Malaria in Cape Verde

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QUESTION

Do you need to take Malaria Tablets in SAL Cape-Verde?

ANSWER

The risk of malaria in Cape Verde is very low. The Centers for Disease Control and Prevention in the US do not recommend taking antimalarials during visits there. In fact, the only part of Cape Verde where a few cases of malaria have been reported is Saõ Tiago Island, so if you visit there, you may just want to be careful and make sure you don’t get bitten by mosquitoes, for example by wearing insect repellent and long-sleeved clothing at night and in the evenings.

CDC Warns of Imported Malaria – U.S. Cases Reach 40 Year High

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Increase underscores importance of taking recommended medicines to prevent malaria when traveling

In 2011, 1,925 malaria cases were reported in the United States, according to data published in a supplement of the Morbidity and Mortality Weekly Report (MMWR) released today by the Centers for Disease Control and Prevention (CDC). This number is the highest since 1971, more than 40 years ago, and represents a 14% increase since 2010. Five people in the U.S. died from malaria or associated complications.

Almost all of the malaria cases reported in the U.S. were acquired overseas. More than two-thirds (69%) of the cases were imported from Africa, and nearly two-thirds (63%) of those were acquired in West Africa. For the first time, India was the country from which the most cases were imported. Cases showed seasonal peaks in January and August.

“Malaria isn’t something many doctors see frequently in the United States thanks to successful malaria elimination efforts in the 1940s,” said CDC Director Tom Frieden, M.D, M.P.H. “The increase in malaria cases reminds us that Americans remain vulnerable and must be vigilant against diseases like malaria because our world is so interconnected by travel.”

Malaria is caused by a parasite transmitted by the bite of an infective female Anopheles mosquito. In 2010, it caused an estimated 660,000 deaths and 219 million cases globally. The signs and symptoms of malaria illness are varied, but the majority of patients have fever. Other common symptoms include headache, back pain, chills, increased sweating, muscle pain, nausea, vomiting, diarrhea, and cough. Untreated infections can rapidly progress to coma, kidney failure, respiratory distress, and death.

“Malaria is preventable. In most cases, these illnesses and deaths could have been avoided by taking recommended precautions,” said Laurence Slutsker, M.D., M.P.H., director of CDC’s Division of Parasitic Diseases and Malaria. “We have made great strides in preventing and controlling malaria around the world. However, malaria persists in many areas and the use of appropriate prevention measures by travelers is still very important.”

Travelers to areas with malaria transmission can prevent the disease by taking steps such as use of antimalarial drugs, insect repellent, insecticide-treated bed nets, and protective clothing.

Travelers in the United States should consult a health-care provider prior to international travel to receive needed information, medications, and vaccines. CDC provides advice on malaria prevention recommendations on-line. If a traveler has symptoms of malaria, such as fever, headaches, and other flu-like symptoms, while abroad or on returning home, he or she should immediately seek diagnosis and treatment from a health-care provider.

Clinicians should consult the CDC Guidelines for Treatment of Malaria and contact CDC’s Malaria Hotline for case management advice, as needed. Malaria treatment recommendations can be obtained online or by calling the Malaria Hotline (770-488-7788 or toll-free at 855-856-4713).

Source: Centers for Disease Control (CDC)

Multiple Malaria Infections Each Year

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QUESTION

My name is Olumide and I live in Nigeria. I have had malaria too frequently and it’s giving me a lot of concern. I had one last August 2012 and am having another one this October as I am speaking with you. If I should count it, I’ll be having nothing less than 6 occurrences in a year. It’s always an headache induced malaria whereby after using the ACT combination recommended by WHO, two days after, am still having headache, am asthmatic though and can’t use more than Paracetamol. I am tired of all these and need your help.

ANSWER

One of the key things you should check is how you are being diagnosed with malaria—the symptoms of malaria are very general, such as headache, chills and fever. I have seen cases where people assume they have malaria and so take ACTs without getting properly diagnosed, and so they never actually go to the doctor to have their real illness diagnosed. Therefore, next time you feel sick, you should go to the doctor or to a clinic and make sure they do a proper malaria test. This will either be via taking your blood and looking at it on a slide under a microscope, or by using a drop of the blood in a rapid diagnostic test (RDT). I believe that in some parts of Nigeria, you can even buy the RDT in local pharmacies, and do the test yourself at home. Only if you test positive for malaria should you take ACTs; if the test is negative, you should go to a doctor and ask about other possible illnesses with similar symptoms (such as flu, pneumonia, etc).

At the same time, it could be that you are suffering from repeated malaria attacks, in which case you will need to improve your personal protection in order to prevent future attacks. Sleeping under a long-lasting insecticide treated bednet is crucial; you should also wear long-sleeved clothing at night and at the evening since this is when malarial mosquitoes in Africa are usually most active. You may also want to consider indoor residual spraying; this coats the inside walls of your house with insecticide, further reducing the number of mosquitoes that may bite you inside your home. For more information, please see our Malaria Prevention overview page: http://www.malaria.com/overview/malaria-prevention

Favism (G6PD Deficiency) and Malaria

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QUESTION

My son has Favism (G6PD deficient). He is going to stay for 2 years in Chad (malaria-endemic country). It is contraindicated for him to take antimalarial drugs. What can we do if he gets a malaria infection? One physician said that he can use Artelum (Artemether + Lumefantrine) for protection. Is it a right prescription?

ANSWER

Yes, you are correct that Primaquine (which along with chloroquine is used to treat people diagnosed with Plasmodium ovale or Plasmodium vivax infection) generally should not be given for people with G6PD deficiency. However, other malaria drugs are okay. The most common type of malaria in Chad is Plasmodium falciparum, and your doctor is correct is saying that  Artemether + Lumetantrine is the drug of choice to treat falciparum malaria and can be used by your son.   It is best however to take precautions against mosquito bites.  Please see more information: Malaria Prevention.

Precautions to Prevent Malaria

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QUESTION

What precautions can be taken to prevent malaria?

ANSWER

This is a common question.  Communities can try to control or eliminate mosquitoes (who when infected with the malaria parasite can bite humans and transmit the disease) by spraying with insecticide, using biological agents, or draining mosquito breeding areas.  These methods are called vector control. On a personal level, people can prevent being bitten by infected mosquitoes by screening their rooms, sleeping under long acting insecticide bednets, wearing protective clothing and using insect repellent. See: Malaria Prevention and Control for more information.

Anti Malaria Tablets – When to Start

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QUESTION

I am due to travel to South Goa on 27th October 2012. It is 9th Oct now. It says I should start taking my tablets 1 week before traveling, however I was wondering if it was okay to start taking them now so my body can get used to the side affects before I travel. I do not want to be ill all the time whilst I am away.

ANSWER

Yes, you do need to take preventive medicine against malaria when visiting India and it is best to follow instructions given by your doctor or the drug insert. For India,  the US Center for Disease Control (CDC)  recommends Malarone (Atovaquone/proguanil), Doxycycline and Mefloquine as drugs to prevent malaria.

Malarone  needs to be started 1-2 days before travel to a malarial area, taken daily and continued for 7 days after leaving the area.

Doxycycline needs to be started 1-2 days before travel, is taken daily and needs to be continued for 4 weeks after leaving malarial areas.

Mefloquine needs to be started 2 weeks before travel, is taken weekly, and needs to be continued for 4 weeks after leaving.

Chloroquine is NOT recommended for India because of resistance, so it is not effective.

What measures can local people take to limit malaria infection?

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QUESTION

What measures can local people take to limit malaria infection?

ANSWER

People living in malarial areas can do a lot to protect themselves from getting malaria.  There are community programs for vector control (to control or eliminate mosquitoes) that include draining swamps to remove mosquito breeding habitat, spraying with insecticide, and using biological control techniques. In addition, to prevent  people from getting mosquito bites,   communities can educate families to screen their windows (if possible), to sleep under long lasting insecticide treated bednets, to cover their arms and legs with clothing  and to avoid being outdoors during dawn and dusk when mosquitoes are biting. Communities can also educate people to identify signs and symptoms of malaria and to seek early treatment to avoid serious disease and possibly death.  See Malaria Prevention and Control for more information.

Bringing Malaria to the United States

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QUESTION

I was recently diagnosed with Malaria still waiting to find out what strand, but either got it in Uganda or Rwanda. I have recently came back to the states and have been bit by mosquito. I have already started to take some medication for it, but I am concerned about spreading the virus to others in the states including my family. Is it possible that if I still have the infection to spread it to others or in the states? If so what should I do.

ANSWER

There actually used to be malaria in the United States, particularly in the southern areas, but concerted mosquito control efforts as well as public health initiatives eradicated it in the 1950s. I don’t think you need to worry too much about transmitting malaria—once you are on treatment, the number of parasites in your blood drops dramatically and it becomes more difficult to transmit the parasite to a mosquito. Also, there are lots of types of mosquitoes in the US, and only those of the genus Anopheles can transmit malaria. As such, if you are concerned about spreading malaria, you should take precautions to protect yourself from mosquitoes especially at night and at dusk and dawn, as this is when Anopheles mosquitoes are most active. The type of mosquitoes which bite during the day usually belong to the genus Aedes, and cannot transmit malaria. During these high risk times of day, you should take care to wear long-sleeved clothing, and also wear insect repellent, preferably containing DEET.

Malaria Infection Even With Prevention

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QUESTION

Can you still get infected with Malaria even when taking a preventative such as doxycycline or Malarone?

ANSWER

Yes, no prophylactic medication is 100% effective though both Malarone and doxycycline are usually over 90% effective, when taken properly. It is important to make sure each tablet is taken approximately at the same time each day, and in the case of Malarone, it is important to take it with some fatty food as this assists in absorption. Conversely, doxycycline should not be taken within 6 hours of consuming dairy products, as the calcium present in milk can prevent uptake of doxycycline. For these reasons, it is important to also use other methods of preventing malaria, such as sleeping under a long-lasting insecticide treated bednet.