Compared to planning your travel route, booking tickets and packing for your adventure, the topic of malaria and travel health can easily fall down your priority list but given malaria can be deadly, it’s a subject that shouldn’t be overlooked.
I’ve been considering writing an article about malaria for a while but without a medical qualification, I didn’t want to stray into this complicated territory and risk handing out bad advice. Fortunately, my travel blogger friend, Michael Huxley, also happens to be a travel nurse in England and he has kindly agreed to write this article setting out the malaria facts every traveller should know.
Malaria is one of the most underestimated, misunderstood and frequently asked about health topics for travellers, and as a travel nurse, it is one of the topics I have to deal with on a daily basis. So this article is here to turn a spotlight on this potentially fatal disease and give you all the malaria facts before you head off on your own travels.
What is malaria?
Malaria is a serious and potentially fatal disease that is transmitted by the bite of an infected female anopheles mosquito. It is caused by a parasite called Plasmodium, of which Falciparum and Vivax are the most common and dangerous in humans, which multiply in the liver and then affect red blood cells.
Fatality rates are relatively low thanks to robust medical intervention, but the fact remains that malaria is potentially lethal with on average 627,000 deaths every single year. That may technically be a low percentage compared to the 207 million cases every year, but it is still a huge number, and one that shows how important it is to protect yourself.
What are the symptoms of malaria?
The symptoms of malaria can include:
- Severe flu-like symptoms.
- Dull, muscular ache.
- Mild to severe fever.
- Diarrhoea and vomiting.
These symptoms can occur anytime from 15 days to 4 weeks after the infected bite, but have been known to occur up to a year afterwards.
These symptoms are very difficult to diagnose as malaria because they are general symptoms to so many illnesses, so it is important to seek medical attention if you get any of these symptoms any time up to a year after travelling through a high risk area.
How to protect yourself from malaria: The ABCD approach
The best way to protect yourself from malaria is to take the ABCD approach. That’s:
- Bite avoidance
- Chemophrophylaxis (the technical name for antimalarials); and
- Diagnosis (if needed)
That means first of all educating yourself as much as possible on malaria, and there is plenty of official and professional advice available from the CDC, the WHO and the NHS’ Fit For Travel website. Do your research before you travel and find out if the areas you will be heading to are a malaria risk.
Awareness: Know your malaria zones
All official health agencies give two categories for malarial zones, high risk a low to no risk. High risk means that if you get bitten, there is a high chance you will catch malaria and antimalarials are usually always advised by medical professionals in these areas. Low to no risk means that you have little to no chance of catching malaria (even though mosquitoes may still be present) and antimalarials are usually not advised for these areas.
Bite avoidance is important so make sure you wear loose, comfortable clothing that covers your skin, use 50% DEET spray and remember to reapply it intermittently and use coils and mosquito nets where appropriate. These measures are generally always advised even in low to no risk areas and even if you are taking antimalarials, as mosquitoes can also carry a number of other diseases including dengue and yellow fever.
(Indiana Jo: You can read my thoughts on the best mosquito repellents here).
Know your Antimalarials
Antimalarials are your next step for protection, and there is often a lot of confusion about these.
Chloroquine and proguanil: are used individually in regions with no or limited drug resistance. Chloroquine is 2 tablets weekly and proguanil is 2 tablets daily. Start a week before, continue when in the high risk area and for 4 weeks after leaving.
Mefloquine: is a weekly tablet, start 1-3 weeks before travelling, each week there and continue for 4 weeks after leaving the risk area.
Doxycycline: is a daily tablet, start 1-2 days before travelling and continue for 4 weeks after leaving.
Atovaquone/proguanil: is a daily tablet, start 1-2 days before entering the risk area, each day there and for 1 week after leaving.
Which antimalarial is prescribed for you will depend on a wide range of individual factors. These will be based on where you are going, how long you will spend there, what you will be doing, if the area is high or low risk and a variety of individual factors such as past medical histories, allergies and past experience with antimalarials, amongst others.
Very basically, if the area you are heading to is considered ‘high risk’ for malaria then yes, antimalarials are usually strongly advised. If you are visiting an area that is low to no risk, then antimalarials aren’t usually advised. It is that simple.
This is only one basic factor however so it is important that you talk to your travel physician or nurse about which antimalarial is right for you as an individual. Do this in good time before you actually leave for your trip, as you may need to take a tester dose.
One of the biggest problems with people taking antimalarials is the general fear mongering and misinformation on the side effects. It is common to hear someone say that they have heard horror stories about side effects and are afraid of taking the medication as a result.
All medications have side effects. All of them. It is just a matter of degree and severity. Antimalarials are no different in this respect.
It is important to remember however that The fact is antimalarials affect different people very differently. Only a small percentage display significant symptoms, and an even smaller percentage display the extreme effects of those symptoms. Most people taking antimalarials experience no symptoms at all or at the very least only mild effects.
So don’t listen to the scaremongering. Speak to a professional if you think you may need to take them.
Diagnosis: If you get sick, get help
The final way to protect yourself is to get a diagnosis quickly if you develop any symptoms of malaria such as flu-like symptoms, fever, muscle aches, chills or sweating. remember that no method is 100% foolproof, and if you start developing any symptoms at all when travelling then seek out medical attention as soon as possible.
Risk of Dengue Fever?
Since this post was written, I had the misfortune of getting dengue fever. You can read about my experience together with tips for what to do if you get it when you travel and how to avoid it.
Michael Huxley is a charge nurse by vocation, with an interest in emergency nursing and travel medicine. He has been travelling the world for the past fifteen years, and is also a published author and the founder of the Bemused Backpacker travel website.
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