MALARIA

Prevention


PREVENTION


Education is the most important factor in preventing malaria among travelers. If you're planning a trip to a malarious area, you must understand the necessity of (1) taking preventive medications and (2) using personal protective measures to prevent mosquito bites.

In many areas of the world malaria is now resistant to ARALEN ® (chloroquine). These areas are frequently referred to as CRFM (chloroquine-resistant falciparum malaria). LARIAM ® (mefloquine) is the drug of choice to prevent malaria in chloroquine-resistant areas, but travelers with a history of epilepsy, psychiatric disorders, or cardiac conduction abnormalities should not use mefloquine. MALARONE ® is a new antimalarial medication recently approved by the FDA and available in September 2000. Carefully check the Medications section of this site for doses, precautions, indications, and side effects of these medications.

Chloroquine remains the drug of choice in the Dominican Republic, Haiti, Central America west of Panama, Egypt, and most countries in the Middle East. Travelers to sub-Saharan Africa who cannot take mefloquine or doxycycline and who use chloroquine should, if possible, also consider simultaneous use with proguanil (only available abroad). MALARONE ® is the other choice for travelers unable to use mefloquine or doxycycline. As with many diseases, however, there is no guaranteed protection against contracting malaria, despite the fact that you take preventive medication. It is always wise to combine the proper anti-malarial medicine with the correct use of insect repellents and other personal protective measures.

Mefloquine and chloroquine are both taken once weekly and should be started 1 week before entering a malarious area and continued for 4 weeks after leaving the area. Doxycycline is taken daily and should be started 1 day before entering a malarious area and continued for 4 weeks after leaving the area. MALARONE ® is taken daily starting 1- 2 days before entering a malarious area, daily while in the malarious area, and continued daily for 7 days after leaving the area.

In your travels, don't be surprised to meet other travelers using different medications than those you are taking. Never share their medication without expert consultation; however, if you are going to reside in an area for an extended period of time, consider following local medical advice regarding malaria medication after 1 month. Travel experts from many countries cannot agree on the best medications to prevent malaria, and the recommendations change frequently.

The prevention of malaria in children, pregnant women, and breastfeeding women are special conditions that require careful medical guidance. Malaria can be more serious in pregnant patients and increase the risk of maternal death, abortion, stillbirth, and low birth weight. At the time of this writing (January, 2001), mefloquine and chloroquine are the only approved preventive medications in the USA for pregnant travelers. According to WHO, mefloquine should only be used during the 2nd and 3rd trimesters. mefloquine should only be used during pregnancy when travel to chloroquine-resistant areas is unavoidable. Doxycycline and MALARONE ® should never be used during pregnancy.

Because most of the world is now resistant to chloroquine, pregnant women should not travel to malarious areas unless it is absolutely essential. Medications used to prevent malaria are passed in breast milk. They are not sufficient to prevent malaria and do not appear to harm the infant. The infant must always take his or her own preventive medication.

Chloroquine is not effective for children in most of the malaria endemic areas of the world, although it's approved as a preventive medication for children of any age. Chloroquine is not available in the USA in suspension form except when mixed by a pharmacist according to the weight of the child. According to the CDC, in consultation with a physician, mefloquine may be used in children under 30 pounds when travel to a chloroquine-resistant area is unavoidable. WHO does not recommend using mefloquine in infants under 5 kg or younger than 3 months. Children under the age of 8 years should not use doxycycline. MALARONE ® should not be used in children under 10 lbs. Overdosage of antimalarials can be fatal, and these drugs should be stored in childproof containers out of the reach of children. For more information on malaria medications, including doses, side effects, contraindications and precautions, see Medications. Check http://lariaminfo.homestead.com for a comprehensive review of LARIAM ® mefloquine.

Because the drugs used for malaria prevention are far from ideal, personal protective measures to avoid being bitten are just as important. These measures must be clearly understood and used correctly.

Based on CDC, Health Information for International Travel 2000-2001, DHHS, Atlanta, GA, 2001; WHO, International Travel and Health, 2002, Geneva; and Dr. Richard Thompson's book Well on the Road - A Practical Guide for the International Traveler, 2002.