Malaria

What is malaria?

Malaria is a potentially serious parasitic infection spread through the bite of an infected female Anopheles mosquito. The disease is caused by 5 different species, however Plasmodium falciparum is the most common malaria parasite on the African continent and is responsible for the most severe form of malaria and the most deaths. Outside of sub-Saharan Africa, P. vivax is the dominant malaria parasite in most countries. Malaria is preventable and curable if diagnosed and treated promptly. A single bite is all it takes for someone to be infected.1

The following is a summary about the disease. For further details speak to your local pharmacist or GP.

What are the causes of Malaria and how is it transmitted?

Malaria is spread through the bite of an infected mosquito, carrying the malaria parasites in its saliva. The female mosquito requires protein from blood for her eggs to mature.

The peak biting period is between sunset and sunrise and are attracted by several factors, most commonly heat and smell.1

The malaria parasite initially infects liver cells, where it matures. Once matured, parasites are released into the blood where they infect red blood cells, causing symptoms. Symptoms are initially non-specific, but can progress to severe malaria and potentially cause death if prompt treatment is not received.2

In which countries are malaria found?

 

Malaria is found in more than 100 countries, mainly in tropical regions of the world, including:

  • Large areas of Africa and Asia
  • Central and South America
  • Hispaniola
  • Haiti and the Dominican Republic
  • Parts of the Middle East
  • Some Pacific islands
  • Oceania

Globally, there were an estimated 216 million cases of malaria in 2016, occurring in 91 countries. As a result, there were 445,000 deaths worldwide from malaria. Around 1,500 cases of malaria have been reported each year from 2007-2016 in UK travellers returning to, or arriving from, malaria endemic countries.3

For more information, click here to learn more about guidelines for malaria prevention in travellers from UK.4

What are the risks for those travelling to countries where malaria can be transmitted?

The risk of malaria varies according to season, geographic location, activities, type of accommodation, and the use of malaria prevention tablets and bite avoidance measures.

All travellers visiting malaria endemic regions are at risk of acquiring malaria.

Migrants to the UK who were born in malaria risk areas and return to visit friends and relatives are at higher risk. This is because they may believe they are immune to malaria and therefore do not seek pre-travel advice or take malaria prevention measures.

Any immunity travellers may have acquired in their country of origin diminishes rapidly on migration to a country with no risk of malaria, such as the UK; their UK-born children will have no protection from the disease.1

Certain travellers who are at increased risk of developing severe disease if they become infected with malaria such as:

  • Pregnant women
  • Those with a weakened immune system
  • Those with an absent or a poorly functioning spleen
  • Those with other complex medical conditions
  • Infants and children
  • Older travellers

Pregnant women are advised to avoid travelling to high risk areas where possible, as they have an increased possibility of developing severe malaria and a higher risk of death compared to non-pregnant women.

More information about guidelines for malaria prevention fortravellers can be found here.4

What are the signs and symptoms of Malaria?

The initial symptoms typically arise 7-18 days after a bite from an infected mosquito.1

At first, the symptoms of malaria may be non-specific, e.g. fever, chills, vomiting and headache, and this can mean that a diagnosis is missed.

Malaria may be misdiagnosed as influenza (flu) or another viral disease, gastroenteritis or lower respiratory tract infection.

Malaria may follow a reoccurring fever pattern of 24, 48, or 72 hours. This means a person may begin to think they feel better temporarily before getting another fever in a cyclical pattern.

Any traveller who becomes ill with a fever or flu-like illness while travelling and up to one year after returning home should immediately seek professional medical care. Travellers should inform their doctor that they have been travelling in a malaria-risk area.

What could happen if I catch malaria?

Complications of severe malaria can occur within hours or days of the first symptoms. It is important to seek urgent medical help as soon as possible. Complication of malaria can include:

  • Anaemia
  • Cerebral Malaria
  • Liver failure and jaundice – yellowing of the skin and whites of the eyes
  • Shock – a sudden drop in blood pressure
  • Pulmonary oedema – a build-up of fluid in the lungs
  • Acute respiratory distress syndrome (ARDS)
  • Hypoglycaemia – abnormally low blood sugar
  • Kidney failure
  • Swelling and rupturing of the spleen
  • Dehydration

Pregnant women are at higher risk of complication if they are infected with malaria. The following complication could arise:

  • Premature birth – birth before 37 weeks of pregnancy
  • Low birth weight
  • Restricted growth of the baby in the womb
  • Stillbirth
  • Miscarriage
  • Death of the mother5

 

What is the treatment for Malaria?

If malaria is promptly diagnosed and treated, most people make a full recovery. It is normally treated using anti-malarial medicines. Quinine, chloroquine and artesunate are some of the different types of medicines available.

The type of medicine prescribed and the duration of treatment can vary from person to person. It depends on various factors such as:

  • Infection caused by type of malaria parasite
  • If anti-malarial medication was used while travelling
  • Severity of the symptoms

Milder symptoms of malaria can be treated at home. However, more severe malaria infections may need treatment and monitoring in hospital.4

What advice is there for those travelling to counties where malaria is common?

Travellers visiting a country with malaria should be aware of the ‘ABCD’ rule.

A – Awareness of the risk

  • High humidity conditions and monsoon season
  • Rural areas
  • Accommodation without air condition
  • Remaining outdoors between sunset and sunrise

B -Bite Prevention

  • Use insect repellents (DEET-based insect repellents)
  • Mosquito nets treated with insecticide
  • Wearing full length clothing
  • Staying in accommodation which use mosquito window screens
  • Use of plug-in vapourisers

C – Chemoprophylaxis (medication prevention)

The common medications to prevent malaria are:

  • Atovaquone-Proguanil
  • Chloroquine
  • Proguanil
  • Doxycycline
  • Mefloquine

Find out more about malaria for your destination here.6

More information about guidelines for malaria prevention in travellers from UK can be found here.4

D – Diagnosis

Seek immediate medical advice if you have malaria symptoms, including up to a year after you return from travelling.7

 

When should I consider taking antimalarials?

It is usually recommended to take antimalarial tablets when visiting an area where there is a malaria risk. Antimalarial medication can reduce the risk of getting malaria by approximately 90%.

The type of antimalarial tablets which can be prescribed is based on the following information:

  • Destination
  • Resistance
  • Medical history (including allergies to medication) and current medication
  • Family medical history – if relevant
  • Age
  • Previous use of antimalarials
  • For women – whether they are pregnant

A short trial course of antimalarial tablets may be required before travelling. This is to ensure that medication was suited and no side effects occurred. If the antimalarial is unsuitable, an alternative can be provided.1

 

References

 

This information is taken from trusted third party websites, NaTHNaC (Travel Health Pro) and EMIS (Patient info) and use of all information has been licenced under the Open Government Licence. http://www.nationalarchives.gov.uk/doc/open-government-licence/version/3/

Although the materials are being used/replicated under the provisions of the Open Government Licence this in no way represents endorsement of Traveljab.co.uk by NaTHNaC, Emis, Public Health England, the NHS or the Department of Health and Social Care.

  1. Travel Health Pro: Malaria Factsheet
  2. NHS: Malaria Causes
  3. World Health Organisation (WHO): Malaria
  4. Public Health England: Guidelines for malaria prevention in travellers from the UK: 2017
  5. NHS: Malaria overview
  6. Travel Health Pro: Interactive Malaria Maps
  7. NHS: Malaria symptoms