Know Your Malaria Risks and Preventative Medicines before Traveling

16.07.2015
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Before you go on a trip, it is important to know the risk of disease and travel vaccinations and medications recommended for the area you are visiting. In several countries, mainly those with tropical areas, risk of malaria is a serious concern. Along with your necessary travel vaccinations, we can provide malaria medications that will help to prevent contraction.

Malaria is a parasitic disease that affects millions of people every year, over 30,000 people globally as well as 1,500 American travelers. One to two million people worldwide die from malaria. Malaria is found in 102 countries, mostly in tropical or subtropical areas. The majority of cases of malaria occur in sub-Saharan Africa, although it is also common in Central and South America and Southeast Asia.

Because of the impact of malaria on travelers, it is important that all travelers:

  1. Become informed about the risk of acquiring malaria in the areas of anticipated travel.
  2. Take measures to prevent mosquito bites. This is the most important step.
  3. Take a prophylactic medication if necessary. Don’t skip prescribed doses.
  4. Know the symptoms of malaria.
  5. Seek immediate medical treatment if symptoms of malaria occur, especially if you are in, or have returned from, a country where falciparum malaria is endemic. Always consider malaria if you develop a fever after returning from a malarious area because symptoms can be delayed for weeks or months, sometimes years, after exposure – even if you took a prophylactic medication.

Malaria is caused by a parasite and is spread to humans via the female mosquito. They tend to feed in the evening and through the night, so extra precautions are needed during these times.

Although most mosquitoes are not infected, a single bite from one infected mosquito can give you the disease. If not on prophylactic medication, the disease can come on as early as 7 days after a bite. Usually you will experience symptoms within 30 days but they could show up months or even years later.

The symptoms of malaria are flu-like, but worse. You may experience a couple days of feeling poorly with the headache, loss of appetite, and a low grade fever. The acute attack has a sudden onset of chills soon followed by fever lasting 205 hours. Chest, stomach, joint, and muscle pain is common during this phase. If not treated, these attacks are recurring.

The most important preventative measure is to avoid the mosquito bite. Use repellants, such as Deet, for exposed skin, permethrin for clothing, and mosquito netting. Wear long sleeves and pants and avoid perfumes.

The four major medications used in the US for prophylaxis are chloroquine (Aralan), mefloquine, doxycycline, and Malarone (atovaquone). As chloroquine resistance is common, Malarone is the most commonly used medicine.

Malarone (atovaquone)

Packaging: each tablet has 250mg atovaquone and 100mg proguanil

Adult Dose: 1 tablet daily, starting 1-2 days before entering malarial area. Continue for one week after return. Take with food or milk. Repeat dose if vomiting occurs within 1 hour.

Prevention Effectiveness: 98%

Adverse Effects:

Frequent: nausea, vomiting, abdominal pain, diarrhea, liver enzyme elevation (transient)

Rare: seizures, rash

Precautions: Do not use with kidney failure. Do not take with gold compounds (used in some arthritic conditions). Avoid metoclopramide (Reglan), rifampin, or tetracycline.

Doxycycline

Packaging: 100mg tablet

Adult Dose: 1 tablet once daily, at the same time each day. Start 1-2 days before entering malarial area through 4 weeks after return. Take with food.

Prevention Effectiveness: >90%

Adverse Effects:

Common: photosensitivity (use sunscreen), upset stomach (take with food), & yeast infections.

Precautions: Not recommended during pregnancy, breast feeding, or in children under 8 years. Do not take dairy products within 1 hour before or after.

Aralen (chloroquine phosphate)

Packaging: 500 mg tablet has 300 mg base

Adult Dose: 1 tablet once weekly. Start 1-2 weeks before entering malarial area through 4 weeks after return. Take with food.

Prevention Effectiveness: >90%

Adverse effects:

Frequent: itching, nausea, headache

Occasional: skin eruptions

Rare: nail and mucous membrane discoloration, nerve deafness, photophobia, myopathy, retinopathy with daily use, blood problems, psychosis and seizures, hair loss

Precautions: Caution with liver disease. Avoid erythromycins and topical anesthetics.

Mefloquine

Packaging: each tablet has 250 mg base

Adult Dose: 1 tablet weekly. Start 1-2 weeks before entering malarial area through 4 weeks after return. Take with food and water.

Prevention Effectiveness: >90%

Adverse effects:

Common: transient dizziness, diarrhea, nausea, vivid dreams, nightmares, irritability, mood alterations, headaches, insomnia

Rare: seizures, psychosis, prolonged dizziness

Precautions: Not recommended for pilots, drivers, or machine operators. Not recommended in those with a history of mental illness, seizures, or heart problems. Caution recommended for SCUBA divers.

Remember, missing doses or stopping early can result in contracting malaria. You can contract malaria even with use of medication, so any malaria-like symptoms after traveling to an infected area should receive medical evaluation as soon as possible. Contact us for more information about malaria and preventative medications as well as travel vaccinations required for your destination. We offer consultation about travel vaccinations and have several common travel vaccinations available at our Vancouver, WA location.

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