Malaria Prophylaxis

MALARIA PROPHYLAXIS

Check carefully the areas you plan to travel to and take anti-malarial tablets if advised by your MASTA Travel Brief.  Some tablets can be bought over the counter in a chemist but others are only available on prescription.  Do not take over-the-counter tablets if prescription-only prophylaxis has been advised

Antimalarials without prescription

These antimalarial drugs are obtainable OTC (over the counter) from a pharmacy for travellers to areas which are chloroquine-sensitive. The pharmacist will advise you which antimalarials you require. Tell the pharmacist if you are pregnant or are planning to become pregnant

There is a choice of antimalarial prophylaxis (preventative drugs) for your proposed travel abroad. Below is a brief outline of the main differences between the drugs

Chloroquine 
(Nivaquine 150 mg
Avloclor 155mg)

Proguanil
(Paludrine 100mg)

Chloroquine and Proguanil
(Paludrine 100mg/Avlocor 155mg)

Effectiveness

Not 100%

Not 100%

Approximately 70%

Most notable adverse effects

Headache, nausea, vomiting, allergy. With prolonged use reversible hair loss can occur

Nausea, vomiting, mouth ulcers. With prolonged use reversible hair loss can occur

Headache, nausea, vomiting, allergy, mouth ulcers. With prolonged use reversible hair loss can occur

Frequency of doses

2 tablets once a week (every 7 days) taken with water after food (one missed dose can result in temporary loss of protection)

2 tablets daily with water after food (one missed dose can result in temporary loss of protection)

Chloroquine 2 tablets once a week and Proguanil 2 tablets daily, with water after food. (one missed dose can result in temporary loss of protection)

Start time before entering malaria area

1 week

24 hours

1 week

Duration of medication required after leaving malaria area

4 weeks

4 weeks

4 weeks

Main contraindications

Epilepsy, psoriasis, (children require different doses)

Severe renal failure, (children require different doses)

Epilepsy, psoriasis, children under 1yr (children require different doses)

Approximate costs

£3 for 28 tablets, to cover for a 14 day holiday (7 weeks of medication) [Sold only as pack to cover two people]

£11 for 98 tablets, to cover a 14 day holiday (7 weeks of medication)

£19-£24 Travel Pack to cover a 14 day holiday (7 weeks of medication)

If you are having intradermal anti-rabies vaccination you must complete the course before starting antimalarial drugs. Intramuscular rabies vaccination is not affected by anti-malarials

Remember that malaria can kill (on average there are 7 deaths per year in the UK from malaria) Malaria prophylaxis is very important. Even though you are taking anti-malarials there is still a small chance that you may develop malaria even after you return to the UK, accordingly please be alert to symptoms; flu-like illness, fever, headache, joint aches. Seek medical advice promptly if you suspect malaria

Remember to use avoidance measures whilst abroad; mosquito repellents containing DEET, cover up body dusk until dawn, mosquito nets (preferably impregnated with permethrin)

Antimalarials on prescription
For travellers in areas at risk from chloroquine resistant P. falciparum

There is a choice of antimalarial prophylaxis (preventative drugs) for your proposed travel abroad. Below is a brief outline of the main differences between the drugs. You should consider your preferred option before your travel clinic appointment

 

Mefloquine (Lariam)

Doxycycline

Malarone (Atovaquone & Proganuil)

Effectiveness

V. good (~90%)

V. good (less evidence)

V. good (less evidence)

Most notable adverse effects

Nausea, vomiting, dizziness, sleep disturbance, stomach upset. More rarely psychiatric disturbance,fits,rashes and heart problems

Photosensitivity rash (up to 3%), Gastrointestinal

Relatively low

Frequency of doses

Weekly

Daily (one missed dose can result in temporary loss of protection)

Daily

Start time before entering malaria area

2-3 weeks

1-7 days

1 day

Duration of medication required after leaving malaria area

4 weeks

4 weeks

1 week

Main contraindications

Epilepsy, psychiatric disorders, early pregnancy, scuba diving (see section below)

Children, pregnancy

Pregnancy

Cost for a trip of 28 days

£20 to £30 (depends on chemist)

£14 to £30 (depends on chemist)

£84 to £110 (depends on chemist)
Note: Licensed for trips of 28 days or less but see: Important note on Malarone below

 

These are available from the private clinics shown on the Travel advice sheet. If you decide you want us to supply a private prescription, you will need to inform the nurse when you come for your vaccinations. We will supply a private prescription, which we charge for. Bring the MASTA Travel Brief with you to the appointment – if you don’t bring it we will not see you, and you will have to book another appointment to attend with the MASTA Travel Brief. The pharmacy might charge an administration fee for dispensing your private prescription, and will charge you for the cost (as outlined above) of the antimalarial drugs

Remember that malaria can kill (on average there are 7 deaths per year in the UK from malaria) Malaria prophylaxis is very important. Even though you are taking anti-malarials there is still a small chance that you may develop malaria even after you return to the UK, accordingly please be alert to symptoms; flu-like illness, fever, headache, joint aches. Seek medical advice promptly if you suspect malaria. Remember to use avoidance measures whilst abroad; mosquito repellants containing DEET, cover up body dusk to dawn, mosquito nets (preferably impregnated with permethrin)

IMPORTANT NOTE ON MALARONE
Many countries do not restrict the length of time Malarone can be taken although the UK product license states it can only be taken for travel up to 28 days. There is a report of Malarone use for periods from 9 to 34 weeks, in which there was no excess of adverse effects and no appearance of unexpected adverse effects (Overbosch 2003). The ACMP concludes that there is no evidence of harm in long-term use and suggests that it can be taken confidently for travel up to one year or longer. Nevertheless, long-term use of Malarone should be prescribed with careful consideration until additional post licensing experience is available

LARIAM & SCUBA DIVING

Lariam (mefloquine) is an anti-malarial drug used in regions of the world where chloroquine resistant falciparum malaria is prevalent. E.g. East Africa, South East Asia

Possible side effects of Lariam such as dizziness, blurred vision and a disturbed sense of balance are common and could cause problems for divers. These effects can often imitate or even worsen the symptoms of Decompression Illness (DCI). There could also be confusion between the side effects of Lariam and the symptoms of DCI or nitrogen narcosis resulting in a misleading diagnosis

Therefore, Lariam must not be taken by persons intending to take part in scuba diving. The manufacturers of Lariam recommend that it should not be taken by persons who carry out tasks demanding fine coordination and spatial discrimination, including scuba diving. If Lariam is taken, these persons should refrain from such activities during and for at least three weeks following use

MALARIA GENERAL GUIDANCE

Malaria is probably the most common and most serious disease you will be exposed to when travelling.  Malaria is caused by a microscopic parasite transmitted by female mosquitoes when they take a blood meal at your expense.  There are four species of malaria parasite, of which Plasmodium falciparum is the most dangerous and can lead to cerebral malaria and death

Malaria usually starts as a fever and you will feel very unwell.  Other symptoms may include diarrhoea, headache or a cough.  In a malarious area, all illnesses with fever should be considered to be malaria until proved otherwise.  Seek medical help as soon as you can if you become ill

Check carefully the areas you plan to travel to and take anti-malarial tablets (prophylaxis) if advised by the MASTA Travel Health Brief.  Some tablets can be bought over the counter in a chemist but others are only available on prescription.  Do not take over-the-counter tablets if prescription-only prophylaxis has been advised

You can get malaria even when taking prophylaxis, but this happens more commonly in individuals who forget to take one or more tablets.  It is essential that you take the tablets you are prescribed regularly and on time and for the whole of the recommended time after leaving a malarious area (sometimes for 4 weeks after)

Mosquitoes that transmit malaria bite mainly at night, but this can be any time from dusk onwards and even just after dawn.  Use insect repellent containing at least 50% DEET, wear long, loose clothing when possible and consider taking a mosquito net impregnated with permethrin to sleep and rest under.  These can be bought in outdoor/camping shops which stock a full range of products.  Do not rely on insect repellent and mosquito nets alone if you have been advised to take prophylaxis as well; all forms of protection are important

  • Take adequate supplies of the antimalarial agent suited to your area of travel and remember to take it. People die every year from malaria in the UK
  • Even with the best prophylaxis you may still catch malaria so have a high index of suspicion
  • Report any unexplained illness with symptoms such as fever, headache, malaise, muscle aches and fatigue
  • Malaria can occur up to two years after being bitten by an infected mosquito
  • If you become unwell with fever up to a year after returning from a malarious area, see your GP and tell them you have travelled abroad

INSECT BITES
Mosquitoes, certain types of flies, ticks and bugs can transmit many different diseases. e.g. malaria, dengue fever, yellow fever. Some bite at night, but some during daytime. The main way to avoid illness is to avoid being bitten:

  • If your room is not air conditioned, but screened, close shutters early evening and spray room with knockdown insecticide spray. In malarious regions, if camping, or sleeping in unprotected accommodation, always sleep under a mosquito net (impregnated with permethrin). Avoid camping near areas of stagnant water, these are common breeding areas for mosquitoes etc
  • Electric insecticide vaporisers are very effective as long as there are no power failures! Electric buzzers, garlic and vitamin B are not effective
  • Cover up skin as much as possible if going out at night, (mosquitoes that transmit malaria bite from dusk until dawn). Wear light coloured clothes, long sleeves, trousers or long skirts
  • Use insect repellents on exposed skin. (Choose those containing DEET or eucalyptus oil base. A content of approximately 50% DEET is recommended for tropical destinations.) Clothes can be sprayed with repellents too. Impregnated wrist and ankle bands are also available. Check suitability for children on the individual products
  • Report any unexplained illness with symptoms such as fever, headache, malaise, muscle aches and fatigue

Malaria Prevention guidelineswww.hpa.org.uk/cdph/issues/CDPHvol6/No3/6(3)p180-99.pdf
Prophylaxis – long term travellerwww.hpa.org.uk/cdph/issues/CDPHvol6/No3/6(3)p200-208.pdf
Health Protection Agencywww.hpa.org.uk/infections/topics_az/malaria/menu.htm
Scuba diving and Lariamwww.traveldoctor.co.uk/scuba.htm

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MALARIA PROPHYLAXIS