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
{ 8 comments… add one }
I’m travelling with my son. When we go to regions where malaria is endemic, he uses Malarone, which is highly effective, and I use Doxy, which is cheaper, but less effective.
In very high risk contexts, such as places where the locals warn you about malaria risk (inland Papua and Halmahera for us), we also use DEET repellent. I’ve been to sub-Saharan Africa, on Malarone, and plenty of malarial parts of Asia and Latin America on either Malarone or Doxy, topped up with DEET in high risk environments, and never caught malaria.
This is because, i think, I’m aware that prophylactics reduce your risk by 90%+ depending on which one and how you take them, but that still leave you with, on doxy, around a 1 in 10 chance of catching it anyway, so topping up with repellent makes sense. It’s something a lot of people forget.
I’m not hardcore enough to impregnate clothing with Permethrin, though might consider that for Papua. Surprised you don’t recommend Malarone as a treatment solution as well as prophylaxis in this post, actually. Any reason why not? The data seems good.
Anyway, like your approach to this. Big fan of evidence-based thinking about travel medicine that’s not trying to sell you stuff. I’d also add, go to a travel clinic, if you can, that’s attached to a tropical diseases hospital, like the Hospital for Tropical Diseases in London, UK. They have access to data on who ACTUALLY contracts what where which can really inform your travel medicine decisions.
Hey Theodora, excellent comment. Thanks for contributing. I also agree DEET repellant is key and I will definitely specify that in an edit of the article. Also, great tip about the travel clinic attached to a tropical disease hospital. In another article on the site, I think it’s linked to in the top of this one, I talk about the different prophylactic options, including malarone. You can check it out here: https://sickontheroad.com/2011/01/20/which-malaria-prophylactic-should-you-take/ Thanks for sharing this info Theordora, very useful stuff!
Yeah, we’re trying to make a site that includes a good amount of empirical evidence. We will of course always tell people to actually go to a doctor and a travel clinic, but perhaps they can get started here.
Take care,
Phil
Thanks for responding, Phil. I’ve been chatting to people about Papua and I’m actually going to do the permethrin thing there as well — so you might want to flag that as an option.
Theodora, adding it to the post now 🙂
Hey Phil
sorry but i don’t speak enghish very well…so if you can translate my experience :
je voyage depuis 2007 en Afrique de l’ouest (Niger) pour des périodes de 1 mois à 3 mois. Je ne prends aucuns traitements (style Malarone), je porte des vêtements amples à manches longues le soir, à la tombée de la nuit, heure où les moustiques se mettent à l’attaque, je recouvre les parties de mon corps à découvert (pieds, bras) avec un anti moustique (5/5 tropiques)…je n’ai jamais développé la malaria jusqu’à présent, malgré des multiples piqures. un médecin nigérien m’a dit que je m’étais sans doute auto vaccinée…
j’ai lu par contre qu’il existait un traitement homéopatique… à voir pour ceux qui ne veulent pas prendre des traitements lourds…
Bye
Chris,
C’est bien possible a voyager pour les periodes comme ca sans developper la malaria, mais je doute l’auto vaccination. J’ai pas beaucoup de confiance dans les traitemants homeopatiques parce qu’on sait jamais si il sont assez concentres. Je voyage moi meme dans la region et je suis au Mali et Cote d’Ivoire pour 9 mois chaque annee. Je prends pas les prophylactics et j’ai pas eu malaria depuis 2010. C’est un peu la chance aussi.
Merci,
Phil
pour l’auto vaccination, je ne suis pas certaine, mais il me semble que cela existe…à voir avec des médecins
c’est peut être aussi la chance… 🙂 …ou bien ?
Merci pour ton blog
à bientôt
Good thorough examination of the options! I purchased malaria pills for a 2 week bike ride through small towns up and down Vietnam. When I got there, I decided not to take it due to my short time in the actual malaria regions and it not being a major threat. I just slathered on the Deet. No problem for me.