Are Anti-malaria pills necessary if no mosquito bites?

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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

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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 Australia and Bali

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QUESTION

Is Australia, Bali or Tasmania in the malaria affected area?

ANSWER

While malaria used to be endemic in parts of Australia (not Tasmania—it is too cold), the country was declared to be free of malaria transmission in 1981. However, several hundred cases are reported in Australia every year, mainly brought back by travellers returning from other regions, such as south-east Asia and Africa.

The tropical northern region of Australia, i.e. Northern Queensland and particularly the Torres Strait area, is climatically very suitable for malaria transmission, and some local outbreaks may occur. Similarly, Bali is climatically very suitable for malaria, and some transmission does occur, though not high levels. For both Bali and northern Australia, it is not usually considered necessary to take anti-malarial medication while visiting the region, but precautions should be taken against getting mosquito bites, as this is how malaria is transmitted. Such precautions include sleeping under an insecticide-treated bednet, wearing long-sleeved clothing in the evenings and at night, and wearing insect repellent on exposed skin.

Malaria in Haiti

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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).

Does Malaria Still Exist?

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QUESTION

does malaria still exist?

ANSWER

Yes, malaria still exists, and is responsible for 250 million cases of illness every year, of which about 700,000 result in death. So it is a very serious global health problem!

Some countries, such as the United States, have managed to successfully eliminate malaria through a combination of vector control strategies (i.e. spraying for mosquitoes, reducing the presence of water bodies where mosquitoes breed, etc) and better health infrastructure for diagnosis and treatment. This strategy has also been successful in other settings, such as the Mediterranean and much of the Middle East, as well as even in some high transmission tropical settings such as Malaysia (particularly in urban areas).

The widespread distribution of long-lasting insecticide treated bednets has further assisted in malaria prevention in high transmission areas. However, much of the rest of the world is still struggling to control malaria, though the number of deaths is dropping every year, and some organisations hope to reduce malaria mortality to zero by the year 2015.

If you have taken medications for malaria, please help Malaria.com by taking our Malaria Survey. Thank you!

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 Recurrence

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QUESTION

My friend suffers malaria due to plasmodium falsciparum at least every two weeks. It has been treated with coartem, artequine, artesunate+fansida, quinine/quinimax since 2004 without any relief at all. It returns a week or two later and lab tests attest to same. What else should be done?

ANSWER

It is rare for someone living in an endemic area to suffer so regularly from malaria—usually after repeated exposure the body builds up a certain level of immunity which prevents mild attacks developing into serious illness. Also, P. falciparum is not resistant to Coartem, so something else is probably going on. 

The first thing to make sure is that your friend complies fully with the medication they are given, and completes the full course of drugs. If they stop taking the pills before the full course is completed, the malaria parasite might be reduced enough for symptoms to subside and for the parasite to be undetectable in blood tests, but is still there in low numbers and so can bounce back after your friend stops taking the pills, resulting in a new bout of disease. This process is called recrudescence, and can be prevented by ensuring that the full course of medication is taken, so that ALL the malaria parasites in the blood are killed.

Otherwise, it is clear that your friend needs to take more preventative measures against contracting malaria. These include sleeping under a long-lasting insecticide-treated bednet, spraying the inside of the house with insecticides to prevent malaria mosquitoes from persisting inside and wearing long-sleeved clothing and insect repellent in the evenings and at night, when mosquitoes are biting most actively.

Your friend may also want to look into taking malaria prophylaxis (preventative medication) at times of the year when they are most at risk from infection, or if they know they will be undertaking activities that leave them vulnerable to mosquito bites (i.e. working outdoors at night for a period of time). Some anti-malarial prophylactic drugs, such as doxycycline, are readily available in most malarial countries at a very good price. However, they cannot be taken indefinitely, so for people living in endemic areas, other preventative measures should be considered first.

Malaria Test for Infant

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QUESTION

What can I do if my infant (6-12 months) gets malaria and how can I tell if they have it?

ANSWER

Your infant can easily be diagnosed by a blood test, so visit a clinic, doctor or hospital immediately. The diagnosis will either be done by looking at a thick and thin blood film under a microscope, or by a rapid diagnostic test.

It is important that a blood test is done in addition to a clinical diagnosis—the symptoms of malaria are very similar to many other infections but the treatment may vary. If found to be positive for malaria, the doctor will recommend appropriate treatment and dosage for the type of malaria they have and their weight/age.

If you live in a malarial area, it is also important to take measures to prevent malaria, such as having your child sleep under a long-lasting insecticide treated bednet, and perhaps spraying your rooms in the evening with insecticides to reduce the number of mosquitoes.

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.

Is it Common to Die of Malaria?

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QUESTION

is it common to die of malaria? Why? Why not?

ANSWER

Thankfully, these days it is not very common to die from malaria. Out of an estimated 250 million cases of malaria around the world every year, there are only about 700,000 fatalities. However, 700,000 deaths every year is still a lot!

If left undiagnosed and untreated, malaria can progress very rapidly and be a very serious disease. This is particular true of Plasmodium falciparum, a specific type of malaria which is found throughout tropical regions in South America, Africa and Asia.

It is dangerous because it reproduces very rapidly in the body and can cause red blood cells to clog up inside blood vessels in organs, restricted blood flow. When this occurs in blood vessels in the brain, the patient may suffer “cerebral malaria,” which can rapidly lead to loss of consciousness, coma and even death if not treated promptly.

The people most at risk from malaria are children under the age of 5 and pregnant women, and so it is particularly important for these people to seek medical care very quickly if they suspect they have malaria.

On a positive note, deaths from malaria are becoming less common around the world due to a number of factors. First of all, there have been many very successful prevention strategies, for example through distribution of long-lasting insecticide treated bednets to at-risk communities living in malaria endemic regions. Indoor residual spraying with insecticides have also drastically reduced the number of mosquitoes in households where this procedure has been carried out, thus reducing transmission. Moreover, improvements to point-of-care diagnostics and other health infrastructures have enabled poor people in developing countries to have access to ways in which their infections can be diagnosed, and then given the appropriate treatment. All of these measures have brought the number of annual deaths down from 1 million just a few years ago to 700,000 today.

The goal is yet more ambitious: organisations such as Malaria No More seek to eliminate deaths from malaria, all over the world, by the year 2015. So, we hope in 2015 we can add to this answer by saying it is now very rare indeed to die from malaria!