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Malaria prevention

Malaria is a preventable disease, but it can be serious and potentially life-threatening. You get it from the bite of a type of female mosquito, which infects you with a parasite called Plasmodium.

Malaria is an infection that can cause serious illness and may be life-threatening. You get malaria from the bite of a type of infected female mosquito called Anopheles. They carry a parasite called Plasmodium, which goes to your liver and then infects your red blood cells.

The Anopheles mosquitoes that carry malaria usually bite at dusk and during the night. If you’re bitten by a mosquito that is carrying malaria, you will usually develop symptoms between seven and 18 days later. However, in some people the symptoms may not develop for up to a year.

Symptoms of malaria include:

  • a fever, sweating and chills
  • a headache
  • aching muscles
  • diarrhoea
  • a cough
  • feeling generally unwell

The symptoms of malaria can get worse very quickly and therefore it’s important to get immediate treatment. If malaria isn’t treated, you may develop more serious health problems, such as fits, difficulty breathing and loss of consciousness. If you have been to a country where there is malaria and develop any symptoms or feel at all unwell, get medical advice straight away.

There are four main types of Plasmodium parasite that infect humans. These are Plasmodium falciparum, Plasmodium vivax, Plasmodium ovale and Plasmodium malariae. Of these, Plasmodium falciparum is the most severe form and is responsible for most deaths from malaria.

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A map showing the distribution of malaria throughout the world

Details

  • Which countries have malaria? Which countries have malaria?

    The mosquitoes that carry malaria are found in more than 100 different countries. This includes countries in Africa, Asia, Central and South America, and parts of the Middle East. Malaria is very common in these countries. As many as 250 million people across the world get malaria every year and up to one million die from the disease. It’s mainly children living in Africa who die from malaria.

    You can’t get malaria in the UK but about 1,500 people are treated for the infection every year in the UK. These people will have been infected while travelling or living in a country where malaria is found.

  • Immunity to malaria Immunity to malaria

    If you live in an area where there is malaria, you may gradually build up some immunity to the disease. This is because you’re continuously exposed to it. However, any immunity you may have built up when living in a country with malaria quickly goes away once you leave it.

    If you usually live in a country where there is no malaria, such as the UK, you’re very unlikely to be immune to it. Therefore, if you’re travelling to a country where malaria is present, it’s important that you take steps to prevent it. You can help to protect yourself against the disease by following the ABCD of malaria prevention.

    • Awareness of risk – find out if the country you’re visiting has malaria.
    • Bite avoidance – take steps to reduce your risk of getting bitten by mosquitoes.
    • Chemoprophylaxis – this means taking medicines to prevent malaria if appropriate.
    • Diagnosis – see a doctor straight away if you have any symptoms while you’re abroad or within a year of returning from a malaria zone.
  • Preventing bites Preventing bites

    The key to preventing malaria is to protect yourself against being bitten by mosquitoes. There are some factors that increase your risk of being bitten. The main ones are listed below.

    • Visiting a country that is warm and wet. Mosquitoes are common in places where the temperature is between 20ºC and 30ºC and there is a lot of moisture in the air (high humidity).
    • Going on a long trip. The longer you stay in an area where there are lots of mosquitoes, the more likely you are to get bitten.
    • Staying in a rural area or village rather than a town or city.
    • It being the rainy season. Mosquitoes breed more at this time so there are more around.
    • Staying somewhere that doesn’t have air conditioning and that can keep out mosquitoes.
    • Being outside between dusk and dawn. This is the time when this type of mosquito is most active.

    You can reduce your risk of being bitten by ensuring you’re well prepared and taking a number of precautions. The main ones are listed below.

    • Wear loose-fitting clothes with long sleeves, long trousers and socks if you’re out at dusk or at night. Tucking your trousers into your socks will make it more difficult for mosquitoes to bite you. You can also buy clothes that have been treated with insect repellent.
    • Apply an insect repellent containing diethyltoluamide (DEET) to your skin and clothes. Stronger preparations last for longer and need to be put on less often. For example 50 percent DEET will last for up to 12 hours on your skin; 20 percent DEET will last for up to three hours. If you’re allergic to DEET, you can use repellents that contain lemon eucalyptus or chemicals called icaridin and IR3535 (3-ethylaminopropinate). However, these aren’t as effective as DEET. Don’t use oil of citronella as it’s not thought to be effective. See our frequently asked questions for more information.
    • Use a mosquito net over your bed. Make sure that it’s impregnated with an insecticide and doesn’t have any holes in it. Ideally the net should to be long enough to reach the floor but if not, tuck it in under the mattress.
    • Spray your room with an insecticide before you go to bed.
    • Use an electrical device that vaporises an insect repellent tablet in your room at night.
    • Cover doors and windows with fine mesh netting.
    • Use air conditioning or a fan in your room, as mosquitoes are less active in cooler temperatures.
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  • Medicines to prevent malaria Medicines to prevent malaria

    There are a number of different medicines that can help to prevent malaria. It’s important to remember that these aren’t completely effective so you also need to follow the advice for preventing mosquito bites. Your GP will prescribe you a medicine based on a number of things. These include:

    • your general health
    • whether you’re taking any other medicines
    • where you’re travelling to
    • what you will be doing
    • how long you will be in a malaria zone

    It’s important to see your GP or a travel health clinic well in advance of when you travel – six to eight weeks if possible. This is because depending on what medicine you’re prescribed, you may need to start taking it several weeks before you go abroad. You will need to take the medicines before you travel, while you’re away and when you come back. The length of time and how often you need to take the medicines will vary. It’s very important to finish the course of medicines prescribed for you.

    It’s important to be aware that no medicine for preventing malaria is totally effective. However, you can reduce your risk of getting the disease if you take the most appropriate one for you as instructed.

    In the past, a medicine called chloroquine was often used to prevent malaria. This is because it has very few side-effects and can safely be taken by most people including children and pregnant women. However, malaria caused by Plasmodium falciparum in most parts of the world is now resistant to chloroquine. Therefore, you will probably be prescribed an alternative. Some of the common medicines are described here.

    Doxycycline

    You may be prescribed doxycycline if you’re travelling at short notice. This is because you only need to start taking it one to two days before going to an area where there is malaria. You will need to take it for four weeks after returning. This is to ensure that any parasite that may be left in your body is killed.

    Side-effects of doxycycline can include feeling sick, vomiting and diarrhoea. Children under 12 and pregnant or breastfeeding women shouldn't take doxycycline.

    Doxycycline increases your skin’s sensitivity to the sun. Therefore, it’s very important that you take extra care to protect yourself from the sun by using a high factor sunscreen or covering up with clothing.

    Proguanil with atovaquone

    You also only need to start taking these medicines one to two days before you go to a malaria area. You must continue taking them for a week after coming back. The side-effects can include headaches, feeling sick, vomiting and diarrhoea.

    Mefloquine

    You only need to take mefloquine weekly, not daily, so it may be preferable if you’re going away for a long time. However, you will need to start taking it two to three weeks before travelling. This is to ensure you don’t have any severe side-effects, which can include sickness, diarrhoea, headache, dizziness and disturbed sleep. You need to continue taking it for four weeks after you come back. You won’t be prescribed mefloquine if you have epilepsy or certain mental health conditions. Don’t try to become pregnant while taking mefloquine or for three months after you stop taking it.

    You may be prescribed other combinations of these medicines, for example chloroquine and proguanil. This will vary according to your general health, where you’re going and whether malaria in that area is resistant to any medicines.

    Emergency standby treatment

    If you’re travelling to a remote place where you won’t have easy access to medical help, your GP may prescribe emergency standby treatment for you. This isn’t used instead of the usual medicines to prevent malaria and you should already be taking these. It’s recommended for use if you think you may have developed malaria despite taking preventative medicines and can’t get to a doctor. Ask your GP for more information.

  • Malaria and pregnancy Malaria and pregnancy

    You’re at an increased risk of developing severe malaria if you’re pregnant. Therefore, you shouldn’t travel to an area where there is malaria unless it’s absolutely necessary.

    If you do have to travel, it’s particularly important that you take all the measures to protect yourself from mosquito bites. You also need to take medicines to prevent malaria exactly as prescribed. Being pregnant means you’re more likely to get bitten, so protecting yourself is very important. If you can, stay indoors between dusk and dawn. Seek urgent medical attention if you think you develop any of the symptoms of malaria while pregnant. Ask your GP or travel health clinic for more information.

  • FAQs FAQs

    Can I buy medicines to prevent malaria once I get to the country I will be travelling in?

    Answer

    No, get your medicines from a pharmacy in the UK before you travel. This is because medicines bought in other countries may be fake or unsuitable for the type of malaria in the country.

    Explanation

    It’s important that you buy all the medicines that you will need to prevent malaria before you go. If you wait to buy them once you arrive, there is a risk that they could be fake. These medicines may not contain enough of the ingredient needed to prevent malaria, or they may be contaminated. They may also have passed their expiry date for being effective but have been repackaged with a new, false date.

    It’s also important to get your medicines before you travel because you will need to start taking them in advance of entering a malaria area. Make sure you see your GP or a travel clinic early enough to allow time for this.

    Get your medicines from a pharmacy in the UK. Some reputable UK pharmacies do now offer an online service. However, if you buy medicines over the internet, there is a risk that they may be from unregulated or illegal websites. If they are, there will be no guarantee of safety, quality or effectiveness. Your GP or a travel clinic can give you advice on where to get your medicines.

    Do I have to keep taking medicines to prevent malaria if I am abroad for a long time?

    Answer

    The longer you stay in an area where there is malaria, the greater your risk of developing the disease. Therefore, you need to keep taking medicines to prevent it and take steps to protect yourself from mosquito bites.

    Explanation

    Taking medicines to prevent malaria is even more important if you’re abroad for a long time because of the increased risk of getting the disease.

    You may find it more difficult to keep taking medicines correctly over a long period of time. It’s possible that you will be more likely to forget or have trouble remembering what to take and when if your prescription is complicated. For this reason, your GP may suggest medicines that you take weekly rather than daily.

    It’s important that you keep taking your medicines as prescribed even if you’re concerned about the side-effects of taking them for a long time. Many of the medicines used to prevent malaria can be taken safely for long periods of time. Talk to your GP if you’re worried about this.

    Should children take medicines to prevent malaria?

    Answer

    Yes, children should take medicines to prevent malaria if they are visiting an area where there is a risk of getting it. Ask your GP for advice about which medicines are suitable for your child. It’s important to remember that babies and children are at an increased risk of developing severe malaria.

    Explanation

    If at all possible, it’s recommended that you don’t take your children to areas where there is malaria. If your children must travel to these countries, it’s very important to follow the advice for preventing mosquito bites. In addition, you need to make sure that your child takes any medicines exactly as they have been prescribed. Not all medicines for malaria are suitable for children and taking too much of certain ones can be dangerous. Your child will probably be prescribed medicines depending on how much he or she weighs rather than his or her age.

    Depending on what medicine your child is prescribed, he or she may be able to take it as a syrup. However, some medicines are only available as tablets, which you may need to crush and give to your child with food.

    Always ask your GP for advice and read the patient information leaflet that comes with your medicine.

    What strength of diethyltoluamide (DEET) insect repellent should I use? Can other types of repellent be as effective?

    Answer

    Use an insect repellent containing DEET at a concentration of at least 20 percent. No other repellent is as effective as DEET. However, if you definitely can’t take DEET, for example if you're allergic to it, there are some alternative repellents that you can use.

    Explanation

    Using an insect repellent that contains DEET is one of the most effective ways of reducing your risk of being bitten by mosquitoes. You can buy insect repellent for your skin as a lotion, spray or roll-on.

    You can buy insect repellents that contain different concentrations of DEET. Use one with a concentration of at least 20 percent. An insect repellent containing 20 percent DEET will give you protection against mosquitoes for between one and three hours. Insect repellents with higher DEET concentrations will protect you for longer – up to 12 hours with 50 percent DEET. Using a repellent with a DEET concentration of over 50 percent won't give you any extra protection.

    Using a repellent that contains a high DEET concentration means that you won't need to reapply it frequently. You can use DEET with sunscreen but you should put the repellent on after applying sunscreen. If you’re sweating a lot, you may need to reapply insect repellent more often.

    Insect repellents with 50 percent DEET are safe for pregnant women and children over the age of two months. Don’t use DEET on babies younger than this.

    Insect repellents containing DEET of a concentration lower than 20 percent aren’t recommended as they aren’t thought to be effective. If you're allergic to DEET, you can use lemon eucalyptus, icaridin or IR3535 (3-ethylaminopropionate). Lemon eucalyptus gives you the same amount of protection as 15 percent DEET. Icaridin is thought to be as effective as DEET. If you use this, choose a repellent with a concentration of 20 percent or more. IR3535 protects you for a shorter period of time than DEET, so you will need to put it on more often.

    Your travel clinic or pharmacist can advise you on which repellent is the most suitable for you.

    You shouldn't use citronella oil, herbal or homeopathic remedies to prevent mosquito bites. There is no evidence to show that these are effective.

  • Resources Resources

    Further information

    Sources

    • Malaria. Health Protection Agency. www.hpa.org.uk, accessed 7 November 2013
    • Malaria. National Travel Health Network and Centre. www.nathnac.org, published July 2010
    • Malaria. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published March 2010
    • Malaria. Centers for Disease Control and Prevention. www.cdc.gov, published December 2012
    • Background information on malaria. Health Protection Agency. www.hpa.org.uk, published April 2012
    • Malaria prophylaxis. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published February 2012
    • Guidelines for malaria prevention in travellers from the UK. Public Health England. www.hpa.org.uk, published August 2013
    • Protection against mosquitoes, ticks and other insects and arthropods. Centers for Disease Control and Prevention. wwwnc.cdc.gov, published August 2013
    • Choosing a drug to prevent malaria. Centers for Disease Control and Prevention. www.cdc.gov, published November 2012
    • Joint Formulary Committee. British National Formulary (online). London: BMJ Group and Pharmaceutical Press. www.medicinescomplete.com, accessed 8 November 2013
    • Malaria prophylaxis. PatientPlus. www.patient.co.uk, published August 2011
    • Medicines for the prevention of malaria while travelling. Chloroquine (Aralen). Centers for Disease Control and Prevention. www.cdc.gov, accessed 11 November 2013
    • Malaria infection. BMJ Best Practice. www.bestpractice.bmj.com, published January 2013
    • Malaria. Health Protection Scotland. www.fitfortravel.nhs.uk, accessed 28 February 2014
    • Counterfeit and substandard antimalarial drugs: information for travellers. Centers for Disease Control and Prevention. www.cdc.gov, published November 2012 
  • Related information Related information

  • Author information Author information

    Reviewed by Polly Kerr, Bupa Health Information Team, February 2014.

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