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Malaria


Expert reviewer, Professor Robert Read, Professor of Infectious diseases
Next review due November 2021

Malaria is a disease caused by a parasite that’s carried by a particular type of female mosquito. When you’re bitten by the mosquito, the parasite gets into your body and infects your red blood cells. It can cause serious and sometimes life-threatening illness, but it can be prevented and treated.

You can’t get malaria from a mosquito bite in the UK, but many people are treated for malaria after trips abroad to places where malaria is common.

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About malaria

Around half of the world’s population live in places where malaria is present. It’s most common in Africa, especially those countries south of the Sahara Desert. It’s also present in other areas, including Central and South America, Asia, the Middle East and part of 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 are treated for malaria which they have caught abroad. Most of these people have been visiting family and friends in the countries where they were born. Some groups of people are more likely to get malaria than others (and have severe illness as a result), including:

  • babies and children under the age of five
  • pregnant women
  • people who aren’t immune to malaria, such as travellers or those who move around a lot (ie migrants)
  • people with HIV or AIDS

Each year in the UK, a small number of people die from malaria that has been contracted abroad. However, it can be treated and cured, so it’s really important to get treatment quickly to prevent complications. If you’ve travelled in an area where there is malaria and you become ill within a year of returning home, you should always get medical advice. 

Types of malaria

Malaria is caused by a parasite called Plasmodium. There are five types of Plasmodium that infect humans. Of these, two cause the majority of cases.

  • Plasmodium falciparum causes the most severe form of malaria and the most deaths. It’s the most common malaria in Africa. About seven out of 10 UK travellers who get malaria are infected with P. falciparum.
  • Plasmodium vivax is the most common malaria outside of Africa. It can stay in your body for many months, so your symptoms may not develop until later.

Symptoms of malaria

Symptoms usually start within a month of having been infected with P. falciparum.If you’ve been infected with P. vivax, the symptoms usually start within three months, although symptoms can also develop up to a year afterwards.

The first symptoms are often like having flu, but they can be mild and not very specific. This can sometimes make malaria hard to diagnose. You may have:

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

If malaria isn’t treated, you may develop other more severe symptoms, such as fits, being confused or very drowsy, and being short of breath. If you’re ill, have a fever and you’ve travelled to a region with malaria within the last year, always see your GP. Make sure they’re aware of your travel history. The symptoms of malaria can get worse very quickly, so it’s important to get immediate treatment.

How long it takes for symptoms to develop can also vary depending on whether you’ve taken any medicines to prevent malaria. You can still get the disease even if you’ve taken antimalarial medicines correctly. See our FAQ on malaria and antimalarial medicine for more information.

While you’re away

If you develop a fever at any time while in a country where malaria is present, get medical help as soon as you can.

If you’re travelling to an area where you're unlikely to be able to get medical attention quickly, your GP or travel clinic may suggest taking emergency standby treatment for malaria with you just in case. You can use it if you develop a fever and you can't reach a doctor within 24 hours. Your GP or travel clinic should give you written instructions, which 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 of malaria

Your doctor will ask about your symptoms and examine you. If you’re back in the UK, be sure to let your GP know that you’ve travelled abroad recently, including any stopovers. You’ll also be asked about any medicines you took to prevent malaria.

If your doctor thinks you may have malaria, you’ll have a blood test straightaway to confirm it. The blood test shows what type of parasite you’ve been infected with and how much parasite there is in your blood. If the test is negative and nothing is found, you’ll need to have more blood tests over the next three days to make sure.

If your GP can’t do this, then you’ll be asked to go to hospital to have the test done.

You may have other blood and urine tests to check for complications. Your doctor may also do other investigations such as a lumbar puncture to rule out other conditions such as meningitis. This procedure can only be done in a hospital.

If you’re diagnosed with malaria, your doctor must tell the public health authorities. You should tell anyone who travelled with you that you have malaria, so that they can look out for symptoms too. If anyone develops symptoms, they should see their doctor straightaway. 

Treatment of malaria

Malaria is a medical emergency and needs to be treated as quickly as possible. If you develop the disease, you can go from having no symptoms to having serious complications within one or two days. Malaria can be successfully treated with medicines. These get rid of all the parasites from your blood. The medicines you need will depend on the type of malaria you have, how severe your illness is and whether the malaria is resistant to treatment. Certain medicines don't work for malaria from some parts of the world.

You’re likely to be treated directly by a specialist in infectious diseases or your doctor may manage your treatment with a specialist. If you have P. falciparum malaria, you’re likely to be treated in hospital, whereas if you have other types of malaria, you’ll probably be able to continue your treatment at home after your initial assessment. If you have severe malaria or complications, you may need to be cared for at a high-dependency unit or in intensive care.

The following medicines are the main ones used to treat P. falciparum malaria.

  • Artemisinin combination therapy (ACT) – used for malaria without complications.
  • Atovaquone-proguanil – used for malaria without complications.
  • Quinine – used for malaria without complications, and severe malaria, where it can be given straight into a vein rather than as a tablet. You may also take doxycycline or clindamycin with quinine.
  • Artesunate – used for malaria with complications and given straight into a vein. You may also take doxycycline or clindamycin with quinine.

It usually takes between three and seven days of treatment to get rid of all the parasites. You’ll have a blood test every day, while you’re taking medicines to check how well they’re working.

Other types of malaria are usually treated using chloroquine. 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, you’ll be asked to take primaquine after you finish taking chloroquine.

Most people with malaria make a quick and full recovery once treatment has started. Sometimes malaria can come back if treatment hasn’t worked, so if you have symptoms again in the future, always see a doctor or your GP straightaway.


Antimalarial medicine and G6PD deficiency

Glucose-6-phosphate dehydrogenase (G6PD) deficiency is a genetic disorder; it’s possible to have it and not know about it. It affects your red blood cells and you’re more likely to have it if you’re of African, Asia or Mediterranean origin.

If you have G6PD deficiency, you shouldn’t take primaquine as it can lead to anaemia and other serious health problems. If you’re prescribed primaquine, your doctor should do a blood test to check for G6PD deficiency.

Complications of malaria

Complications are more likely to develop if you have the P. falciparum type of malaria, rather than other types of malaria. They include:

  • fits (seizures) and a change in your level of consciousness
  • kidney problems
  • anaemia
  • problems breathing or fluid in your lungs
  • very low blood sugar levels
  • blood clotting problems
  • organ failure
  • blood poisoning (sepsis)

Prevention of malaria

There’s a lot you can do to reduce your chance of getting malaria. A good way to remember what to do to prevent malaria is by using A, B, C, D:

  • A – awareness of your risk. Find out about malaria, how you get it and know whether you’re at risk in the area you’re travelling in. 
  • B – bite prevention. You get malaria from being bitten by a female Anopheles mosquito, which are most active from dusk to dawn. You can prevent bites by using insect repellent, bed nets and wearing long sleeved tops and trousers. 
  • C – chemoprophylaxis (or similar medicines to prevent infection). Your GP or travel clinic can give you the right medicines to take, depending on where you’re travelling to. It’s important to take them as they’re prescribed, which also means you should carry on taking them when you return home or leave the area. Make sure you take medicines with you from the UK, as preventive medicines in some countries may be poor quality. 
  • D – diagnosis. If you get symptoms of malaria, it’s important to get medical help quickly. 

For more information about how to prevent 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.

If you're born in an area where there is malaria, you may develop some immunity to the infection. However, if you leave and move to a country that doesn’t have malaria, you’ll quickly lose any immunity. Therefore, you’ll need to take antimalarial medicines if you travel to an area with malaria.

Malaria and pregnancy

If you’re pregnant, the safest option is not to travel to an area where there is malaria. This is because you’re more likely to contract malaria and more likely to get severe malaria and complications.

Malaria can also cause serious harm to your unborn baby. You’re more likely to have a miscarriage or stillbirth and your baby is also more likely to be born early and underweight. It can be particularly serious if you get it in the last three months of your pregnancy (the third trimester).

If you get malaria when you’re pregnant, you can pass it on to your unborn baby, but this is rare. If this happened, your baby would be born with the illness – this is called congenital malaria. Your baby would have symptoms of malaria such as fever, problems feeding and jaundice (yellow skin and whites of the eyes) or anaemia.

If you have to travel to an area where there is malaria, you should always take antimalarial medicines and do as much as you can to prevent mosquito bites.

Make sure you tell your doctor that you’re pregnant and how many weeks you’ll be when you travel. This is so your doctor knows which medicines to give you. Not all medicines to prevent malaria are safe in pregnancy, or at specific times during pregnancy.

You should also tell your doctor that you’re pregnant if you develop the symptoms of malaria or are diagnosed with it. Some medicines used to treat malaria are safe to take when you’re pregnant but some aren’t.

Frequently asked questions

  • Not directly. Malaria can’t be spread from person to person like a cold or flu and you can’t catch it by having close contact with someone who has it. It can’t be passed on by having sex with someone who has it either. However, malaria can sometimes be passed on through infected blood, for example, during a blood transfusion or through sharing needles and syringes.

  • You can sometimes get malaria even if you’ve been taking antimalarial medicines to prevent it. However, it’s unusual – taking medicines and using a mosquito net at night prevent malaria nine times out of 10.

    To give you the best protection, it’s important to take the right medicines exactly as they have been prescribed. That means starting to take them before you travel and carrying on when you return home, usually for four weeks. You should also get specific advice about the country you’re travelling to. Your GP, practice nurse or travel clinic can give you the information you need. 

    Because antimalarial medicines can’t give you total protection, it’s important to take whatever steps you can to prevent bites as well.

  • You can give blood if you’ve been to a malaria area, but you may need to wait for a minimum of four months after coming back to the UK. The Scottish National Blood Transfusion Service recommends waiting for a year. When you give blood, you’ll be asked about any travel abroad and you should always tell the staff if you’ve been to any area where there is malaria. Staff will also routinely check your blood for malaria parasites on the day you give blood.

    There may be different rules if you’ve lived in a malaria area for at least six months or you’ve had malaria in the past. Check with your local blood and transplant service for more information.

    The NHS Blood and Transplant website has information about individual countries and whether you’ll be able to give blood if you’ve travelled there. See our section ‘Other helpful websites’ for contact details.

  • Yes, your symptoms can sometimes come back if you have either the P. ovale or P. vivax types of malaria, and you will receive further treatment.

    About one in seven people with these types of malaria will have symptoms that return. The malaria parasite can live in your body for months without making you ill, until it 'wakes up' and causes symptoms. This can happen several months or years after the infecting mosquito bite. Symptoms can come and go.

    If you’re diagnosed with one of these types of malaria, your doctor may offer you a second medicine called primaquine as a follow-up to your treatment. This reduces the chance of malaria coming back.

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


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Related information

    • 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

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    • Health, Eligibility & Travel. NHS Blood and Transplant. my.blood.co.uk, accessed 1 September 2018
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  • Reviewed by Alice Rossiter, Specialist Editor, Bupa Health Content Team, November 2018
    Expert reviewer, Professor Robert Read, Professor of Infectious diseases
    Next review due November 2021



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