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.

Meaning of DDR

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QUESTION

what’s the meaning of DDR?

ANSWER

Within the context of malaria and health more generally, “DDR” often refers to “Drug Development Research,” meaning investigation of new anti-malarial compounds, both for malaria prevention (prophylaxis) and treatment.

However, in some health contexts (for example recreational drugs) it can also mean “Drug Demand Reduction,” which is very different. Therefore the specific program in question may determine the meaning of the acronym.

Passing Malaria to Baby

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QUESTION

I contracted Malaria 3.5 years ago (either in Uganda or Rwanda). I believe it was the Plasmodium falciparum strain. Upon my diagnosis, I was treated and have been healthy since.

In regards to pregnancy, is it safe for me to have a baby? What are the chances of passing the malaria virus to the baby?

ANSWER

First of all, malaria is caused by a single-celled parasite, not a virus.  Secondly, you probably don’t have to worry—malaria is only very rarely transmitted directly between a mother and her unborn baby, via infected red blood cells passing through the placenta. When I say rare, I mean very rare, especially in developed countries without endemic transmission. There are only 48 cases of this occurring in the United States in the last 60 years, for example. Moreover, this can only occur if you actually have malaria during the pregnancy; if you were successfully treated when you had malaria 3.5 years ago, the parasite should no longer be present at all in your body.

P. falciparum does not lay dormant in the body, unlike some other types of malaria. The only thing to consider is if you plan to travel to malarial areas while you are pregnant – pregnancy makes women more vulnerable to malaria infection, and many forms of malaria preventative medication and treatment have not been thoroughly tested for safety in pregnant women. If you are planning on travelling to malarial areas while pregnant, it would be wise to consult with a specialist travel doctor for the most up-to-date recommendations of malaria prevention when pregnant.

Medicines to Prevent Malaria?

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QUESTION

Which medicines are used to prevent malaria?

ANSWER

There are a number of drugs used to prevent malaria infection, known as malaria prophylactic medication. These vary in terms of how they are taken, how long they are taken for, how much they cost and the typical side effects people experience while they are taking them. In addition, some are recommended more highly for certain types of malaria or certain regions of the world, due primarily to the emergence of resistance in certain areas.

The most common forms of malaria prophylaxis used are doxycycline, atovaquone/proguanil (sold under the brand name Malarone), chloroquine (sold as Aralen) and mefloquine (sold as Lariam). More information on these, on other types of prophylaxis and malaria prevention in general can be found on our Malaria Prevention page.

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.

Malaria prophylaxis

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QUESTION:

What name brand medicine should you take if you are traveling to area where malaria is present?

ANSWER:

That depends on a few factors, such as where exactly you are going, whether you have had bad experiences with any malaria preventative drugs (prophylactics) in the past, and how much money you want to spend! Common brand names of malaria prophylactic drugs include Lariam (generic name mefloquine) and Malarone (a combination of atovaquone and proguanil). Doxycycline is also a popular antimalarial, which is often sold under its generic name.

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.

Is there malaria in North America?

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QUESTION:

Are there malaria-infected mosquitoes in North America?

ANSWER:

North America is usually defined as including Canada, the United States and Mexico. Of these, Mexico has known regions of regular malaria transmission; specifically the regions bordering Guatemala and Belize in the south (Chiapas, Quintana Roo and Tabasco), rural areas in the tropical lowlands slightly further north (parts of Oaxaca, Nayarit and Sinaloa) and a very localised section of northern Mexico, located across the states of Chihuahua, Sonora and Durango. Travellers to these areas are recommended to take measures to prevent against malaria infection, such as minimising mosquito bites or taking prophylactic medication. Both P. falciparum and P. vivax are known to be transmitted in Mexico, so you should consult with a travel physician before deciding which form of preventative (prophylactic) medication to take, depending on the length of your stay, your budget and the type of malaria most commonly found in the area to which you are travelling.

Malaria was once also widespread in the southern USA, though a concerted public health campaign that started in 1947 (mainly consisting of reducing the number of mosquitoes through insecticide spraying and control of stagnant water bodies) greatly reduced transmission and led to the disease being considered eliminated by the 1950s. Occasionally, small pockets of transmission will be reported, though stringent diagnosis and treatment quickly places these outbreaks under control once more.

However, there are additional cases of malarial mosquitoes occasionally also reported even from northern parts of the United States and Canada; these are when mosquitoes are accidentally transported from malarial regions, for example in airplanes, in luggage or in shipping containers. These mosquitoes almost never transmit the disease to people, and in most temperate regions, do not live long enough to be a public health threat or to enable the persistance of the disease.

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.

Malaria in Malaysia

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QUESTION:

Is there malaria in Malaysia?

ANSWER:

Yes, there is malaria in Malaysia, although efficient vector control campaigns, alongside a well-functioning health system which effectively diagnoses and treats malaria cases has vastly reduced the transmission of the disease in peninsular Malaysia at least. Transmission is still a problem in rural, interior areas, and especially in Sabah and Sarawak.

The history of malaria control in Malaysia is actually something of a success story; back in 1961, there were over 240,000 reported cases of malaria across the country; this was reduced to about 40,000 cases by 1980, due to the measures mentioned briefly above, and in 2008, that number had further dropped to only about 7,000 cases a year.

The fatality rate of malaria in Malaysia is also very low, being about 0.09%, or about 50 deaths a year, which is a testament to the effectiveness of national health systems at monitoring for the disease. Having said that, Plasmodium falciparum, the most severe type of malaria, is present in Malaysia—it was this that was responsible for all the reported fatalities in 2008. As such, if you are visiting or living in rural regions of Malaysia, where malaria transmission still is relatively high, it is recommended that you take preventative measures against the disease, such as sleeping under an insecticide-treated bednet, or taking prophylactic (preventative) medicine. This latter measure is usually only worthwhile if you are visiting a malaria area for a relatively short time, as the drugs can be quite expensive.

If you have visited these rural areas, and have symptoms of malaria, such as fever and chills, within two weeks of returning, you should go to the hospital or visit a physician immediately for diagnosis. If it is malaria, the doctor will be able to provide you with the most appropriate medicine for the type of malaria that you have.