Malaria

What is it?

Malaria is a serious disease caused by a parasite called Plasmodium. It is spread from person to person by mosquitoes. If it is not treated, malaria can result in severe illness and even death.

Where Is Malaria?

Malaria occurs in more than 100 countries. Nearly all tropical and developing countries pose a threat. Most popular international tourist destinations have Malaria risk. Our travel doctors can advise you of the specific risks for your trip, and the precautions you need to take.

The following map shows Malaria endemic zones, in red, around the world.

What Are The Symptoms of Malaria?

The initial symptoms can be non-specific and similar to the Flu. Other symptoms include:

• Shaking Chills
• Tiredness
• Nausea and vomiting
• Headache
• Muscle Aches

Even though you may take precautions against Malaria it is still possible to contract and so it is important to be able to diagnose it early as this can result in 100% effective treatment, but if left too late it can result in severe complications such as respiratory and kidney failure, liver problems, anemia, seizures, coma and even death.

Why Should You Care?

Malaria is a very serious illness and it is found in many popular tourist destinations.

Malaria causes over 2 million deaths a year. Several hundred cases occur in Canadian travelers each year. A few Canadians die each year.

Tourists are particularly vulnerable to severe complications because they come from non-malaria regions and so they haven't built up any natural immunity to the disease

What Can You Do To Prevent Malaria?

Malaria is not preventable by vaccination. There is no vaccine as yet.

You can protect yourself by taking precautions to prevent mosquito bites and take anti-malarial medications.

Try and avoid places when mosquitoes are most active. Damp and wooded areas are where mosquitoes live and breed.

• Reduce your outdoor exposure between dusk and dawn. This is when the female anopheles mosquito bites.
• Wear long sleeves and long pants/skirts. (if the weather allows)
• Wear light colored clothing. Dark clothing affords camouflage to the mosquito.
• Sleep under a mosquito net at night. These may be impregnated with permethrin, which further increases their efficacy.
• Use a repellent containing DEET. This is the most effective repellent. Use repellant that has a DEET concentration between 22% and 50%.
• Between dusk and dawn, apply the repellant every 5-6 hours (or earlier if needed) on all exposed areas of the skin and areas that may become exposed later on in the day.
• In regions where there is Dengue Fever apply the repellant during the day as well.
• Garlic, Vitamin B, and ultrasound/ zappers do not work.
• If sunscreen is needed, the recommendation is to apply sunscreen first, before applying the repellent.
• Clothing, shoes, bed nets, mesh jackets, and camping gear can be treated with permethrin for added protection. Permethrin should never be applied to skin, but only to clothing, bed nets, or other fabrics as directed on the product label.
• Do not use DEET on clothing. DEET can damage clothing, leather and car seats, but it is safe on human skin.
• DEET is safe in children down to two months of age.

Precautions when Using Insect Repellents

• Apply repellents only to exposed skin and/or clothing, as directed on the product label. Do not use repellents under clothing.
• Never use repellents over cuts, wounds or irritated skin.
• Do not apply repellents to eyes or mouth, and apply sparingly around ears. When using sprays, do not spray directly on face-spray on hands first and then apply to face. Wash hands after application to avoid accidental exposure to eyes.
• Do not allow children to handle repellents. When using on children, adults should apply repellents to their hands first, and then put it on the child. It may be advisable to avoid applying to children's hands.
• Use just enough repellent to cover exposed skin and/or clothing. Heavy application and saturation are generally unnecessary for effectiveness. If biting insects do not respond to a thin film of repellent, apply a bit more.
• After returning indoors, wash treated skin with soap and water or bathe. This is particularly important when repellents are used repeatedly in a day or on consecutive days. Also, wash treated clothing before wearing it again. (This precaution may vary with different repellents-check the product label.)
• If anyone experiences a rash or other bad reaction from an insect repellent, the repellent use should be discontinued, the repellent should be washed off with mild soap and water, and a local poison control center should be called for further guidance. If seeking health care because of the repellent, take the repellent to the doctor's office and show the doctor.

PREVENTION: ANTI-MALARIAL PILLS

• Anti-malarials that prevent Malaria are Doxycycline, Malarone, Chloroquine, Mefloquine and Primaquine.
• They have to be taken before, during and after the trip. Plan ahead, ideally visit our Travel Doctor a month before departure.
• Like all medications they do have side effects, however this is mostly in a small percentage of patients. The effects of Malaria are far more serious.

TREATMENT OF MALARIA

There are a few medications that would be appropriate for the treatment of malaria. In most cases, one should assume that he or she has chloroquine-resistant falciparum malaria. Remember, that potentially deadly strain! They include:

• quinine sulfate taken 3 times daily for 5 to 7 days
• Malarone - 4 tablets daily for 3 days
• Artemesinin derivatives - these medications are available throughout most of the malarious world

ACT refers to artemesinin-combined therapy, that is, a form of artemesinin in combination with a second drug, such as amodiaquine or lumefantrine. By using combination drugs, it is hoped that the inevitable drug resistance can be delayed.

There are several different preparations of artemesinin that are available under various names, including Riamet, Cotexcin, Artenam, Alaxin, Arsumax and Coartem. These drugs are widely available over there. There is some concern about counterfeit malaria drugs in Africa. Shop carefully.

A FEVER IN ANY TRAVELER TO A MALARIA ZONE , EITHER DURING THE TRIP OR IN A PERIOD OF THREE MONTHS AFTER THE TRIP, SHOULD BE PRESUMED TO BE MALARIA UNTIL PROVEN OTHERWISE