Malaria is a preventable, life threatening disease transmitted by the bite of mosquitos which have been infected with the malaria parasite. It’s essential that it is quickly identified and treated, otherwise the outcome can be fatal.
It’s the female mozzies which spread malaria, and once you’ve been bitten the parasite enters your bloodstream and makes its way to your liver. The infection then re-enters the bloodstream and grows and multiplies in red blood cells which explode, leading to more parasites entering the bloodstream. It is important to recognise that it only takes one bite from an infected mosquito to develop malaria.
The malaria parasite is a plasmodium (multi-nuclei) parasite. Plasmodium falciparum is responsible for the majority of malarial deaths in the world, but is predominantly found in Africa. In Asia and South America Plasmodium vivax is more common and is reported to produce milder symptoms, however it can have an extended length of stay in the liver of the infected person, which can cause relapses of symptoms for up to three years.
Where am I most likely to get it?
It’s really unfortunate that Malaria is endemic in over 100 countries worldwide, including those offering some of the best riding and most rewarding travel experiences. The majority of these are in Africa, South & Central America, Asia and the Middle East. When you are planning a trip it is important to identify the malarial risk within each region and country you are planning to visit, and www.fitfortravel.nhs.uk provides a useful resource for this.
Africa has the largest burden of the disease but there are approaching a million deaths per year worldwide. The majority of victims are children. Around 2,000 cases of malaria are even identified in the UK each year, but these are in patients who have recently travelled to countries where malaria is present. In most years this does result in a small number of deaths.
How do I know if I’ve got malaria?
One of the main problems with identifying whether you have contracted malaria is that it usually starts with non-specific general flu-like symptoms. It can take up to a year for symptoms to fully develop. Because of this, anyone who has travelled through a malarial region should be aware of the risk and should highlight their travel history to healthcare professionals, particularly if they experience such symptoms as:
• Fever, sweats and chills
• Muscle aches and pains
If the fevers, sweats and chills seem to occur in cycles of up to 48 hours this is particularly important, as this correlates to the cycle of infected red blood cells bursting and releasing more parasites into the bloodstream.
What treatment is there?
Once malaria is diagnosed, using a blood test, it must be treated as quickly as possible. Due to the differences in malaria infections caused by the parasites in the various parts of the world, it is essential that if you think you may have malaria you communicate the following to healthcare professionals treating you:
• Exactly where you have travelled
• Any anti-malarials you have been taking
• Potential incidences of exposure, such as times and locations when you have been bitten
In most mild cases, treatment is tablet based, perhaps delivered in a hospital setting in order to monitor the progression of the infection, although the treatment may be given to you to take at home. In the case of a severe infection the treatment is intravenous quinine followed by tablet based treatments.
How can I avoid it?
The risks of a severe malaria infection when travelling should not be underestimated. Although tonic water does contain some quinine, a stiff G&T at sundown just isn’t going to be up to the job. Prevention is clearly the best option and this can be through preventing bites themselves, and taking anti-malarial medications. It is important to remember that even if anti-malarials are taken in accordance with their prescription, they may not be fully effective. In addition to this there are increasing incidences of drug resistance in parts of the world. It sounds bad, but good bite prevention should always be maintained:
• Avoid being outside after dusk
• Wear long, loose sleeves and trousers
• Use DEET based insect repellent
• Stay in places with effective screening and air conditioning, but if this is not possible, sleep under an insecticide-treated mosquito net
For the majority of effective anti-malarial medications a prescription will be required. In order to ensure that you have the most appropriate treatment for the locations you are visiting, you should have a consultation with a GP practice or specific travel health service well in advance of travel. It is important to follow the instructions for taking medication closely to ensure that you receive the highest level of protection, this may include having to start taking it before the trip and continuing for a couple of weeks after you’ve left an infected area.