Malaria is an extremely serious disease that occurs in tropical parts of the world; the majority of cases and deaths from malaria happen in sub-Saharan Africa although you are still at risk if you are travelling to South-East Asia, the Western Pacific and the Americas.
The risk, if you contract malaria, is higher for some groups than others in that they are more vulnerable to developing severe malaria if infected. These groups include infants, children under 5 years old, people suffering from HIV or AIDS, non-immune migrants, mobile populations and travellers.
Malaria is caused by a parasite, the plasmodium parasite, of which there are a number of species although there are only five which cause malaria:
Plasmodium falciparum - this is the most common species of the malaria parasite and as a result, is the cause of most of the worldwide deaths from malaria.
Plasmodium ovale - is a relatively common species of the plasmodium parasite and tends to be found in West Africa. It can lie dormant in the liver for a number of years without exhibiting any symptoms.
Plasmodium vivax - is a species of plasmodium which is found mainly in Asia and South America. This species tends to cause milder symptoms than those seen in cases caused by Plasmodium falciparum. However, the main risk from this variety is that it can lie dormant in the liver for up to three years at which point it may cause relapses
Plasmodium malariae - this type of plasmodium is only found in Africa and is quite rare.
The variety of mosquito responsible for transmitting the parasite is the female Anopheles mosquito. This particular type of mosquito are at their most active, and most likely to bite, between dusk and dawn and so are known as ‘night biters’.
If a person who is already infected with malaria is bitten by a female Anopheles mosquito, the mosquito can then become infected and when they bite a person who is not infected with the Plasmodium parasite, that person can become infected. The parasite cannot be passed from human to human.
Once a person is bitten by the infected mosquito, the parasite enters the bloodstream and heads straight to the liver. The parasite reproduces rapidly in the liver and then in the red blood cells of the infected person. Under normal circumstances, the first symptoms of malaria will manifest in one to two weeks. The symptoms can include:
It is vital at this stage that the symptoms are treated promptly as if left untreated, malaria can result in death by infecting and destroying red blood cells and by blocking capillaries that are responsible for carrying blood to the brain and other vital organs.
For this reason, it is extremely important to protect yourself if you are planning a trip to a malaria risk area.
The first line of protection should involve avoiding as many risks of being bitten as possible. This should begin with researching the area you are planning to travel to and if it is a malaria risk area, undertake to prepare for travel in plenty of time. It is also important to make yourself aware of when in the day you are most likely to be bitten and what areas mosquitoes are more commonly found. To answer these questions, mosquitoes, as mentioned above, are night biters and so the most important time to protect yourself is from dusk to dawn. Their favourite haunts are warm, dark places in the day and they tend to live in areas where fresh or salt water is found, even fresh water rain puddles!
The next line of protection to be considered is physically preventing the mosquitoes from biting. This should include sleeping under a mosquito net, covering exposed skin with clothing thick enough that the mosquito cannot bite through it and using insect repellent at all times. In addition, keeping windows and doors shut wherever you are staying; if you can afford it, stay in air conditioned accommodation, mosquitos hate the cold!
There are a variety of prophylactic medications available, a couple that is available over the counter and a few that are only available on prescription.
There are several types of prophylactic medication for preventing malaria, should you be bitten. It is important to speak to your doctor well in advance of your trip as their advice will be invaluable in choosing which would be the best and most affordable drug for you.
Some medications are particularly recommended for use in particular countries and this is because different areas can have different types of malaria caused by different species of Plasmodium.
Your doctor will also be aware of your medical history and will be able to advise on which antimalarials will not interact with any medication you are taking.
Prophylactic medication, however, is not infallible and so the other measures to prevent being bitten which are described above must be adhered to.
This medication can be purchased over the counter as it does not need a prescription. Dosage is 1 tablet daily for adults (check the dosage for infants and children) beginning 1 - 2 days prior to travels but continuing for seven days after leaving the malaria risk area. This is suitable for last minute travel as dosing can begin a couple of days before travelling although the dose is daily and some people may find this inconvenient, Side effects from this medication are rare and it is generally well tolerated.
This medication, however, is not suitable for women who are pregnant or breastfeeding nor is it suitable for children weighing less than 5kg. In addition, a person with kidney problems cannot use this drug and it tends to be more expensive than other options.
This medication needs a prescription and dosing begins 1 - 2 days prior to travelling and it is taken daily (100mg) for adults (check the dosage for infants and children). Dosing continues on a daily basis and after leaving the area it must be continued for a further three weeks.
This is also good for last minute travellers and it is the least expensive antimalarial. As doxycycline is an antibiotic medication it may also be a useful prophylactic against bacterial infections that may arise.
The downside of this type of antimalarial is that it is not suitable is a woman is pregnant or breastfeeding and if a woman is prone to thrush type infections it may not be an advisable choice.
This medication does not need a prescription and can be bought over the counter in a pharmacy. The dosing is once per week beginning 1 week before travelling and continuing once per week whilst travelling and for four weeks after returning; the dose is 300mg for an adult, but seek advice on the dose for infants and children.
A big advantage of this type of antiviral is that it can be taken by pregnant women at any stage of pregnancy.
The downside is that Plasmodium falciparum, the most common cause of malaria, is now resistant. In addition, it can aggravate psoriasis and is no good for last minute travellers.
The weekly dose for this is 250mg orally for adults (check for infants and children) and begins 1 - 2 weeks prior to travelling, continuing for four weeks after returning from the area.
This antimalarial is also safe during pregnancy and is a good choice for long trips as the dosage is only once per week.
Parasites in some areas, however, have developed resistance to Mefloquine and in addition, it is unsuitable for people with seizure disorders, some psychiatric disorder and some heart conditions.
If you are bitten by a mosquito, all being well, the prophylactic you have chosen will protect you from contracting the disease.
The incubation period for malaria, that is, the time between being bitten and developing symptoms, is generally 7 - 30 days depending on the infecting parasite. In some cases, it can take up to one year for symptoms to appear.
As mentioned above, initial symptoms are flu-like and may be:
If you begin to manifest symptoms like this at any time up to one year after travelling to the risk area, it is important that you seek medical attention immediately because if it turns out to be malaria, it is a medical emergency and early treatment helps to ensure a positive outcome.
Drugs for emergency treatment abroad
If you are planning to travel to a remote area where it may not be possible to access medical care, it is worth discussing with your doctor whether to take with you when you travel, what is known as ‘emergency standby treatment’. This covers the eventuality that you may develop the disease in a location that has no access to emergency medical care. Based on the fact that time is of the essence in treating malaria, your doctor may describe one of the following:
I think we can be quite certain about how important it is to protect ourselves when it comes to malaria, especially when we realise that malaria is a preventable and curable disease that is one of the biggest killers of humans on earth. It is fair to say however that to those of us lucky enough to live in the western world, provided we act promptly, the outcome after contracting malaria is very positive and it can be successfully treated.
When it comes to malaria tablets on prescription, I think it is fair to say that whether they are on prescription or not, the most important thing is that the medication you choose is whatever will suit your situation best. The best way to make this decision is by taking advice from a medical professional; this can be your GP or perhaps even better, a doctor who specialises in medicine for travellers.