Complete Course of Anti-Malarial Drugs

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QUESTION

Hi, I am in Goa and so far have not been bitten by anything. I am taking anti malaria tablets which I do not like. My question is this. If I do not receive any bites do I need to complete the course when I get home?

ANSWER

It is always better to complete the course of anti-malarials, just in case you actually did get bitten but just did not notice it. However, in some cases, the side-effects of anti-malarials can be uncomfortable and unpleasant, so I understand your dilemma. Just remember that there is always a risk of contracting malaria if you stop your anti-malarials early.

We at MALARIA.com are very interesting in learning about people’s experiences with anti-malarial drugs. Please take a few minutes to complete our Malaria Survey. All answers are anonymous and we will post the results on MALARIA.com.

Malaria Recurrence and Treatment

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QUESTION

Since September 2011 I had malaria falciparum. The first medication I took was Coartem, after 2 weeks  I had the same symptoms then the test was +1.5 ,i took Coartem again. 2 weeks after the doctor gave me Malarone ,then 19 days it come back . the doc. gave me Quinine -tablets without doxycycline. but no thing change.

Until now each 14-25 days the malaria comes back, I ask my doctor to do any extra test or to do any thing else, but he told me that “I don’t have severe malaria.”  So why all this medication but i still sick??

On 10 feb 2012 I took Artequin. I feel better but after 15 days it came back , then I take Artequin again. I`m confused what to do?
PLEASE HELP!!!

ANSWER

I think I replied to the comment you made on the “Diagnostic Advice” Q&A post – I will copy the response I wrote there below:

It is certainly unusual to have such persistent malaria; usually Coartem cures it very quickly. Where are you obtaining your medication? It could be that the drugs you took were out of date (expired) or counterfeit; this can decrease efficacy and lead to a reduction of symptoms but not a complete cure. Also, what kind of test is your doctor using? If it is a blood smear, you might want to ask if another technician could read the slides, to double-check the diagnosis. I have seen cases elsewhere in Africa where doctors diagnose malaria by default without really examining the blood slide closely. You could try to get a malaria rapid diagnostic test; this looks for specific proteins associated with malaria infection in your blood, and can be more sensitive than blood slides. You can even perform these tests at home, so double check what the doctor tells you.

Otherwise, if you are truly getting re-infected very rapidly, you should look into more effective preventive measures against getting bitten by mosquitoes. This includes sleeping under a long-lasting insecticide treated bednet, wearing long-sleeved clothing at night and in the evenings and applying insecticide to exposed skin.

Malaria In Africa

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QUESTION

What factors cause Africans to get this disease?

ANSWER

The highest number of malaria cases every year occur in Africa, not because of anything specifically due to the people living there (in fact, they may be better protected against malaria than most—I will come onto this later) but because malaria transmission is very high in many parts of sub-Saharan Africa and sufficient preventative measures are still lacking in some places.

Malaria transmission requires specific environmental criteria, such as sufficient temperature and rainfall. These conditions are met in many countries in Africa, and unlike some other parts of the world, temperatures are suitable year-round for the development of the Anopheles mosquitoes that act as the vector for mosquito, meaning that in some places, transmission can occur throughout the year. In addition, many people do not take appropriate preventative measures against malaria; in some cases, this is due to a lack of means to buy items such as insecticide-treated bednets, and in other cases people have not been educated about the dangers of malaria or how to prevent it, so they do not know what preventative measures they should be undertaking.

Organisations such as the World Health Organisation, the US Agency for International Development, the Global Fund, the Roll Back Malaria consortium and Malaria No More are working to improve both access to preventative measures, such as bednets and indoor residual spraying, while also educating people about the need for prevention and also what to do if they suspect themselves or a family member has malaria. These efforts have already reduced the burden of malaria in Africa; the number of deaths is dropping every year, and they hope to have eliminated deaths from malaria altogether by the year 2015.

I mentioned that Africans may be better protected against malaria naturally—scientists have noted that populations living in areas with high levels of malaria have some genetic protection against infection. One example of this is the Duffy antigen. People who are negative for this gene seem to be protected against Plasmodium vivax and P. knowlesi malaria (it was originally thought they were resistant to infection, but more recent evidence from Kenya suggests in fact they still get infected, but do not get as sick). Another is the gene for sickle cell anaemia; despite causing highly debilitating and even lethal anaemia if both copies of the gene are inherited, a single copy of the gene confers strong resistance against malaria. Both of these genetic traits are highly prevalent in African populations.

In addition, early exposure to malaria results in the acquisition of immunity to infection. This, over time, Africans who survive childhood malaria go on to be less susceptible as adults. The exception to this are pregnant women; in order to support the growing foetus, a pregnant women’s immune system becomes much weaker (otherwise there is a risk of the immune system rejecting the foetus). As such, even if she had high levels of acquired immunity to malaria prior to her pregnancy, once pregnant she becomes much more susceptible. This is particularly true for a woman’s first pregnancy.

Malaria in Borneo, Indonesia

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QUESTION

We fly to Borneo tomorrow and have been very stupid not thinking about Malaria medication. Can someone quickly tell if I should take medication when there and also what type would be best to take?

Thank you for your help.

ANSWER

Yes! Malaria prophylaxis is recommended for trips to Indonesian Borneo, particularly rural areas. Recommended forms of prophylaxis are Malarone (atovaquone-proguanil), doxycycline and Lariam (mefloquine). The first is the most expensive, but has the fewest side effects, the second is the cheapest but can induce sun sensitivity and needs to be taken for 4 weeks after returning home and the third only requires one pill a week (the others are taken daily) but side effects can be severe and disturbing, including vivid dreams, impaired consciousness and hallucinations.

I am less familiar with south-east Asia, but I know in Africa doxycycline is readily available, for very little money, at local pharmacies. Therefore if you don’t have time to get the necessary anti-malarials before you leave, don’t panic! You may well be able to buy them in-country, particularly if you stop in Jakarta or another major city on your way. Check expiry dates and make sure the drugs are in the original packaging before you purchase though, as counterfeit drugs are distressingly prevalent. Also, do not buy chloroquine (or indeed any anti-malarial not listed above)—malaria in Borneo has been reported to be resistant to chloroquine and so this is not an appropriate anti-malarial for this area.

Please consider sharing your experiences with whichever prophylactic you choose when you return from your trip. We at MALARIA.com are trying to compile data on people’s experiences with malaria prophylactics and treatment medication, and we would be very grateful if you would take our malaria survey. Thank you!

Please also use other preventative measures against malaria while you are in Borneo—sleeping underneath an insecticide-treated bednet and wearing long-sleeved clothing in the evenings and at night, plus applying insect-repellent to exposed skin, can all help to reduce the incidence of mosquito bites and thus the risk of contracting malaria. Plus, avoiding insect bites will probably improve your enjoyment of the trip as a whole!

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.

Dietary recommedations

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QUESTION

Can I have the dietary recommendations please.

ANSWER

I am afraid I do not completely understand your question. There are no known dietary measures that can be used to prevent malaria infection, nor are there and recommended ways of treating malaria with common foods. In the past, people drank tonic water, which contained quinine, as a way of preventing and treating malaria. However, in modern times, tonic water contains very low levels of quinine, insufficient to protect against malaria. More effective means of prevention, such as prophylactic medication and sleeping under a long-lasting insecticide treated bednet, are recommended instead.

Malaria’s Impact on Tourism

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QUESTION

How is malaria’s impact on tourism?

ANSWER

These days, with effective preventative measures such as prophylactic medication and long-lasting insecticide treated bednets, the risk of contracting malaria as a tourist is greatly reduced. However, there is some evidence that the risk of contracting malaria is a deterrent for some tourists, particularly during high transmission periods of the year, in certain places.

For example, in South Africa, a group of researchers surveyed tourist facilities in KwaZulu-Natal and found that risk of contracting malaria was the major cause behind lack of bed occupancy. Improving tourists’ awareness of how the disease is transmitted and ways of preventing infection will go a long way to reducing the negative impact of the disease on the tourism industry in malarial countries.

Malaria Muscle Aches

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QUESTION

I am someone who has traveled to malaria-infected areas in the past and will do so again in the future. I also happen to have a form of musculr dystrophy (myotonic dystrophy type II) that, among other things, causes me to experience frequent episodes of muscular pain. Thus, the mere presence of muscle pain, in my particular case, can tell little about whether I might have malaria.

Though I do understand there are several other symptoms to look for, I also would still like to have a better understanding of what malarial muscle aches tend to feel like in the hope that this information could perhaps help me distinguish this particular form of muscle pain from the other muscle pains I already experience. For example, I have also occasionally experienced pulled muscles, or muscles that simply were overused during a recent, too prolonged session of resistance training. Thus I am familiar with how these feel and how they differ from the more usual pains caused by my muscular dystrophy. This helps me recognize what is likely causing a particular muscle pain on a particular occasion.

Can you describe malarial “muscle aches” in more detail? For example, which muscles are affected? (The muscular dystrophy tends to cause pain more often in certain muscles while others are more rarely, or not at all, affected … so this information alone could be helpful). Does the ache tend to stay in one set of muscles, or does it move around, hurting one set of muscles on Monday morning and another on Monday night, etc.? Is it a persistent, steady pain (hurting as much on Wednesday as it did on Tuesday) or does it fluctuate? Is it a sharp pain? Dull? Throbbing? What? Does moving or using the aching muscle make it hurt more? Does it come with joint pain, or not? What?

I do, of course, intend to educate myself further about malaria and am already aware of other symptoms that are more helpful for me to be aware of. (Headaches is NOT among these since I have so many of those also, but some of the other symptoms I’ve read are far more unusual for me and thus more helpful in signaling to me the possibility that I’m actually sick and not just having a “bad pain day”) But knowing more about typical malarial muscle pain would help give me an additional data point to consider.

Your assistance will be much appreciated.

ANSWER

I have checked in with one of our medical advisors here at MALARIA.com and this is what he has replied:

Unfortunately, there is no useful characterization of muscle aches associated with malaria. Malaria is not a subtle disease that needs to be detected by characterizing the location or quality of muscle pains.  The main symptoms of malaria are high fever and shivering/shaking chills.  The presence of these symptoms should prompt an evaluation for malaria.  That being said, it should not be an issue if the person takes malaria chemoprophylaxis and uses appropriate mosquito avoidance measures.

Hope that helps!

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.