Malaria Pills: Timing For Travel

Malaria is a serious and potentially fatal disease spread by mosquitoes. It is caused by a parasite which is transmitted via mosquito bites, and is found in tropical regions including large areas of Africa and Asia, Central and South America, the Dominican Republic, Haiti, parts of the Middle East and some Pacific islands. If you are travelling to a malaria-prone area, it is important to take antimalarial medication before, during and after your trip. This is because the parasites that cause the disease can linger in your body long after you've been bitten. The drugs kill the parasites when they are in your liver or red blood cells, before they get out of control.

The type of antimalarial medication you take will depend on where you are travelling to, your medical history and the activities you have planned. It is important to consult a doctor or travel clinic about 4-6 weeks before your trip to determine which medication is right for you.

When to start taking malaria pills before travel

It is important to check the malaria risk for the country you're travelling to before you go. Malaria is caused by being bitten by an infected mosquito and is found in tropical regions, including large areas of Africa and Asia, Central and South America, the Dominican Republic, Haiti, parts of the Middle East, and some Pacific islands.

If you're travelling to an area where malaria is found, get advice from a GP, nurse, pharmacist, or travel clinic before you go. It's best to do this at least 4 to 6 weeks before you travel, but you can still get advice at the last minute if you need to. You may be prescribed antimalarial tablets to reduce the risk of getting malaria and told how you can prevent mosquito bites.

Different types of antimalarial tablets are available, and they differ in how they protect you against malaria, how they should be taken, and the places in the world where they can be used. It is important to discuss the suitability of antimalarial tablets with a qualified doctor, nurse, or pharmacist.

You should begin taking antimalarial tablets before arriving in a malaria-risk area as guided by your travel health professional. Some tablets need to be started a few days before you travel, while others may need to be started a week or more before. This means there will be enough antimalarial medication in your system to start preventing infection as soon as you arrive in the country.

• Atovaquone-proguanil (Malarone): Start taking this pill daily 1 to 2 days before your trip.
• Chloroquine: Start taking this drug once a week about 1 to 2 weeks before your trip.
• Doxycycline: Start taking this daily pill 1 to 2 days before your trip.
• Mefloquine: Begin taking this weekly drug 1 to 2 weeks before travel.
• Primaquine: Take this weekly drug 1 to 2 days before travel.
• Tafenoquine (Arakoda, Kozenis, Krintafel): Take this drug daily for 3 days before travelling to the region.

How long to take malaria pills after returning from travel

It is important to continue taking antimalarial tablets after leaving a malaria-prone area, as the parasites that cause the disease can linger in your body for some time after you have been bitten. The length of time you should continue taking the tablets after you leave the malarial area depends on the drug you are taking.

For example, if you are taking atovaquone-proguanil (also known as Malarone), you should continue taking the tablets for 7 days after leaving the affected area. For other drugs, such as chloroquine, doxycycline, and mefloquine, you should continue taking the tablets for 4 weeks after leaving the malarial area. It is important to follow the instructions provided by your doctor or travel health professional and to complete the course of tablets as directed.

In addition to taking antimalarial tablets, it is important to take other preventive measures, such as using insect repellent, wearing long sleeves, and protecting your sleeping area with a mosquito net. These measures will help to reduce your risk of contracting malaria.

If you develop symptoms of malaria during your trip or after returning home, seek medical attention urgently, even if you have been taking antimalarial tablets. Malaria is a serious disease that can be life-threatening if not treated quickly. The symptoms of malaria include high fever, chills, and flu-like symptoms.

Which malaria pills to take

It is important to consult a doctor, nurse, or pharmacist about which malaria pills to take. They will be able to advise you on the best course of treatment for your specific needs.

There are several types of malaria pills available, and they differ in how they protect you against the disease, how they should be taken, and where in the world they can be used. The type of pill you take will depend on the type of malaria parasite you may encounter, your physical condition, and your medical history.

• Atovaquone-proguanil (also known as Malarone or Maloff Protect): This pill is taken daily, starting 1-2 days before your trip, and continued for 1 week afterward. Side effects are less common with this drug, but pregnant women or people with kidney problems are advised against taking it. Atovaquone-proguanil is also more expensive than some other options.
• Chloroquine: This drug is taken once a week, starting about 1-2 weeks before your trip and continuing for 4 weeks after. Chloroquine is rarely used anymore because it is not effective against P. falciparum, the most common and dangerous type of malaria parasite. However, it may be recommended if you are travelling to areas where there is a different type of malaria parasite.
• Doxycycline: This is the most affordable daily pill option. It is started 1-2 days before travel and continued for 4 weeks after. Side effects can include an upset stomach, bad reactions to the sun, and yeast infections in women. Pregnant women and children under 8 should not take this pill.
• Mefloquine: This weekly drug is started 1-2 weeks before travel and continued for 4 weeks after. It is safe for pregnant women but not for people with a history of seizures, severe heart problems, or psychiatric conditions. Side effects may include dizziness, sleep disturbance, and psychiatric reactions.
• Primaquine: This is another weekly drug, taken 1-2 days before travel and continued for 1 week after. Side effects can include an upset stomach. It should not be taken by pregnant women or people with G6PD deficiency, a condition where certain drugs cause red blood cells to break down.
• Tafenoquine: This newer drug is recommended for adults aged 16 and older. It is taken daily for 3 days before travel, once a week during travel, and then once a week after exiting the area. It can also be used to stop relapse in those already infected with malaria. Tafenoquine may cause an upset stomach and should not be taken by those under 16, pregnant or breastfeeding women, those with G6PD deficiency, or those with a history of psychiatric disorders.

How to avoid mosquito bites while travelling

Malaria is a serious and potentially fatal infection spread by mosquitoes. It is very common in certain parts of the world, including large areas of Africa and Asia, Central and South America, the Dominican Republic, Haiti, parts of the Middle East, and some Pacific islands.

If you are travelling to a region where malaria is prevalent, it is important to take antimalarial medication and to protect yourself against mosquito bites. Here are some ways to avoid mosquito bites while travelling:

Before Your Trip

Before embarking on your journey, it is recommended that you visit a travel clinic, a healthcare provider, or a GP, nurse, or pharmacist to get advice and any necessary prescriptions. It is best to do this at least 4 to 6 weeks before you travel, but you can still get advice if your trip is imminent.

Insect Repellent

Use a good-quality insect repellent containing one of the following active ingredients:

• DEET (N,N-Diethyl-m-tolumide)—the most effective insect repellent, safe for babies over 2 months old, pregnant and breastfeeding women. A concentration of 50% DEET is recommended in areas where malaria is present.
• Picaridin (KBR 3023/icaridin outside the US)
• Oil of lemon eucalyptus (OLE)—a plant-derived ingredient
• Para-menthane-diol (PMD)
• 2-undecanone—another plant-derived ingredient

Apply the repellent to all exposed skin not covered by clothing. If you are also using sunscreen, apply the repellent after the sunscreen. Reapply the repellent regularly, especially if mosquitoes are landing on your skin, and after swimming, washing, or sweating. Be careful when applying it to your face, avoiding the eyes and mouth, and do not breathe it in. Do not apply repellent to children's hands, eyes, mouth, cuts, or irritated skin.

Clothing

Wear loose-fitting clothing that covers as much of your skin as possible. Mosquitoes are less likely to bite through looser clothing, and they cannot bite through fabric if it is not tight against your skin. In hot climates, clothing can be thin as long as it is loose.

Consider treating clothing and gear (such as boots, socks, and tents) with 0.5% permethrin, an insecticide that kills or repels mosquitoes. Alternatively, buy clothing and gear that has already been treated with permethrin.

Mosquito Nets

If you will be sleeping outside or in a room without window and door screens or air conditioning, use a mosquito net. Choose a net that is compact, white, rectangular, with 156 holes per square inch, and long enough to tuck under your mattress. A net treated with insecticide will provide more protection.

Accommodation

Stay in a room with window and door screens or air conditioning, if possible. If not, use a mosquito net. Keep windows and doors closed, and use an insecticide spray or plug-in.

Outdoor Areas

Reduce the number of mosquitoes outside your accommodation by eliminating sources of standing water, such as puddles, where mosquitoes breed.

Other Precautions

Be aware that mosquitoes that transmit malaria typically bite at night, after sunset, but there are also day-biting mosquitoes that spread other serious diseases, so protect yourself at all times. Activities such as hiking, camping, working with animals, and visiting farms and forested areas will increase your risk of mosquito bites.

What to do if you experience malaria symptoms during or after travel

Malaria is a serious and sometimes fatal disease caused by parasites that are spread to humans through mosquito bites. It is important to take preventive measures such as taking antimalarial medication and avoiding mosquito bites before, during, and after travel to high-risk areas. However, if you experience malaria symptoms during or after your trip, it is crucial to act promptly. Here's what you should do:

Recognise the Symptoms

Malaria symptoms can vary but generally include a high fever, shaking chills, sweats, headaches, muscle or joint pain, nausea, vomiting, diarrhoea, and a general feeling of discomfort. In some cases, malaria may also cause yellow skin or eyes (jaundice), chest pain, breathing difficulties, and coughing. Symptoms typically appear within 7 to 30 days after being bitten by an infected mosquito but can take up to a year or longer to develop in rare cases.

Seek Medical Attention Urgently

Malaria can be deadly if left untreated. If you experience any symptoms suggestive of malaria during or after travel to a malaria-endemic area, seek medical attention immediately. Inform the healthcare provider about your travel history, including any recent visits to countries where malaria is present. A blood test will be performed to confirm the presence of malaria parasites and determine the appropriate treatment.

Start Treatment Promptly

Malaria requires prompt treatment to prevent severe health complications. Your healthcare provider will prescribe antimalarial medications to kill the malaria parasite. It is important to start treatment as soon as possible to increase the effectiveness of the medication. Be sure to inform your doctor about any other medications you are currently taking to avoid potential drug interactions.

Prevent Further Infection

Malaria is spread by infected mosquitoes, so it is crucial to prevent further mosquito bites. Take measures such as using insect repellent, wearing long-sleeved clothing and trousers, sleeping under mosquito nets, and staying in accommodations with screens on windows and doors. These precautions will help protect you from additional mosquito bites and reduce the risk of spreading the infection to others.

Inform Your Travel Companions

If you develop malaria symptoms during or after travel, it is important to inform anyone you travelled with. They may also be at risk of developing malaria and should monitor themselves for symptoms. Encourage them to seek medical attention if they experience any symptoms, as early diagnosis and treatment are crucial for effective management of the disease.

Frequently asked questions