If you go to a travel clinic (which you should) before traveling to a place where malaria is endemic, chances are the doctor is going to recommend that you take malaria prophylactics. A lot has been said in recent years about the efficacy of malaria prophylactics and about possible side effects of taking them. This article will take a look at what factors should be considered when making this decision. Keep in mind, at the end of the day it is a decision you should make during a consultation with a travel health doctor. The information here will help prepare you for that consultation, however.
There are three principal malaria prophylactics currently on the market: Mefloquine (popularly known as Lariam), Atovaquone and Proguanil (together known as Malarone), and Doxycycline, an antibiotic that has proven effective in preventing malaria. For more detailed information on each one of these options, please read our guide to malaria prophylactics.
All malaria prophylactics have their downsides to go with their obvious benefit, preventing you from getting malaria. Let’s be sure not to discount that benefit, either. Malaria is a devastating and potentially fatal disease. Considering that most prophylactics offer at least 90% protection if taken faithfully, it would seem crazy not to take them. So what are some of the factors to consider and for what reasons would you not take a malaria prophylactic?
Where are you Traveling?
You plan on traveling to a place where malaria is endemic, but that doesn’t necessarily mean you need to be taking prophylactics. For example, if you are traveling to sub-Saharan Africa, the case for taking prophylactics is strong. Plasmodium falciparum, the strain of malaria responsible for nearly all of the severe and fatal cases worldwide, is the most common strain in Sub-Saharan Africa (just check out this map).
However, if you are traveling to parts of SE Asia, malaria may be endemic, but not widespread.
Consult this table from the CDC to see if malaria is endemic where you are traveling. The table will also make recommendations for prophylaxis.
How Long are you Traveling for?
If you are traveling for a short time, it would be silly not to take a prophylactic if you are traveling in an area where malaria is endemic. The cost will not be too prohibitive, even if you are taking malarone, the costliest of the prophylactics, and you will likely be able to manage the side effects (if you experience any) in this short period of time (unless they are severe, in which case you should of course stop taking that prophylactic and consult a doctor for a better option). If you are traveling for significantly longer time periods (several years, for example), then the prophylactic question becomes trickier and it really depends on your location. Regardless of whether you are experiencing strong side effects, malaria prophylactics are taxing on your liver and in the case of doxycycline, you are actually taking an antibiotic every day.
What is the Alternative?
If you and your doctor decide that the risk is not high enough to warrant taking prophylactics, you should still take the following actions:
- Apply mosquito repellant (try 3M Ultrathon Insect Repellent Lotion
or, if you find DEET too harsh, try a picaridin product like Natrapel® 8 hour 6oz. Continuous Spray).
- Sleep under a mosquito net (imperative)
- Wear long sleeved clothing if you can, especially at dawn and dusk
- Use permethrin on your clothing (it will actually kill mosquitos when they come in contact with it) and on your mosquito net. See: Sawyer SP657 Permethrin Premium Insect Clothing Repellent
I would also highly recommend traveling with a treatment option. Depending on where you are traveling, different strains of malaria will be present. Again, this is something to discuss with your doctor. I primarily travel in West Africa where the plasmodium falciparum strain of malaria is common. For that reason, I carry Coartem (artemether/lumefantrine), a malaria treatment option that is capable of treating acute cases of p. falciparum. If you are traveling in rural areas, make sure you have a treatment option, such as coartem, on hand with you on all times. You can easily buy a treatment option at a local pharmacy. I have written about my own experiences with Coartem here.
Whether you are taking prophylactics or not (you can still get malaria when taking one, none of them are 100% effective), you should go to a clinic immediately if you are feeling the symptoms of malaria in a place where the disease is widespread. From wikipedia, the primary symptoms of malaria:
fever, shivering, arthralgia (joint pain), vomiting, anemia (caused by hemolysis), hemoglobinuria, retinal damage, and convulsions. The classic symptom of malaria is cyclical occurrence of sudden coldness followed by rigor and then fever and sweating lasting four to six hours, occurring every two days in P. vivax and P. ovale infections, while every three days for P. malariae. P. falciparum can have recurrent fever every 36–48 hours or a less pronounced and almost continuous fever.
If you do not have access to a clinic, begin taking treatment immediately. Even if you are not sure you have malaria, it would be wise to start the treatment if you are experiencing the above symptoms. Untreated, the symptoms of malaria escalate dramatically.
The Bottom Line
Before traveling, go to a travel clinic and consult a doctor. We are not here to tell you whether you should or should not take a prophylactic, but hopefully this article provided some things to think about when you do talk to a doctor about your trip. At a travel health clinic, the doctor will be able to discuss your destination and whether or not a prophylactic is recommended in addition to what kind of effective treatments are available.
I have had malaria twice. Both times I was taking a prophylactic (once on lariam and once on doxy). I will concede that I missed consecutive doses of doxy and that may very well have contributed to my second bout with the disease. On both occasions, I took coartem to treat it. I’m very thankful I had this treatment option on hand. Preparation is important when it comes to your travel health. Regardless of what you decide, make sure to talk to a doctor about your trip.
Have you taken malaria prophylactics before? Which one? Have you had malaria before? Have you traveled to a place with malaria without taking prophylactics? Let us know in the comments.
Photo credits: flickr user otisarchives2 and dr_relling