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Malaria - prevention

Published by Bupa's health information team, December 2009.

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 the anopheles mosquito and passed on to people through mosquito bites.

Around 1,750 people a year in the UK are infected with malaria while abroad. Worldwide, almost one million people die from malaria each year.

Malaria parasite
Immunity to malaria
Which countries have malaria?
Avoiding bites
Antimalarial medicines
Standby treatment
Malaria and pregnancy
Malaria vaccine
Questions and answers
Related topics
Further information
Sources

Malaria parasite

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

Plasmodium falciparum

Plasmodium vivax

Plasmodium ovale

Plasmodium malariae

Plasmodium falciparum is the most severe form and causes around eight out of 10 malaria infections. People aren't usually infected with more than one type of Plasmodium parasite at once.

Only female anopheles mosquitos carry the malaria parasite.

Immunity to malaria

People who live in an area with malaria may gradually build up some immunity because they are continuously exposed to the disease. It can take at least four to 10 years of repeated malarial infection to build up immunity to it.

If you move away you will lose this immunity six to 12 months after you leave. It's important that you follow the advice for malaria prevention if you go back to the affected area.

If you have children who were born in the UK and you return to an area where the risk of malaria is high, they won't have any immunity and should follow the advice for malaria prevention.

Which counties have malaria?

Malaria is mainly found in tropical areas such as sub-Saharan Africa, Central and South America, South-East Asia and the Pacific islands. Parts of Europe and the Middle East are also affected.

If you're planning on travelling to a country with malaria, talk to your GP before you leave.

Avoiding bites

The key to preventing malaria is to avoid getting bitten by mosquitoes. You're at higher risk of being bitten when:

you're on a long visit - the longer you stay, the more likely you'll be bitten
you're in a rural area or village
it's rainy season time of year - mosquitos breed in water, so there are more around when it's wet
you're staying in hostels rather than air-conditioned hotels
you're outside between dusk and dawn - peak biting time is 2 am

You should take precautions to avoid mosquito bites and reduce your risk of getting malaria.

Use a mosquito net impregnated with a pyrethroid insecticide such as permethrin over your bed at night.
Spray rooms at dusk with an insecticide and vaporise insecticides during the night.
After sunset, wear long sleeves, trousers and socks - ankles are a particular target for mosquitos.
Apply an insect repellent containing diethyltoluamide (DEET) to your skin and clothes. If you are allergic to DEET, lemon eucalyptus oil is an alternative, although it's not as effective.
Cover bedroom doors and windows with fine mesh netting.

Antimalarial medicines

There are medicines that help to prevent malaria, although you still need to follow the advice for preventing mosquito bites. No antimalarial medicine is totally effective, but your risk of malaria will be greatly reduced if you take the right medicine for your destination. Some of the common medicines are listed below.

Chloroquine (eg Avloclor, Malarivon, Nivaquine)

This medicine has often been used in the past, but in most parts of the world malaria has become resistant to it. This means that it will not protect you from malaria in most regions. The side-effects of chloroquine can include stomach pains, diarrhoea or sickness, and headache. 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 (Paludrine)

Proguanil isn't usually used on its own because there is also widespread resistance to it. However, proguanil may be an option if you're visiting an area where malaria isn't resistant to chloroquine (ie certain parts of Central and South America and the Caribbean) but there is a medical reason why you can't have chloroquine. Common side-effects of proguanil include stomach pains, diarrhoea or constipation, and mouth ulcers.

Chloroquine with proguanil

You can take both medicines together to help protect you in areas where some malaria is resistant to chloroquine. Mouth ulcers are more common with this combination than if you take proguanil alone.

Mefloquine (Lariam)

This is an effective antimalarial for areas where malaria is resistant to chloroquine. Some people taking mefloquine have emotional side-effects such as anxiety and depression. You should contact your doctor straight away if you start to feel unusually anxious, depressed, tearful or aggressive. You shouldn't take it if you've had a mental illness in the past or you have epilepsy. Other side-effects can include dizziness, headache, stomach pains, diarrhoea and sickness, and sleep disorders. It's recommended that mefloquine be taken two weeks before departure so that possible side-effects are identified. You shouldn't take mefloquine if you're pregnant and you should avoid becoming pregnant for three months after stopping the medicine.

Doxycycline (Vibramycin)

This is an alternative to mefloquine or atovaquone with proguanil (see below) for areas where malaria is resistant to chloroquine. Side-effects can include diarrhoea, thrush and heartburn. Doxycycline may also make your skin more sensitive to the sun so it's important that you use high-factor sunscreens. It can reduce the effectiveness of combined oral contraceptives so you should take extra contraceptive precautions. Children under 12 years shouldn't take doxycycline.

Proguanil with atovaquone (Malarone)

You can take this combination instead of mefloquine and doxycycline for areas where malaria is resistant to chloroquine (eg much of sub-Saharan Africa). Side-effects can include headaches and tummy upsets.

Taking antimalarial medicines

It's important to ask your GP or pharmacist which antimalarial medicine you should take. He or she will ask you about your health and any other medicines you're taking, as well as where you plan to travel and how long you'll be staying.

You can buy some antimalarial medicines at pharmacies without a prescription, but most need a prescription from your GP or a travel clinic doctor. For some antimalarial medicines you may need to pay for a prescription.

You will usually start a course of antimalarial tablets a few days or a week before your trip and keep taking them during your visit. Treatment should be continued for four weeks after leaving (except for proguanil with atovaquone (Malarone), which should be stopped one week after leaving). Children may need a lower dose than adults, and you will need to know how much they weigh to find out the correct dose from your pharmacist.

Long trips

You can take some antimalarial medicines for long periods. For example, you can take chloroquine with proguanil for over five years. You can take mefloquine for one year, and doxycycline for two years. However, proguanil with atovaquone (Malarone) is only licensed for 28 days although it has been used for up to one year with caution. You can switch to a different medicine once you've reached the time limit if you need to.

Standby treatment

Your doctor might recommend standby treatment if you're taking antimalarial medicines and visiting an area where you would not be able to get medical help within 24 hours. You can use standby treatment 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're pregnant. The same applies to babies and young children. Pregnant women and babies are at greater risk of severe malaria.

If you have to travel, it's essential that you take care to avoid mosquito bites and take malaria prevention medicines. Ask your GP or travel health advisor for advice about which medicines to take, because 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.