What You Should Know About Malaria

If you're traveling, don't forget your malaria meds

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Each year, about 1,700 cases of malaria are reported in the U.S., according to the Centers for Disease Control and Prevention (CDC). The disease, which was once eradicated, returned as a result of travelers who brought it from overseas. 

Today, travelers can take precaution by taking medications to prevent malaria—prophylaxis. Travelers should see a medical professional for prophylaxis prior to travel.

Malaria is a serious disease. It likely infects over 200 million people a year worldwide, causing over 600,000 deaths.

Health care providers will offer different drugs based on travel destination. These drugs include: Malarone, Doxycycline, Chloroquine, Mefloquine, and Primaquine. Each works differently. Some work on specific species of Plasmodium that cause malaria (P. falciparumP. vivaxP. ovaleP. malariaeP. knowlesi). Some strains are resistant to certain medications. P knowlesi is increasingly becoming a problem in and around Malaysia.

Most malaria in the U.S. is from travel to Africa, especially West Africa. The most common single country where malaria is acquired by U.S. travelers is, however, India. The disease is also acquired in parts of Latin America, China, Indonesia, and elsewhere. Countries may not have malaria throughout; high altitudes, deserts, cold seasons, and malaria eradication programs can keep malaria at bay.

The CDC provides information for healthcare providers about which drugs work in each country.

Here are some of the myths that perpetuates risk for malaria:

Myth 1: I can just take the meds if I get sick.

Malaria is a deadly disease. Falciparum malaria can rapidly cause severe disease with a loss of consciousness, seizures, shock, kidney failure, difficulty breathing, or stroke.

Delayed care can mean worse outcomes, which can mean death.

Medications need to be continued sometimes up to four weeks after returning. Even if you feel well, you can develop malaria weeks, months, or even a year later. The medications should not be stopped.  It may be difficult to acquire treatment and medical care needed for malaria. It is better to use prophylaxis than to risk real illness.

Myth 2: I can start the medications when I get there.

Some malaria medications need to be taken for one to two weeks before arriving. (Mefloquine, Chloroquine)

Myth 3: It's too late to start meds. I'm leaving soon. 

Some medications can be started one to two days before leaving. (Doxycycline, Malarone, Primaquine)

Myth 4: I've had malaria before, I'll be OK.

Simply having malaria once or twice does not create immunity.

After many repeated infections during childhood, some develop partial immunity, but this immunity is thought to wane when a person leaves a malaria area and does not have repeated re-infections. Others do not have malaria enough times to develop sufficient immunity and so are at risk regardless.

Even those who have genes that protect them from malaria can still get malaria, such as people with sickle cell.

Myth 5: I'm going home, so I'll be OK.

Half of malaria cases in the U.S. are among those who returned to their country of origin and visited friends and family. First and second-generation immigrants are at highest risk. Even those who develop partial immunity during childhood will be at risk.

Myth 6: I can just use the malaria meds I had for somewhere else.

Different locations need different medications. Some areas have drug resistance. Some areas have different species requiring different meds.

Myth 7: The side effects aren't worth it.

​If you're going to be at real risk for malaria, the meds are certainly worth it.

Malaria kills over 600,000 people a year. That's a pretty awful side effect of not taking medications. If you need the medications, you need the medications. Different medications have different side effects. One of the most concerning side effects has been hallucinations and other psychiatric and mental health concerns associated with mefloquine. These effects can be avoided largely by taking other drugs, which are unrelated. Chloroquine rarely is associated with psychiatric side effects.

Other drugs also can be associated with other side effects. Doxycycline can cause notable sunburns and gastrointestinal problems. Primaquine is a problem for those with G6PD deficiency. Specific drug side effects can be avoided by choosing a different medication. The drugs are, for the most part, very different. Side effects from one don't translate into side effects for the other drugs. Discuss with your doctor your risk for malaria and the medications that are available for you to make the right choice. 

Myth 8: The medications will make me hallucinate.

There are different malaria medications with different side effects. Mefloquine, in particular, can cause nervous system changes and mental health effects. Some very rarely have some psychiatric side effects from chloroquine. Other drugs can be taken if this is a concern.

Myth 9: I won't get mosquito bites.

Many do not realize how many mosquito bites they have. Insect repellant alone cannot prevent all bites. In areas with high malaria rates, this can be dangerous. However, insect repellant with DEET, sleeping under bed nets and window screens, and avoiding small pools of still water does help.

Myth 10: Malaria meds can't be taken during pregnancy.

​Actually, malaria is a lot worse during pregnancy. There are drugs that can be used as prophylaxis in pregnancy.

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