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Malaria - prevention

Published by BUPA's health information team, healthinfo@bupa.com, December 2007.

This factsheet is for people who are travelling to, or are going to live in, a country with malaria and want to know how to protect themselves against malaria.

Malaria is an infection. It's caused by a parasite called Plasmodium which is carried by a certain type of mosquito and is passed through bites.

Malaria is mainly found in tropical areas such as Sub-Saharan Africa, Central and South America, South East Asia and the Pacific islands. Over 2,000 people a year in the UK are infected with malaria while abroad.

Worldwide, more than one million people die from malaria each year.

Malaria parasite
Risk of getting malaria
Prevention
Standby treatment
Malaria and pregnancy
Malaria vaccine
Further information
Sources
Related topics

Malaria parasite

There are four different types of Plasmodium parasite that can infect people and cause malaria, they include:

Plasmodium falciparum
Plasmodium vivax
Plasmodium ovale
Plasmodium malariae

P. falciparum (the most severe form) and P. vivax are the most common infections.

It's possible to get infected with more than one type of Plasmodium parasite at once.

Do all mosquitoes carry the parasite?

Only the female of the Anopheles species of mosquito carries the malaria parasite.

The Anopheles mosquito lives in hot humid climates. Areas with significant seasonal changes are less prone to malaria as the mosquitoes cannot survive cold winters. They are also less likely to transmit the disease in temperatures under 16�C.

Risk of getting malaria

There are a number of factors that can affect your chances of getting malaria including:

your destination - whether malaria is present in the country and whether there is resistance to any antimalarial drugs
your location - whether you are in urban or remote rural areas
length of stay - the longer your trip, the greater the risk of being bitten by an infected mosquito
time of year - there are more mosquitoes in the rainy season
your means of travel - for example backpackers may be more exposed to mosquitoes than business travellers
your activities - for example if you do outdoor pursuits such as safari, particularly between dusk and dawn when mosquitoes are more likely to bite

Local immunity

People who live in an area affected by malaria may gradually build up some form of immunity as they are continuously exposed to malaria throughout their lifetime. It takes at least four to 10 years of repeated malarial infection to build immunity to it.

However, people who move away from an area where malaria infection is high lose this immunity relatively quickly. Therefore, if you revisit an area affected by malaria where you used to live, you become prone to attacks of malaria again. You should take preventative measures against malaria.

If you have children who were born in the UK and you return to an area where the risk of malaria is high, they will not have any immunity so you should take adequate preventative measures which are explained in Prevention.

Prevention

Avoiding bites

The key to preventing malaria is to prevent getting bitten. You should take precautions to avoid mosquito bites reducing your risk of getting malaria.

Use a mosquito net impregnated with permethrin insecticide, if sleeping outdoors or in an unscreened room.
Spray rooms at dusk with an insecticide and vaporise insecticides during the night.
After sunset, cover your arms, feet and legs.
Apply an insect repellent containing diethyltoluamide (DEET) to your skin and clothes. If you are allergic to DEET, lemon eucalyptus oil is an alternative.

Antimalarial medicines

There are a number of medicines that help prevent malaria, when used alongside measures to prevent bites. No antimalarial medicine is 100 percent effective, but if you take the correct medicine for your destination, and take it as prescribed, your risk of malaria will be greatly reduced. Some of the common medicines are listed below.

Chloroquine

Chloroquine (eg Avloclor or Nivaquine) has been frequently used in the past but there is increasing resistance to it. This means that the medicine may not protect you from malaria in certain regions. Chloroquine may cause a mild tummy upset and headaches when taken. If you are of African descent it may make your skin itchy. Occasionally, chloroquine causes hair loss and temporary blurred vision. You shouldn't take this medicine if you have epilepsy, and it can make psoriasis worse.

Proguanil

Proguanil (Paludrine) may be used as an alternative to chloroquine in malarious areas where there is no resistance to chloroquine. Progaunil is rarely used on its own as there is also widespread resistance to it. Common side-effects include a mild tummy upset and mouth ulcers.

Chloroquine plus proguanil

Chloroquine plus proguanil is a combination treatment that can protect you in areas where there is limited-to-moderate chloroquine resistant malaria. Mouth ulcers are more common with this combination than if you take proguanil alone.

Atovaquone plus proguanil

Atovaquone plus proguanil (Malarone) is a combination medicine. It's a suitable alternative to mefloquine and doxycycline for areas where there is significant chloroquine resistance (eg much of Sub-Saharan Africa). At present Malarone is not licensed in the UK for trips lasting longer than 28 days. However, current UK guidelines suggest that three months use is acceptable. Side-effects include headaches and tummy upsets.

Mefloquine

Mefloquine (Lariam) is an effective antimalarial for areas of highly chloroquine resistant malaria. Mefloquine is a prescription only medicine and is not suitable for everybody - ask your doctor or a travel health adviser whether it's appropriate for you. Some people have reported a temporary problem which interferes with the way the brain works (neuropsychiatric disorder), causing symptoms such as anxiety and depression. You shouldn't take it if you have experienced a psychiatric illness in the past or have epilepsy. Common side-effects include dizziness, headache, tummy upsets and sleep disorders.

Doxycycline

Doxycycline (Vibramycin) is an alternative to Mefloquine or Malarone if you are going to areas where there are high levels of chloroquine resistance. It can cause diarrhoea, thrush and heartburn. Doxycycline may also make your skin more sensitive to the sun so use high factor sun screens. If you take the combined oral contraceptive pill you should take extra contraceptive precautions for the first month of taking doxycycline. Children under 12 years of age shouldn't take doxycycline.

You can buy some antimalarial medicines at pharmacies without a prescription. Some require a private prescription that you can get from your GP or a travel clinic doctor before getting them from a pharmacy. It's important to ask your doctor or pharmacist about which antimalarial medicine you should take to ensure you are taking the correct medicine to help protect you.

Usually, you start a course of antimalarial tablets a few days or a week before your trip and you will then continue to take them during, and for up to one month after, your trip abroad. Children may need a lower dose than adults, you will need to know how much they weigh to be able to find out the correct dose from your pharmacist.

Using antimalarials long-term

Many of the antimalarial medicines may be taken for extended periods. For example, there is no specific time limit for taking proguanil, you should be able to take it for several years.

If you are in a region where the risk of malaria is only high during the rainy season you may be able to tailor your antimalarials around the seasons. Ask your doctor for more advice.

Standby treatment

This is recommended for people who are taking antimalarial medicines and are visiting an area where they are unlikely to be within 24 hours of medical attention. This is used if you develop symptoms of malaria while taking antimalarials. You will need clear instructions about the standby treatment, its side-effects and when to take it. Ask your doctor or pharmacist for more advice.

Malaria and pregnancy

Ideally, you shouldn't travel to an area where there is a risk of malaria if you are pregnant. The same applies to infants and young children. Pregnant women and infants are at greater risk of severe malaria.

If travel is unavoidable, it's essential that you take strict precautions to avoid mosquito bites and take preventative medicines. Ask your doctor or travel health advisor for advice about which antimalarial medicines to take, as not all are suitable if you are pregnant or planning to conceive.

Malaria vaccine

At present there isn't a malaria vaccine available. Researchers are currently developing vaccines to prevent malaria.

Further information

Department of Health
020 7210 4850
www.dh.gov.uk
Health Protection Agency
www.hpa.org.uk

Sources

Eddleston M, Pierini S. Oxford Handbook of Tropical Medicine. Oxford: Oxford University Press, 1999:20-45.
Guidelines for malaria prevention in travellers from the United Kingdom. Health Protection Agency. 2007.
www.hpa.org.uk
accessed 7 June 2007
Malaria. World Health Organisation
www.who.int
accessed 7 June 2007
PRODIGY Guidance - Malaria prophylaxis. Background information UK Department of Health. PRODIGY
www.cks.library.nhs.uk
accessed 7 June 2007
Simon C, Everitt H, Kendrick T. Oxford Handbook of General Practice. Oxford: Oxford University Press, 2005:507
Vaccines for preventing malaria. The Cochrane Collection.
www.cochrane.org
accessed 18 June 2007