Malaria Prophylaxis for the First Trip

Malaria is a serious disease which is found mainly in tropical and sub-tropical areas of the world. Its very common - it is thought there were 207 million cases of malaria in 2012 alone and so it is incredibly important to consider when travelling outside of the UK especially to the tropics.

What is Malaria?

Malaria is an disease which is spread by mosquitos. It is a parasite which resides in certain types of mosquitos and is transferred to humans when we are bitten by them.

What are the Symptoms?

Symptoms don't tend to develop until 7-28 days after being bitten by an infected mosquito but in some cases they may not appear until more than a year later.

The main symptoms to watch out for are:

• Very high temperature
• Sweats (especially at night)
• Shivering and shaking
• Flu-like symptoms of lethargy and muscle aches
• Headaches
• Vomiting and diarrhoea

If you develop the above symptoms either whilst abroad or up to a year after returning home, make sure you seek medical help urgently as your condition can deteriorate quickly. If you are already back home, ensure that you mention that you have been abroad - this is very important information!

How is it Treated?

If malaria is suspected, a blood test can be taken to look for evidence of the parasite being in your bloodstream. If it is diagnosed, it can be treated with medications (the exact type and length of treatment depends on where in the world you were infected, which strain of malaria it is and your age and past medical problems among other factors.)

How Can Malaria be Prevented?

The two main ways to prevent malaria is to avoid getting bitten in the first place and to take tablet prophylaxis whilst you are visiting 'at risk' countries'.

Bite Avoidance

• Wear long sleeved tops and trousers in the evening when visiting high risk areas as the most common type of mosquito which carries malaria tends to bite at night
• Use of a mosquito net (especially one impregnated with insecticide if possible)
• Use insect repellent on exposed skin but also on light clothing as mosquitos can still bite through these

Tablet Prophylaxis

When travelling abroad it is important to have a consultation with a trained health professional to find out if malaria prophylaxis is required and if so, which tablets you can take based on your past medical history and the countries you are visiting (there are areas of resistance throughout the world and so certain medications will only work in some places).

Detailed below are the most common tablets used for prophylaxis, how to take them and some of the most likely side effects. Some of the tablets can interact with other medications, not all are safe in pregnancy and many are contra-indicated if you have certain medical conditions so please do make sure you get advice from a health-care professional before starting any of them. In most cases you also need to have a prescription to be able to buy these in the UK.

Mefloquine

How to take: Once weekly. If you have never taken before, it is advised to start 3 weeks before departure (as this tablet can have some nasty side effects). If you have used it previously, it is started 1 week before departure. It is then continued during the time in the 'at risk' country and for 4 weeks after leaving the area.

Common side effects: Nausea, diarrhoea, itching, rashes, abdominal pain and dizziness. Other reported side effects include headache, convulsions, sleep disturbances (mostly very vivid dreams/nightmares and insomnia), hallucinations and mood disturbances. These may be worse if alcohol is taken around the same time.

Doxycycline

How to take: Once daily. To be taken 2-7 days before departure, during the time in the affected area and then for 4 weeks after leaving. Take whilst upright and with a full glass of water.

Common side effects: Sunlight sensitivity and sunburn more easily, loss of appetite, nausea, diarrhoea, thrush infection (mouth) and sore tongue.

Atovaquone plus proguanil (most commonly known as Malarone)

How to take: Once daily. Started 1-2 days before departure, during the time in the affected area and for 7 days after leaving. (NB this tablet is only licensed for trips of up to 28 days whereas the other tablets are licensed for longer periods of time).

Common side effects: Loss of appetite, mouth ulcers, abdominal pain, headache, nausea, diarrhoea and coughing.

Chloroquine

How to take: Once weekly. Usually this is started one week before departure, throughout the time in the 'at risk' country and for 4 weeks after leaving the area. It is better taken with food.

Common side effects: Headaches, itchy skin, rashes, blurred vision and hair loss.

Proguinal

How to take: Once daily. Usually started 1-2 days before departure, during the period of time in the 'at risk' country and for 4 weeks after leaving the area.

Common side effects: Loss of appetite, nausea, diarrhoea and mouth ulcers.

Our Situation

At the minute we are unsure of which countries we will be visiting in South-East Asia (possibly Indonesia and Malaysia) but we know that the maximum possible period of time will be 28 days. We therefore decided to get enough malaria prophylaxis to last for 28 days and then if we don't need it all, there is no harm, it would be much worse to run out!

We looked on the NHS travel advice website to get an idea of which tablets were recommended for our potential travel areas. The website is excellent for everything travel health related and I would highly recommend giving it a read before you leave.

We thought we would either go with Malarone or chloroquine/proguinal but the Malarone was working out so expensive! I happened however to stumble across a forum where someone mentioned that Asda were selling Malarone for £1 per tablet and so we decided to go to an Asda pharmacy and check.

Turns out that it was true and after having a consultation with the pharmacist to work out if it would be suitable for us and the area we were visiting, we walked out with 36 tablets each, costing us £72 in total (which is unbelievably cheap for Malarone!)

Hopefully the above was a bit of a helpful guide in terms of malaria and its prevention. If you have any questions, don't hesitate to get in touch or check out the NHS choices website and the Fit for Travel website which are both excelllent and trustworthy sources.