Malaria is widespread in many tropical
and subtropical countries. It is transmitted by the bite of an infected
female Anopheles mosquito usually between dusk and dawn, kills more people
than any other disease and is on the increase.
In the United Kingdom there are 2000 new
cases a year imported from overseas, (mostly from Africa) about 9 of whom
will die. Tablets reduce the risk but are never 100% effective, so
AVOID BEING BITTEN
Use an insect repellent
containing 30% DEET (Diethyl-Toluamide) on exposed skin and garments. It
is safe and effective.
mosquitoes are most active at night, so cover arms and legs between dusk
If your accommodation is not
air conditioned or does not have insect screens or windows which close,
sleep under a mosquito net.
Mosquito nets are more
effective if impregnated with insecticide such as permethrin. An electric
mat to vapourise insecticide overnight can help.
Scrupulously follow the
advice for taking the medication you are prescribed (see below). Many of
the cases in the UK occur due to people not continuing to take their anti-malarials
on their return to Britain.
If you develop fever or flu
like symptoms, even several months after leaving a malarious region,
see a Doctor immediately and ask if you might have malaria. The
doctor you see might not know you've been away.
If you are pregnant or
planning pregnancy or taking young children please tell your doctor.
Children require a lower dose.
period is usually 12-30 days. There are
several different strains, so symptoms vary from a recurring
flu-like illness with high fever and shaking chills to coma and rapid
death. Diagnosis is only confirmed by examining a blood smear.
Effective treatment is available if started in time.
There is no suitable inoculation as yet,
so prophylactic medication must suffice. There is rarely definitive
advice on what tablets to take for many reasons including:
Place(s) to be visited (6% of
travellers to West Africa on no medication acquire malaria each month).
Duration of visit (longer stay, bigger
Activity and mode of travel (beach,
jungle, safari, especially between dusk and dawn).
Level of drug resistance.
Type of traveller/accommodation (back
packer or business).
Time of year (worse in wet season).
Previous experience of and reactions
Current and previous illnesses (e.g.
kidney, liver, heart, psoriasis, epilepsy).
Current medication (e.g.
anti-coagulants, anticonvulsants, anticancer, antibacterial, heart
irregularities and failure, gout).
Inadequate local data.
Advice rapidly changes because:
- New areas become endemic.
- New strains of malaria emerge and also
drug resistance develops.
- New medication becomes available.
Therefore, up-to-date advice is essential, from your Occupational Health Department or the Malaria Reference
Laboratory (recorded advice) on
Usually there is a range of acceptable
options, again remembering that none are 100% effective. Many can have
adverse reactions, so this risk must be
balanced against the risk of Malaria.
Side effects of some medications preclude
their use by pilots though they may be recommended for travellers. Beware!
You may be offered one of the following
options which are acceptable for pilots.
- Proguanil (paludrine) 100mg
- 2 tablets daily
- Chloroquine (avloclor 250 mg or
Nivaquine 200mg) -
2 tablets weekly
at least 7 days before entering malarious zone, during your
stay and for 4 weeks after return.
Malarone (atovaquone 250mg and proguanil
100mg) - 1 tablet daily - from 1-2 days before entering
malarious zone, each day during your stay and for 7 days
after return. Maximum stay 28 days.
Vibramycin (Doxycycline 100mg daily) - 1
tablet daily - from 1-2 days before entering malarious zone
and continued daily until 4 weeks after
leaving malarious zone.
All have their own advantages and
- Proguanil plus chloroquine
16 tablets per week-for a 3 day stay you will need 88 tablets!
Now available in combined blister packs. Safe, but efficacy of
protection decreasing (only 70% effective in Africa a decade ago,
probably much less now). Limited value for standby roster.
For a 3 day stay you will need just 12 tablets. New, few side effects
yet reported. More effective than Proguanil and Chloroquine where the
more serious strain P.falciparum is rife. Expensive per tablet, but
compare cost for a short course.
38 tablets needed to cover a 3
day stay. 3% develop skin sensitivity to sunlight. Some indigestion.
AVOID GETTING BITTEN - TAKE MEDICATION EXACTLY AS
REPORT RELEVANT SYMPTOMS
Please also refer to our Malaria Update Article.
Airport Medical Services Limited
35 Massetts Road, Horley (Nr Gatwick), Surrey RH6 7DQ United Kingdom
Tel: +44 (0)1293 775336 Fax: +44 (0)1293 775344 email: email@example.com
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