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.

Recurrent Malaria

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QUESTION

Malaria has been with me since the late 1980’s after 6 years in Malawi.
During the 90’s I had it twice per year in Feb and Sept. Blood tests always came up negative. Treatment was with Chloroquine, later Halafantrin and then Co Artem. 2 or 3 treatments were required as symptoms appeared 2 weeks after completion of initial treatment.

In 2004 I treated with a bodyweight specific dose of Arinate and did not have another bout until 1 week into a Southern Mozambique visit in Aug 2008. (I was on doxycycline as a prophylactic but discontinued due to it causing diarrhoea.) Treatment was with Artecospe (unsuccessful) and CoArtem (successful.) In Nov 2010 after a visit to N Botswana another bout – treated twice with CoArtem.
Sept 18 2011 it struck again. (I have not been near a malaria area since Nov 2010). CoArtem unsuccessful 3 times with Artecospe have not worked and now on Co Arinate.

Have I some resistant strain of Malaria? Does eating during a malaria bout reduce the efficacy of treatment?

ANSWER

So far, no strains of malaria have been discovered to be resistant to Coartem. Moreover, recurrent malaria is only caused by Plasmodium vivax and Plasmodium ovale—neither of these are nearly as common in Malawi as Plasmodium falciparum, which can recrudesce (parasites re-appear in the blood) if not treated appropriately but will not relapse or reoccur months or years after the initial infection—if you have tested positive for malaria in your more recent bouts of illness, you should ask your doctor whether it could be P. vivax or P. ovale.

If it is one of these two species of malaria, you should ask about the possibility of taking primaquine to kill the dormant liver stages of the parasites and prevent future recurrence. You will need to be tested for G6DP prior to being able to take primaquine.

However, since you tested negative in Malawi initially, I suspect you did not have malaria at all at that point, and should have been tested further to determine what was causing your symptoms. Moreover, chloroquine should not have been the first treatment of choice, as resistance is rife in sub-Saharan Africa.

The symptoms of malaria are notoriously non-specific and therefore diagnosis is crucial prior to treatment, as many other infections will present with similar clinical symptoms, such as fever and nausea. Therefore, if you have any further symptoms which you suspect might be malaria, please visit a doctor or travel medicine clinic straight away for a blood test. If it is not malaria, there is no point taking further doses of Coartem or other anti-malarials and further tests might reveal another diagnosis.

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.

Anti-Malarial Tablets for Kenya

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QUESTION

Which are the best tablets to take against malaria in Kenya?
Is there a malaria vaccination?

ANSWER

I’ll answer your second question first—no, there does not yet exist a commercially available malaria vaccine. Currently, one promising vaccine candidate is undergoing Phase 3 clinical trials in children in sub-Saharan Africa; recently published preliminary findings suggest that it provides roughly 50% protection against malaria.

As for which tablets you should take, there are a number of options, and choosing between them is basically a matter of personal preference. The three main kinds recommended for sub-Saharan Africa are doxycycline, atovaquone/proguanil combination (sold under the brand name Malarone) and mefloquine (sold as Lariam). These three differ in how you take them (usually once a day for doxycycline and Malarone and once a week for Lariam), how expensive they are (doxycycline is the cheapest, Malarone the most expensive) and the side effects you might experience (sun sensitivity is a big problem for some people on doxycycline, some people report hallucinations on Lariam, whereas Malarone usually has the fewest severe side effects).

If you’re not sure what’s best for you, you can always talk it over with your doctor when asking for the prescription, and they might have recommendations, based on their knowledge of your health and specific requirements.

It is worth noting that levels of chloroquine resistance are very high in sub-Saharan Africa, and so chloroquine is not recommended as a prophylactic when travelling to this region.

Malaria Treatment Time and Hiccups

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QUESTION

I am suffering from pf malaria with enlarged liver and spleen under the treatment from last one week and the abdominal pain has subsided. But I am experiencing hiccups. How long it will take for complete recovery?

ANSWER

It is a good sign that you are already feeling better following your treatment for malaria. Interestingly, hiccups have been linked to infections with parasites, including malaria; in one case, it was discovered that the treatment the patient was taking (doxycycline) had actually caused some secondary problems of the esophagus which was causing the hiccups. The patient was given medicine which treated these secondary problems and cured the hiccups. So if you continue to experience hiccups after you have completed the treatment for malaria, you should ask your doctor if it is possible to arrange for an endoscopy, to check for any secondary problems caused by the medication.

As for recovery time otherwise, you will probably feel much better as soon as the course of medication is completed. However, many malaria patients still feel fatigued for weeks or even months after they have had the disease, so full recovery can take some time.

It is important, however, to visit your doctor again if you have any recurring symptoms of malaria after you have finished the medication (such as fever or nausea) since this could indicate that the infection was not completely cured the first time; another blood test may then be required, with another course of treatment if you test positive again for malaria.

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.

Drugs to Treat Pregnant Woman with Malaria

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QUESTION:

What are the drugs for a pregnant woman who has malaria for the first to third trimester?

ANSWER:

The treatment of malaria in pregnant women has become more challenging in recent years, as many types of malaria are developing resistance to the standard arsenal of drugs. In locations where the dominant form of malaria is still chloroquine-sensitive, chloroquine can be used safely throughout pregnancy.

However, given the high levels of chloroquine-resistance, other drug regimens may be required. Currently, first-line treatment options for uncomplicated malaria caused by Plasmodium falciparum (many strains of which are resistant to chloroquine), is quinine plus clindamycin (doxycycline is contraindicated in pregnant women). In the second and third trimesters, artesunate plus clindamycin can be administered, or the artemisinin-based combination therapy (ACT) commonly used in that region, although some of these combinations, particularly those containing artemether, have limited safety testing in pregnant women. In general, the paucity of controlled, randomized trials has posed a problem to creating safe and effective recommendations for the treatment of malaria in pregnant women.

Diagnosis of malaria or another condition?

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QUESTION:

Patient is responding to malaria intravenous medicines but the blood test are not showing any strains of malaria parasites.
Is it possible it is malaria or some other disease?

ANSWER:

I’m afraid it is hard to answer this without more information regarding what steps have been taken to diagnose infection, what medication is being given, and what other clinical information is available. Intravenous medication for malaria is usually quinine or artesunate, and it is unlikely that any medical institution or practitioner would give these unless they had seen malaria on testing, as these agents are generally reserved for severe disease. Another thought is that they are using doxycycline, which is an antibiotice with a broader spectrum of use, and the patient’s improvement is due to the drug taking care of something else other than malaria (Babesia, Bartonella, Borrelia).