How to Prevent Malaria

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QUESTION

How to 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 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.

Malaria Treatments

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QUESTION

What are the of different types of antimalaria drugs?

ANSWER

Most drugs used in treatment are active against the parasite forms in the blood (the form that causes disease) and include:

  • chloroquine
  • atovaquone-proguanil (Malarone®)
  • artemether-lumefantrine (Coartem®)
  • artesunate-pyronaridine (Pyramax®)
  • dihydroartemisinin-piperaquine (Duo-Cotecxin®)
  • mefloquine (Lariam®)
  • quinine (given intravenously, this is recommended first-line treatment for severe, complicated malaria)
  • quinidine
  • doxycycline (used in combination with quinine)
  • clindamycin (used in combination with quinine)

All of the treatments above which combine an artemisinin-derivative (such as artemether, artesunate or dihydroartemisinin) in combination with another anti-malarial are called the artemisinin-based combination therapies (ACTs) and are collectively recommended by the World Health Organisation as the first line medication against uncomplicated malaria.

In addition, primaquine is active against the dormant parasite liver forms (hypnozoites) and prevents relapses. Primaquine should not be taken by pregnant women or by people who are deficient in G6PD (glucose-6-phosphate dehydrogenase). Patients should not take primaquine until a screening test has excluded G6PD deficiency.

How can I get malaria pills?

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QUESTION

I do have symptoms of severe malaria. How can I get malarial pills in Holland? I went to the hospital the doctors said nothing is wrong with me which is not true.

ANSWER

If you have the symptoms of severe malaria (high fever, chills, nausea, body aches) then you should go to an emergency room at a hospital immediately.

Malaria infection can be very serious if not treated promptly and with appropriate medicine. You must inform the doctors of your travel and medical history. Malaria is not transmitted in Holland so you must have been infected elsewhere.

Tell the doctors in particular if you have recently (in the past month) travelled to an area where malaria is transmitted (sub-Saharan Africa, South America, some parts of Central America, Haiti, Central Asia, South-East Asia, many of the Pacific Islands). I am certain that if you truly have the symptoms of severe malaria they will not turn you away from the hospital, and especially not if you make it clear that you may have been at risk for malaria.

However, if you have not travelled to malarial areas recently, then it is much less likely you have malaria. However, some forms of malaria can “relapse” after a long dormant period. If you have had malaria previously, and have suffered these relapses, then this is also very important information to tell your doctors.

It is important to take anti-malarial medication only if you have had a blood test to confirm that you have malaria. The symptoms are general enough that they are often mistaken for malaria when they are in fact caused by another disease. Moreover, in most parts of Europe, it is difficult to get malaria medication without a prescription.

It is very important that you visit an emergency room, hospital or your doctor as soon as possible to get tested for malaria and given the appropriate treatment if indeed you test positive for malaria.

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.

Is Malaria Fatal?

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QUESTION

Can you die from malaria?

ANSWER

Yes. If left untreated, certain types of malaria in particular can cause severe complications, and can even lead to death. Plasmodium falciparum is the most dangerous form of malaria and is responsible for 90% of the approximately 700,000 annual deaths caused by malaria.

However, P. vivax infections can also be very serious, and more recently, cases of P. knowlesi in south-east Asia have been shown to develop into severe disease very rapidly, thus making it dangerous for people who are not close to health care services and thus delay getting treatment.

The people most at risk from severe malaria are children under the age of five and pregnant women, as well as travellers to malarial areas who are not taking adequate preventative measures (such as not taking anti-malaria medication or not sleeping under a long-lasting insecticide treated bednet).

However, malaria is still dangerous to all people, so if you think you might be infected, it is crucial to seek out diagnosis immediately, so that you can be quickly given appropriate treatment. If diagnosed early, malaria is usually very easily treated and full recovery occurs quickly.