Health Centres - Prevention of malaria
Malaria is a serious disease, which in the worst case may be fatal. It is widespread in tropical and subtropical areas.
From a global viewpoint, malaria constitutes an enormous health problem, with 500 million new cases a year. In the UK about 2500 people return home every year with the disease, and an average of 12 people die each year.
Prevention requires A, B, C and D:
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Awareness of risk.
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Bite avoidance.
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Chemoprophylaxis (taking preventive medicines if you are travelling to or living in a malaria region).
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Diagnosis made promptly with early treatment of an infected case.
Awareness of risk
The risk of being bitten by a mosquito and the type of malaria transmitted varies, depending on the country you are visiting and the time of year. Measures to avoid bites should always be taken, and if malaria is prevalent in an area you are travelling to, you should always take preventive medicine.
Areas of greatest risk are those where there is a high prevalence of multi-resistant
The Public Health Laboratory Service (PHLS) Malaria Reference Laboratory produces guidelines for UK travellers, based on the current risk of contracting malaria in particular areas of the world. There are guidelines on risk and preferable preventive regimens for each of the regions described below.
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North Africa and the Middle East.
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Sub-Saharan Africa.
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South Asia.
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South East Asia.
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Oceania.
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Latin America and the Caribbean.
For specific guidelines about the risks and recommendations for each individual country, talk to your pharmacist, doctor or travel health clinic.
For optimal prevention of malaria, protection from mosquito bites is essential, even if you are taking preventive medicines.
Avoid mosquito bites
Mosquitoes bite particularly at twilight and at night, so you should take most precautions during this time.
Spray the room with an insecticide before entering to kill any mosquitoes that have got inside during the day.
Otherwise, you should use a mosquito net around your bed, impregnated with an insecticide such as pyrethrum (a harmless substance manufactured on the basis of extract of chrysanthemum) or permethrin.
Long trousers, long-sleeved clothing and socks thick enough to stop the mosquitoes biting will also protect you, and should be worn outside after sunset. However, it may be hard to follow such advice in a hot climate. Light colours are less attractive to mosquitoes.
Use mosquito repellent cream
Mosquito repellent containing diethyl toluamide (DEET) is recommended as the most effective form of bite-preventive treatment. It has an excellent safety profile in adults, children and pregnant women.
It's important that the manufacturer's recommendations are not exceeded, particularly when using it on small children. Insect repellents containing over 30 per cent DEET will effectively repel mosquitoes when applied to exposed skin.
Other products are less effective, but may have some use. Lemon scent was found to protect citrus groves from mosquitoes, and refined lemon eucalyptus oil on skin also repels mosquitoes.
Mosquito nets
When sleeping outdoors or in an unscreened room, have an insecticide-treated mosquito net around your bed. This significantly reduces the risk of bites.
The net should be small-meshed, with no holes, and tucked in under the bottom sheet. During the day, it should be rolled up, so mosquitoes and other insects can't get inside while it's not in use.
Take your own net with you. You can't always expect to find an impregnated net at your destination.
Impregnation lasts from six months to one year, depending on how much the net is used and whether you pack it away in a plastic bag when you return from the tropics. Just remember not to wash the net in between re-impregnation with the insecticide!
Preventive medicines
Taking medicines to prevent malaria is essential if you are visiting an area where malaria is prevalent. The problem can be choosing the most appropriate antimalarial for the country you're visiting. You also need to take into account your individual circumstances.
Because resistance to chloroquine and other drugs is spreading, preventive (prophylactic) medicines that were effective five years ago may no longer be so.
The geographic spread of chloroquine resistance in the malarial parasite Plasmodium falciparum is increasing. It exists throughout sub-Saharan Africa, Southeast Asia, the Indian subcontinent and large portions of South America.
There are currently six drugs on the market that are licensed for preventing malaria, and the most appropriate one(s) will depend on the country you are visiting and your individual circumstances.
1 The type of malaria in the area you're visiting.
2 The risk of being bitten by a mosquito.
3 Individual considerations:
- are you pregnant?
Mefloquine
Other milder side effects include sleep disturbances and abnormal dreams. It is taken weekly and should be started two to three weeks before travelling, so that three doses have been taken before departure. This enables blood levels of the drug to reach a protective level.
More than 75 per cent of side effects will have appeared in this time if they are going to happen, allowing time to change to another antimalarial if necessary.
Mefloquine should be continued for four weeks after leaving the malarious area. It should not be taken by people with a history of psychiatric disturbances (including depression) or convulsions (eg epilepsy).
Doxycyline or Malarone are considered to be the drugs of first choice in areas where the malaria is mefloquine resistant. They are also an alternative to mefloquine in areas of high chloroquine resistance.
- are you breastfeeding?
- are you epileptic?
- is it for a child?
- are you taking other medicines?
Mefloquine
is much more effective for areas of chloroquine-resistant malaria, ie over 90 per cent in Africa. Its main side effects, such as mood changes and paranoia, have been well aired in the media.
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