Malaria Prevention Advice for Travelers
Overview - Malaria Preventions, Precaution, Causes, Vaccines and Facts:
Malaria is caused by a parasite that is transmitted from person to person by the bite of an infected Anopheles mosquito. These mosquitoes are present in almost all countries in the tropics and subtropics. Anopheles mosquitoes bite during nighttime hours, from dusk to dawn. Therefore, anti-malarial drugs are only recommended for travellers who will have exposure during evening and nighttime hours in malaria risk areas.
Symptoms of malaria include fever, chills, headache, muscle ache, and malaise. Early stages of malaria may resemble the onset of the flu. Travelers who become ill with a fever during or after travel in a malaria risk area should seek prompt medical attention and should inform their physician of their recent travel history. Neither the traveller nor the physician should assume that the traveller has the flu or some other disease without doing a laboratory test to determine if the symptoms are caused by malaria.
Malaria can often be prevented by the use of anti-malarial drugs and use of personal protection measures against mosquito bites. The risk of malaria depends on the traveller's itinerary, the duration of travel, and the place where the traveller will spend the evenings and nights.
Travel-lers can still get malaria, despite taking preventative measures. Malaria symptoms can develop as early as 6-8 days after being bitten by an infected mosquito or as late as several months after departure from a malaria area, after anti-malarial drugs are discontinued. Malaria can be treated effectively in its early stages, but delaying treatment can have serious consequences.
All travellers to areas in Africa or worldwide, where malaria is present are advised to use the appropriate drug regimen and take personal protection measures to prevent malaria.
Preventing Mosquito Bites
The best way of preventing getting malaria is prevent being bitten in the first place. One way of doing this is by going to Malaria Free Lodges, the other one is to read through this paragraph and follow the advice. In addition to using drugs to prevent malaria, travellers should use measures to reduce exposure to malaria-carrying mosquitoes, which bite during the evening and night. To reduce mosquito bites travellers should remain in well-screened areas, use mosquito nets, and wear clothes that cover most of the body. Travellers should also take insect repellent with them to use on any exposed areas of the skin. The most effective repellent is DEET (N, N-diethyl meta-toluamide) an ingredient in most insect repellents. DEET-containing insect repellents should always be used according to label directions and sparingly on children. Adults should use 30-35% DEET on exposed areas of the skin. Avoid applying higher-concentration (greater than 35%) products to the skin. Pediatric insect repellents with 6-10% DEET are available.Toxic reactions or other problems rarely develop after contact with DEET. Travellers should also purchase a flying insect-killing spray to use in living and sleeping areas during the evening and night. For greater protection, clothing and bed nets can be soaked in or sprayed with PERMETHRIN, which is an insect repellent licensed for use on clothing. If applied according to the directions, permethrin will repel insects from clothing for several weeks. Portable mosquito bed nets, DEET containing repellents, and permethrin can be purchased in hardware, backpacking, or military surplus stores.
Drugs Used in chloroquine-resistant areas
MEFLOQUINE: This drug is often marketed in the under the name Lariam™. The adult dosage is 250 mg (one tablet) once a week. Mefloquine should be taken one week before leaving, weekly while in the malaria area and weekly for 4 weeks after leaving the malaria area.
Minor side effects one may experience while taking Mefloquine include gastrointestinal disturbances and dizziness, which tend to be mild and temporary. Other minor side effects, such as nausea, dizziness, and difficulty sleeping, usually do not last long and do not require stopping the drug. Travellers who experience serious side effects should see a physician. More serious side effects at the recommended dosage have rarely occurred. Mefloquine should NOT be used by:
· travellers with a history of epilepsy or psychiatric disorder,
· travellers with a known hypersensitivity to mefloquine.
In consultation with a physician, pregnant women and children less than 30 pounds may use mefloquine, when travel to an area with chloroquine-resistant malaria is unavoidable.
DOXYCYCLINE: Travellers who cannot take Mefloquine should take Doxycycline to prevent malaria if they are traveling in a malaria area. This drug is taken every day at an adult dose of 100 mg, to begin on the day before entering the malaria area, while there, and continued for 4 weeks after leaving. If Doxycycline is used, there is no need to take other preventive drugs, such as Chloroquine.
Possible side effects include skin photosensitivity that may result in an exaggerated sunburn reaction. Wearing a hat and using sunblock can minimize this risk. Women who take Doxycycline may develop vaginal yeast infections and should discuss this with their doctor before using Doxycycline.
Doxycycline should not be used by:
· pregnant women during their entire pregnancy,
· children under 8 years of age or
· travellers with a known hypersensitivity to doxycycline
CHLORORQUINE & PROGUANIL: Chloroquine is used to prevent malaria for travellers who cannot take MEFLOQUINE or Doxycycline. Chloroquine is often marketed under the brand name Aralen™. The adult dosage is 500 mg (salt) once a week. This drug should be taken one week before entering a malaria area, weekly while there and weekly for 4 weeks after leaving the malaria area. Travellers to sub-Saharan Africa who use Chloroquine should, if possible, also consider taking simultaneously, Proguanil. The adult dose of Proguanil is 200 mg/day. Proguanil is not available in the United States, but can be purchased in Canada, Europe, and many African countries.
Rare side effects to Chloroquine include upset stomach, headache, dizziness, blurred vision, and itching. Chloroquine may worsen the symptoms of psoriasis. Generally these effects do not require the drug to be discontinued.
Drugs used for temporary self-treatment.
FANSIDAR™: Chloroquine may not prevent malaria (in areas where there is Chloroquine -resistant malaria) and travellers who use Chloroquine must take additional measures. In addition to stringent personal protection measures, they should also take with them one or more treatment doses of Fansidar™. No one with a history of Sulfa allergy should take Fansidar™. Each treatment dose for an adult consists of 3 tablets. These 3 tablets should be taken as a single dose to treat any fever during the travel if professional medical care is not available within 24 hours. Such presumptive self-treatment of a possible malaria infection is only a temporary measure; the traveller should seek medical care as soon as possible. Travellers should continue taking the weekly dose of Chloroquine after treatment with Fansidar™.
Malaria, pregnant women & children:
Malaria may pose a serious threat to a pregnant woman and her fetus. Malaria infection in pregnant women may be more severe than in non-pregnant women. Malaria may increase the risk of adverse pregnancy outcomes, including premature births, abortion, and stillbirth.
Therefore, pregnant women who are travelling to a malaria risk area should consult a physician and take prescription drugs to prevent malaria. In areas with chloroquine-resistant P. falciparum, MEFLOQUINE maybe used by pregnant women travelling to these areas. DOXYCYCLINE should not be used during the entire pregnancy. In chloroquine-sensitive areas, pregnant women should take CHLOROQUINE for malaria prevention. NEITHER mefloquine nor chloroquine HAS BEEN DEMONSTRATED TO HAVE a harmful effect on the fetus when it is used to prevent malaria.
Very small amounts of anti-malarial drugs are secreted in the breast milk of lactating women. The very small amount of drug that is transferred in breast milk is neither harmful to the infant nor does it protect the infant against malaria. Therefore, infants need to be given drugs to prevent malaria in child dosages according to recommendations for children. Each attack of malaria must be treated promptly.
All children travelling to malaria risk areas, including young infants, should take anti-malarial drugs. Therefore, the recommendations for most preventive drugs are the same as for adults, but it is essential to use the correct dosage. The dosage depends on the age and/or the weight of the child.
Overdosage of antimalarial drugs can be fatal!
MEFLOQUINE: For all children, the Mefloquine dosages are once a week. The dosage of Mefloquine depends on the weight of the child: <30lbs (13kg): 4.6 mg base (5 mg salt) per kilogram of body weight; 30-40lbs (13-18kg), use 1/4 tablet; 40-60lbs (18-27kg), use ½ tablet; 60-90lbs (27-41kg), use 3/4 tablet; 90lbs (41kg) and over, use 1 tablet.
CHLOROQUINE: For all children, the chloroquine dosages are once a week. The dosage of chloroquine depends on the weight of the child. The dosage is 8.3 mg (salt) per kilogram of body weight. In the United States, chloroquine is made only in 500mg tablets. Pharmacists can pulverize the tablets and prepare gelatin capsules with the calculated pediatric dosages. The weekly dose should be mixed in juice, jelly, or chocolate syrup to hide the extremely bitter taste.
In other countries, chloroquine is widely available as suspensions that generally contain 10 mg of Chlororquine in each ml. The dosage is usually indicated on the bottle or the package.
DOXYCYCLINE: For all children, the Doxycycline dosages are once a day. The dosage of Doxycycline depends on the weight of the child. DO NOT GIVE DOXYCYCLINE TO CHILDREN UNDER 8 YEARS OF AGE. Over 8 years of age, the dosage is 2mg/ kilogram of body weight, up to the adult dose of 100 mg daily.
Risk in northern part of country (north of 21degree latitude south).
Mefloquine (Lariam®) is the recommended drug for most travellers to risk areas.
All areas, except no risk in Addis Ababa and at altitudes higher than 2,000 meters (6,561 feet).
All areas, including game parks, except no risk in Nairobi and at altitudes higher than 2,500 meters (8,202 feet).
Mefloquine (Lariam®) is the recommended drug for most travellers to risk areas.
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