tested for long term use, plus they can be expensive if taken for an extended period of time. As such, they may not be appropriate for people living in endemic areas for malaria. However, medication can be useful for preventing malaria in high risk groups, even when they are living in a malaria endemic area. One example is the use of intermittent preventive treatment (IPT) for preventing malaria infection in pregnant women, infants and young children. For more information on this, please see the review article written by Dr Felicia Lester for this website: http://www.malaria.com/research/malaria-pregnancy-preventive-treatment

2) Protection from getting mosquito bites

This section links in with the more general vector control strategies, which will be discussed below. Since malaria is transmitted through the bite of infected mosquitoes, preventing mosquito bites is a very effective way of reducing malaria incidence. One of the most popular methods for personal protection, especially in areas where malaria is endemic, is through sleeping under a mosquito bednet. The mesh prevents mosquitoes from being able to fly close to the person sleeping; however, if there are holes in the net, or the person skin is pressed directly against the mesh, the mosquito may still be able to bite them. This is where insecticide-treated bednets come in – they are impregnated with mosquito repellents to stop mosquitoes from biting through the mesh or passing through holes. Newly developed long-lasting insecticide treated bednets (LLINs) are even more effective, in that they don’t require “re-dipping” to maintain the level of repellent in the fibres, and so can protect a person for several years without losing efficacy. These LLINs have been instrumental in reducing cases of severe and fatal malaria, especially among pregnant women and young children, who are often targeted by bednet distributors.

Other methods for preventing mosquito bites include wearing long-sleeved clothing and personal application of mosquito repellent, particular those containing a percentage of DEET, which is a very effective insecticide. These measures should be especially taken in the evening, early morning and at night, which is when the Anopheles mosquitoes that carry malaria are most active.

3) Vector control

Finally, malaria can be prevented from reducing numbers of mosquitoes directly. Some methods target the adult mosquitoes; one such initiative is indoor residual spraying (IRS), whereby the inside of a house is sprayed with an insecticide to kill mosquitoes. Twelve different insecticides are approved by the World Health Organisation for this purpose, though pyrethroids are among the most popular, as they can be used on a variety of surfaces, do not leave a visible stain and can also protect against other insect pests, such as bedbugs.

Other methods for vector control focus on other parts of the mosquito lifecycle. Mosquito larvae require stagnant freshwater for their development, so some projects have worked to eliminate standing water sources, such as unnecessary ditches and puddles, which reduces the amount of habitat available for mosquitoes to lay their eggs and sustain larvae. Other programmes have spread insecticides directly in stagnant water to kill the larvae, or sought to introduce fish or other aquatic organisms, such as copepods, which consume mosquito eggs and larvae. This latter biological control approach is popular because it can also supply an area with fish for local consumption, and doesn’t contaminate water sources with chemicals.