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Malaria - the disease

Malaria is a serious infectious disease spread by mosquitoes. You can’t catch it in the UK, but many people are treated here each year after being infected while abroad.

The disease is caused by a parasite called Plasmodium, which is carried by a particular type of mosquito. When the mosquito bites you, the parasite goes to your liver, and then infects your red blood cells.

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  • About About malaria

    Malaria is most common in sub-Saharan Africa. It also occurs in other tropical areas including Central and South America, the Indian subcontinent, South East Asia and the Pacific Islands. If you’re travelling to these areas, there’s a lot you can do to help prevent yourself getting infected.

    Every year, around 1,500 people in the UK need treatment for malaria which they caught abroad. Sadly, a few people die. So it’s really important to learn how to protect yourself against infection, and seek immediate medical help if you think you might have malaria.

  • Types Types of malaria

    Four main types of Plasmodium parasite infect humans. These are called Plasmodium falciparum, Plasmodium vivax, Plasmodium ovale and Plasmodium malariae. P. falciparum causes the most severe form of malaria and the most deaths. P. vivax and P. ovale can stay in your body for many months, so your symptoms may come back later.

    About seven out of 10 UK travellers who get malaria are infected with P. falciparum. You can be infected with more than one type of Plasmodium parasite but this is uncommon. Symptoms are similar whichever form of Plasmodium causes the infection, except that P. falciparum can cause much more severe symptoms.

  • Symptoms Symptoms of malaria

    It usually takes between seven and 14 days for the symptoms of malaria to develop, but it can take longer. This is called the incubation period. It’s more likely to take longer if you’re infected with one of the less severe types of malaria. It may take up to a year or even longer before you have any symptoms. The incubation period can also vary depending on whether or not you’ve taken any medicines to prevent malaria. You can still catch malaria even if you have taken antimalarial medicines correctly. See our FAQ ‘Malaria and antimalarial medicine’ for more information about how well they work.

    The first symptoms of malaria are similar to those of flu. You may have:

    • a fever 
    • a headache 
    • chills, where you shake and shiver 
    • aching muscles 
    • a lack of energy, tiredness 
    • tummy ache, perhaps with diarrhoea and vomiting 
    • loss of appetite

    Some people have malaria attacks that happen every two or three days and last between six and 10 hours. These attacks have three stages: feeling cold and shivering; fever and headaches; sweating and tiredness.

    If you have an illness with a fever and have travelled to a region with malaria within the last year, visit a doctor. Always tell them where you’ve travelled. The symptoms of malaria can get worse very quickly, so it’s important to get immediate treatment.

    While you’re away

    If you develop a fever at any time while in a country where malaria is present, seek urgent medical attention (ideally within 24 hours).

    You may be travelling to an area where you're unlikely to be able to get prompt medical attention. If so, it’s recommended that you take some emergency standby treatment for malaria with you just in case. Use it if you develop a fever and you can't reach a doctor within 24 hours. Your GP or travel clinic should provide you with written instructions, which will explain how and when to take it, and any side-effects you may have. It’s important to see a doctor as soon as you can after taking this emergency treatment.
  • Diagnosis at home Diagnosis of malaria at home

    Your doctor will ask about your symptoms and examine you. They’ll ask you about which countries or regions you’ve visited within the last year. It’s very important that you tell them if you’ve travelled abroad. This includes any stopovers you’ve had.

    If your doctor suspects you may have malaria, they will do a blood test straight away. If this isn’t possible for any reason, they’ll refer you urgently to the hospital for the test. You should get the results on the same day.

    This test is to find out what type of parasite you’ve been infected with and how much parasite there is in your blood. If your blood test is negative (nothing has been detected), you’ll still need to have two further blood tests over three days to make sure.

    Malaria is a medical emergency and needs to be treated as soon as possible.

    If you’re diagnosed with malaria, your doctor must tell the public health authorities. It’s important that anybody you travelled with is warned, so that they can look out for symptoms themselves. They should seek immediate medical attention if they have symptoms, and tell their doctor that someone they travelled with has malaria.

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  • Treatment Treatment of malaria

    Malaria can be treated with medicines but it’s important that you start these as soon as possible. Your treatment will depend on a number of things including what type of malaria you have. Certain medicines don't work for malaria from some parts of the world – your doctor will ask where you have been and take this into account.

    Medicines 

    Treating mild P. falciparum malaria

    If you have P. falciparum malaria, even if your symptoms are mild, you’ll usually need to stay in hospital to be monitored. This is because malaria can rapidly progress and become more severe.

    There are three main treatments which doctors in the UK use for mild P. falciparum malaria. These are:

    • quinine followed by a second medicine, usually doxycycline but sometimes clindamycin 
    • artemether with lumefantrine (Riamet®) 
    • atovaquone with proguanil (Malarone®)

    Your doctor will discuss with you which of these is best in your particular circumstances.

    Treating severe P. falciparum malaria

    The standard treatment for severe P. falciparum malaria is quinine, which is injected directly into your blood through a vein (intravenously). Once you're well enough, you can have the rest of your treatment as tablets that you swallow. If quinine isn’t effective, on expert advice your doctor may offer you a medicine called artesunate. This medicine isn’t yet licensed in the UK, but your doctor may prescribe it for you if they feel that the benefits outweigh the risks.

    If you have severe P. falciparum malaria, you’ll be monitored carefully and treated for any complications.

    Treating other types of malaria

    If you have one of the three less severe types of malaria, it’s likely your doctor will offer you chloroquine tablets (eg Avloclor®, Malarivon®or Nivaquine®). If you have malaria caused by P. vivax or P. ovale, you’ll need treatment to stop the infection coming back. This is because the parasites can stay in your liver. To get rid of these, your doctor will offer you primaquine after you finish taking chloroquine. If you’re pregnant, please see our section ‘Malaria and pregnancy’ as your treatment may be different.

    You’ll probably be able to take your medicines at home and won’t need to go into hospital. However, you’ll have to go to hospital if you develop complications or need to be given medicines intravenously.

    Making a full recovery

    It’s likely that you’ll recover fully from malaria if you receive the right treatment promptly. If left untreated, malaria is more likely to be life-threatening. Sadly, even with treatment malaria can sometimes be fatal, especially if there are complications such as those affecting the brain.

    The key to recovery from malaria is getting the right treatment early enough. So seek medical attention if you get symptoms after travelling to an area where malaria is common. And make sure your doctor knows where you’ve visited so that they know malaria is a possibility.

    Recovery time

    The time it takes to recover from malaria varies from person to person. However, if you get prompt treatment, you’re likely to start feeling better within a couple of days of starting it.

    The time it will take for you to recover will depend on a number of things.

    • The type of parasite you were infected with. Plasmodium falciparum is more likely to cause severe symptoms than the other types, so it may take you longer to get better.
    • Whether or not you took antimalarial medicines and if you took them correctly. It’s important that you continue to take them after you return from your trip to make sure that you completely get rid of the parasite. Otherwise, the parasite may remain in your body and cause symptoms weeks or even months later. 
    • The severity of your symptoms. If you develop complications, they can affect your brain, kidneys, blood and lungs. These complications will increase your recovery time.
    • Your age and general health. Malaria is likely to be more severe and take longer to recover from in certain people. This includes pregnant women, children under the age of five, older people and those with a weakened immune system, such as those who have HIV/AIDS. 
    • Whether or not the parasite that infected you is resistant to the malaria. This means that you may be at risk of your symptoms getting worse or returning.
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  • Complications Complications of malaria

    Malaria can progress to a more severe form (also called complicated malaria). This is more likely to happen if you’re infected with Plasmodium falciparum. Complications can affect your brain, kidneys, blood and lungs. They can develop within hours or days of your first symptoms and can be fatal within 36 to 48 hours. This is a medical emergency.

    Symptoms of severe malaria can include:

    • confusion, or loss of consciousness 
    • kidney failure 
    • jaundice – yellowing of your skin or the whites of your eyes 
    • fluid on your lungs – this can lead to difficulty in breathing 
    • low blood sugar (hypoglycaemia) – this can make you feel light-headed or shaky 
    • bleeding 
    • pale skin 
    • fits

    Severe malaria is more likely in:

    • pregnant women 
    • children under the age of five 
    • elderly people 
    • people who have a weakened immune system, such as those with HIV/AIDS 

    Treating complications

    If you’re diagnosed with severe malaria, your doctors will monitor you so that they can treat any complications quickly. If you have severe malaria or complications, you’ll be admitted to hospital where you’ll be closely monitored. Malaria can affect your kidneys, lungs and blood sugar level, so these will be checked every day.

  • Prevention Prevention of malaria

    There’s a lot you can do to reduce your chance of getting malaria. Malaria prevention can be summed up simply by remembering A, B, C, D:

    A – awareness of your risk. Know why it’s important to take malaria seriously. Find out what the risks of malaria are where you’re travelling.

    B – bite prevention. You get malaria from being bitten by a female Anopheles mosquito. These are most active from dusk to dawn. Find and carefully follow travel advice on clothing, insect repellents and mosquito nets.

    C – chemoprophylaxis (medicines to prevent infection). Your GP or travel clinic can give you the right medicines for you, taking into account where you’re travelling. It’s very important that you then take them properly. Ask your pharmacist if you have any queries about your medicines.

    D – diagnosis. If you get symptoms of malaria, it’s important that you seek medical attention promptly. Tell your doctor about your travel to help them decide on your diagnosis and treatment.

    For detailed advice about prevention of malaria speak with your GP or travel clinic, ideally several weeks before you travel. There’s also a lot of useful information online, for example from the Travel Health Pro site of the National Travel Health Network and Centre (NaTHNaC) – see our section ‘Other helpful websites’ for contact details.

    Malaria vaccine

    Until very recently there was no vaccine to prevent malaria. There is now a vaccine for young children, which has been very promising in medical trials in Africa. It works against Plasmodium falciparum, which causes the most severe form of malaria. The vaccine has not yet been licensed for general use, but it is hoped to offer it to children in various pilot studies in sub-Saharan Africa soon.

  • Immunity to malaria Immunity to malaria

    If you're born in an area with malaria, you may develop some immunity to the infection. However, if you leave the area, you’ll quickly lose this immunity. So, you’ll need to take antimalarial medicines if you return or go to another area with malaria.

  • Malaria and pregnancy Malaria and pregnancy

    If you’re pregnant, you’re more likely to get malaria, and more likely to get severe malaria and complications. You’re also more at risk of having a miscarriage or stillbirth or your baby being born prematurely. If you get malaria when pregnant, it’s possible to pass it on to your unborn baby, but this is rare. If this did happen, your baby would be born with the illness – this is called congenital malaria. Your baby would have symptoms of malaria such as fever, difficulties feeding and jaundice or anaemia.

    If you’re pregnant, the safest option is to not travel to an area where there is malaria. If this isn’t possible, it’s very important that you take antimalarial medicines and take precautions to prevent yourself from being bitten by mosquitoes. Make sure you tell your doctor that you’re pregnant because this will determine which medicines you’re given.

    It’s also important to make sure that if you do get malaria, the doctor treating you is aware that you’re pregnant. Chloroquine, one of the main medicines used to treat malaria, can be used in pregnancy. But primaquine, which doctors may use to stop malaria coming back, shouldn’t be used in pregnancy. If you’re pregnant, your doctor will recommend postponing your treatment with primaquine until after you deliver.

  • Antimalarial medicine and G6PD deficiency Antimalarial medicine and G6PD deficiency

    Glucose-6-phosphate dehydrogenase (G6PD) deficiency is a common genetic disorder. It is possible to have this deficiency and not know about it. It’s a condition where your red blood cells may break down when you take certain medicines or if your body is under stress during an infection. It’s more common in men than women and in those of African, Asian and Mediterranean descent.

    If you’re prescribed primaquine, you may need to have a blood test to check that you don’t have this condition. If you have G6PD deficiency and take primaquine, it can lead to you developing anaemia and other serious side-effects.

  • FAQ: Malaria transmission Can I catch malaria from an infected person?

    Not directly. Malaria is nearly always passed from person to person through the bite of a particular type of mosquito. Rarely, a person can get malaria from contaminated blood as in blood transfusion, organ transplant or sharing needles and syringes. Malaria can also be passed from a mother to her baby before or during birth, although this is unlikely.

    Malaria can't spread directly from person to person. You can’t get the disease through being in close contact, or having sex with someone who has it.

  • FAQ: Malaria and antimalarial medicine Can I get malaria even if I take antimalarials?

    It is possible, but it’s unlikely. Medicines to prevent malaria are by and large very effective. They can reduce your risk of getting malaria by about 90 percent. Under the ABCD method of preventing malaria, C stands for chemoprophylaxis – taking medicines to prevent malaria. It’s vital that you take antimalarials correctly, so it’s important that you don’t miss any doses and that you don’t stop taking them too soon after returning to the UK.

    It’s also important that you get the right medicine for the area you’re travelling to and that you get the medicine from a reputable place. Your local travel clinic or GP surgery can help you with this.

    More information

    The best way to prevent malaria is by following every step of the ABCD method. This combined approach will give you significant protection from the disease.

    The ABCD method includes:

    • awareness of risk 
    • bite prevention 
    • chemoprophylaxis (taking medicines to prevent malaria) 
    • diagnose quickly and treat without delay

    See our ‘prevention’ section for more detail about the ABCD method.

  • FAQ: Malaria and giving blood Can I give blood if I’ve been to a malaria area?

    You’ll have to wait six months after returning from an area with malaria before you can give blood. If you’ve actually had malaria, you mustn’t give blood for three years after you’ve recovered and finished your medications. It’s important to tell someone at the blood donation centre that you’ve been travelling, and if you’ve ever had malaria.

    On the NHS Blood and Transplant website you can look up individual countries you’ve been to. The site will tell you if there are any restrictions on giving blood after your visit. See our section ‘Other helpful websites’ for contact details.

  • FAQ: Malaria and returning symptoms Can symptoms come back after treatment?

    Yes, with some types of malaria it's possible that your symptoms may come back. However, if you’ve received the correct treatment and taken it as directed, this is very unlikely.

    More information

    Two of the four main types of Plasmodium parasite that cause malaria have a dormant stage (P. vivax and P. ovale). This means that the parasite can live in your body for months without making you ill, until it 'wakes up' and causes malaria symptoms. These two types of the parasite can stay in your liver in their dormant form and release parasites into your blood from time to time. This means you may get repeated bouts of malaria symptoms.

    If you’re diagnosed with one of these types of malaria, your doctor will offer you a second medicine after you complete your initial treatment. This is to reduce the risk of malaria coming back. However, if you don’t receive the right treatment or don’t take it for long enough, malaria can reoccur.

    If at any time you develop malaria symptoms again after being treated for it, contact your GP as soon as possible.

  • Other helpful websites Other helpful websites

    • Travel Health Pro (National Travel Health Network and Centre)
      www.travelhealthpro.org.uk 
    • Public Health England
      www.gov.uk
    • NHS Blood and Transplant direct line for further information
      0300 123 23 23

    Sources

    • Malaria infection. BMJ Best practice. bestpractice.bmj.com, last updated 7 September 2015 
    • Malaria. Medscape. emedicine.medscape.com, updated 27 October 2015 
    • Malaria. Travel Health Pro. National Travel Health Network and Centre. www.travelhealthpro.org.uk, published 15 October 2015 
    • Malaria. PatientPlus. patient.info/patientplus, last checked 22 February 2016 
    • Malaria. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised March 2010
    • Malaria, treatment. Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. www.medicinescomplete.com, accessed 20 January 2016 
    • Malaria, prophylaxis. Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. www.medicinescomplete.com, accessed 20 January 2016 
    • Primaquine. Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. www.medicinescomplete.com, accessed 20 January 2016 
    • Map of Medicine. Malaria. International View. London: Map of Medicine; 2011 (Issue 1) 
    • Malaria imported into the United Kingdom: 2014. Public Health England 2015. www.gov.uk 
    • Guidelines for malaria prevention in travellers from the UK: 2015. Public Health England 2015. www.gov.uk 
    • Lalloo D, Shingadia D, Bell D, et al. UK malaria treatment guidelines 2016. J Infect 2016; 72(6):635–49. doi:10.1016/j.jinf.2016.02.001.  
    • Questions and answers on malaria vaccines. World Health Organization. www.who.int, published 27 November 2015 
    • Malaria and pregnancy. Royal College of Obstetricians and Gynaecologists, 2014. www.rcog.org.uk 
    • Malaria in pregnancy. PatientPlus. patient.info, last checked 23 February 2016 
    • Malaria. Centers for Disease Control and Prevention. www.cdc.gov, reviewed 11 March 2016 
    • Health and travel. NHS Blood and Transplant. www.myblood.co.uk, accessed 20 January 2016 
    • Glucose-6-phosphate dehydrogenase (G6PD) deficiency. Medscape. emedicine.medscape.com, updated 7 April 2016
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