How to Protect from Malaria

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QUESTION

How can I protect my body from 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 travelers 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 repels the mosquitoes and prevents them from biting through the mesh.

Paludrine/Avloclor Anti Malaria Travel Pack

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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 Medicine for Pregnant Women

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QUESTION

What medicine can be given to a pregnant woman who has malaria?

ANSWER

The type of anti-malarial that should be given to a pregnant women depends on the type of malaria they have, its severity and how long she has been pregnant. Chloroquine, quinine and artemisinin-derivatives can be given during all trimesters, but in many places malaria is resistant to chloroquine.

In general, the World Health Organisation recommends ACTs (artemisinin-based combination therapies) as the first line treatment against uncomplicated malaria. Mefloquine and pyrimethamine/sulfadoxine are able to be given the second and third trimesters; again, in some areas, resistance to mefloquine has been detected. Moreover, some people are allergic to sulfas, and so pyrimethamine/sulfadoxine would not be appropriate for these patients. Primaquine, doxycycline and halofantrine are contraindicated during pregnancy.

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.

Chloroquine side-effects

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QUESTION

For about two years in the early ’90s I indulged in self-prescription of chloroquine because then, I lived in a mosquito infested environment which made me suffer constant malarial attacks. Could this be why I now suffer from severe pains around my pelvis and down my thighs to one of my knées? I make this guess as a layman because recently, following a malarial attack, I took a non-chloroquine anti-malarial and discovered that the drug also provided me with temporary relief from those pains.

ANSWER

I have not found any information that suggests pelvic/leg pain could be one such effect. In fact, the only conclusive data is on irreversible retinal damage, which is a known consequence of long-term or high dosage chloroquine use. If you have experienced difficulty reading or other visual problems, it may be worth getting screened.

Since your symptoms improved with taking another anti-malarial, it may be that you have some other infection or illness which responds to the anti-malarial drugs (which are known to be effective against other diseases – for example, artemisinin can be used to treat schistosomiasis, a parasitic worm infection). This is something you should discuss with your doctor, as chronic pelvic pain can have a variety of causes and is often misdiagnosed.

Malaria from Dominican Republic?

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QUESTION

Hi i just came back from the Dominican Republic. I started to have a mild fever, chills, muscle pains, a headache, and a cough. Today the fever and chills are gone but my cough and headache have gotten worse. It hurts my head a lot when I cough, I feel a lot of pressure in my head. Can you please tell me why my head hurts so much.  Is this a symptom of malaria? hope to hear from you guys soon thanks!

ANSWER

Headaches can be caused by many things – they are usually classified as primary (tension headaches, migraines or cluster headaches), secondary (as a side effect to some other illness or syndrome, which can very commonly be an infection or response to an allergen) and neuralgia and “other” headaches (neuralgia is inflamed nerves). Malaria, as a serious infection, can cause secondary headaches, while other symptoms include fever (usually in cycles of 2 or 3 days), chills, nausea and aches. However, these symptoms are also consistent with a wide range of other illnesses, including influenza and other common diseases. Malaria symptoms will only appear at least one week after being bitten – if you have started feeling symptoms sooner than this, then you probably don’t have malaria.

Malaria is present in the Dominican Republic, with highest transmission risk in the western part of the country, near the Haitian border. The cities of Santiago and Santo Domingo are considered very low risk for malaria. It is actually recommended that all travellers to the DR take anti-malarial medication (called prophylaxis), to protect against malaria infection. If you were taking prophylaxis, then the risk of getting malaria is very low. However, if you were visiting areas outside of these cities, were not taking anti-malaria medication and it has been at least a week since you were bitten by mosquitoes while there, it may be worth going to your doctor or a hospital to have a malaria test. If you are diagnosed with the disease, then your doctor can quickly prescribe you effective treatment, which should clear up the infection in a matter of days. The type of malaria in the Dominican Republic (Plasmodium falciparum) can be dangerous if left untreated, though in this area, it responds readily to several different drugs, including chloroquine, so treatment will be uncomplicated.

If you have taken medications for malaria, please help Malaria.com by taking our Malaria Medication Side-effects Survey: Treatment and Prophylaxis. Thank you!

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.

Prevention of Malaria

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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.

Malaria Prevention

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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.

Malaria Cure

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QUESTION

What is the cure for malaria?

ANSWER

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.

For more information, see the WHO recommendations for malaria treatment.