What is Malaria and How is it Transmitted?
A tropical disease, malaria is widespread closer to the equator. It is a serious disease and can sometimes be fatal. The deadly parasites that cause the disease thrive in hot and humid climates, as do their carriers, the female Anopheles mosquitoes.
There are four types of malaria parasites that affect humans, Plasmodium falciparum, P. ovale, P. vivax, and P. malariae. Infections from P. falciparum are the most likely to cause severe symptoms and can have deadly consequences if it not treated promptly.
The Plasmodium parasite is transmitted from a infected mosquito to humans when the insect bites through human skin and the parasite travels into the bloodstream during feeding. The immune response kicks into high gear and can annihilate the invading parasites within half an hour. However, any surviving parasites will lodge themselves in the cells of their new host and continue to develop, eventually interfering with the host’s functioning and onset the symptoms of malaria.
Once the malarial parasite is in the red blood cells, the disease can be transmitted through blood transfusions, sharing needles or syringes contaminated with blood, and organ transplants. Another way it can be transferred from one person to another is from mother to unborn child just before or during childbirth.
What are the Symptoms of Malaria?
At first, symptoms of malaria resemble a particularly bad bout of the flu; tiredness, muscle aches, and headaches. By the time you exhibit clinical symptoms such as fever, chills, anaemia and vomiting, the parasites are in an advanced stage of growth and can alter the shape of your red blood cells.
Unlike the cold or flu, malaria is not contagious so it cannot be spread from an infection person by casual contact or by sitting next to them.
Who is at Risk of Malaria?
Just about anyone can get malaria but there are some who are more susceptible to the disease than others. Those that live in malaria endemic countries are most at risk due to exposure to the mosquitoes carrying the parasite – it is very common in many African countries south of the Sahara desert.
People with low immunity to malaria, including young children under the age of five, pregnant women and those with immunosuppressed systems are most at risk. Also, limited access to health care increases the risk of getting sick from infection.
The key points to malaria prevention are:
- Awareness of risk
- Bite prevention
- Diagnose promptly and treat without delay
Do your research and be aware of the risks in the country in which you will be travelling. Keeping the mosquitoes at bay is a vital step to preventing malaria as they won’t get the chance to infect you. Buy a potent insect repellent and apply it liberally, often.
Your medical history and travel destination will determine the vaccines and medication your doctor or pharmacist will recommend you take as a precaution against endemic parasites and diseases. When it comes to malaria, there are different preventive treatments, and which one you take can depend on which type of malarial parasite poses a risk. These include:
Antimalarials don’t give a patient 100% protection from malaria and so should be used in combination with the ABCD malaria preventive measures.
Which Antimalarial Should you Choose?
You will notice that each antimalarial treatment comes in a different strength. A higher strength does not mean that this antimalarial is more effective than another. Why? They all have different active ingredients and so cannot be directly compared on strength alone. Your choice will depend on your destination, itinerary, and duration of stay.
It’s worth noting that for Central America, each region and country will have distinct risks and antimalarial requirements. Your pharmacist, doctor or travel clinic can advise you on the medication best suited for your trip.
|Active ingredient||Doxycycline – broad spectrum antibiotic||Atovaquone/ Proguanil hydrochloride||Mefloquine hydrochloride|
|Strength||100mg||250mg / 100mg||250mg|
|Region||Africa, South & East Asia, South America||Africa, South & East Asia, South America||Africa, South & East Asia, except Thailand Myanmar and parts of Laos and Cambodia, South America|
|Directions||1-2 days before departure, continue throughout, and 28 days after leaving.||1-2 days before departure, continue throughout, and 7 days after leaving.||2-3 weeks before departure, continue throughout, and 4 weeks after leaving.|
|Once daily||Once daily with food||Once weekly with food|
|Nausea, headache, stomach pain, diarrhoea, anxiety, sensitivity to light||Nausea, headache, stomach pain, diarrhoea||Nausea, headache, stomach pain, diarrhoea, anxiety, depression, sleeping problems, dizziness, hallucinations, heart problems, unusual behaviour.|
Diagnosis and Treatment
Other than preventative measures and prophylaxis, early diagnosis can save lives. The quicker the detection, the sooner you can begin to treatment in those first critical hours. Malaria is a disease which develops rapidly and can become life-threatening if you don’t get treatment within 24 hours. If your temperature raises to the point of a fever while you are travelling, seek urgent medical attention as soon as possible.
If you develop a fever in areas that are unlikely to have urgent and prompt medical facilities and it will be more than a day by the time you see a doctor, you should carry some emergency standby treatment with you. But it is still important to reach a doctor after you have taken this treatment, and sooner rather than later.
When you get to the doctor, they will ask you many questions, particularly where you have been travelling, and for how long. You must tell your doctor that you have been abroad and the exact countries and regions you have visited or passed through, even if it was just a stop-over. Try to add as much detail of your itinerary as possible to give the doctor the best chance to assess the type of parasite that may have affected you and so the long-term treatment necessary to bring you back to full health.
If your doctor suspects that you have malaria from the symptoms exhibited, he will carry out a blood test to confirm this immediately. The parasites can be seen in the blood under a microscope – the lab will be able to tell you which class of parasite is attacking your red blood cells, the amount of the parasite present, and the course of treatment that would be the most suitable for you. The main treatments for P. falciparum are –
- Atovaquone and proguanil – either the generic form or the branded version Malarone
- Quinine, followed by a secondary medication such as doxycycline
- Artemether with lumefantrine – not licenced at the moment
For severe cases, a course of quinine is the standard treatment, given to patients intravenously and then followed by tablets. Other types of malaria are less severe and your doctor will likely prescribe chloroquine tablets.
Recovering from Malaria
The sooner treatment is sought and the correct treatment given, the faster the recovery. The time it takes to recover from the infection varies from person to person, but if you get the proper medication promptly, you should be feeling better after a few days. It depends on a few factors –
- The type of parasite present in your body – P. falciparum is a more severe strain and may take slightly longer to bounce back from
- The severity of your symptoms – if you develop any complications of malaria including kidney failure, jaundice, low blood sugar and fluid in your lungs, it can take longer for you to get well again
- Your age and overall health – those with a weaker immune system may take more time to recover. This includes pregnant women, children under the age of five, older patients, and immunosuppressed patients such as those with HIV and AIDS.
- If you have taken antimalarials and taken them correctly, you have a better chance of recovering quickly. It is important to continue taking the treatment even after you have left the malaria endemic region to ensure the parasite is eliminated from your body for good and has no chance of returning and causing symptoms weeks and months later.
Some born in countries and regions with malaria can develop some level of immunity to the parasite. Trials for a malaria vaccine for children in some parts of Africa show some promise against P. falciparum. But this vaccine is still being tested and is not ready to be circulated to the public yet. Until then, we have antimalarial tablets and preventative measures.