How to Prevent Malaria

In my last post, I did tell you how unfortunate if you got malaria, but nothing can stop us from enjoying the beautiful natures and experiencing cultures of the places with malaria risk. There are many good information relating to this disease, though most of them are really technical (seems written for medical students). Well in this post, I just want to recap and to keep it simple.

not pictured: malaria

Ooppps.. Disclaimer first! The following information I will give you are as I interpreted. I didn't have any medical education whatsoever, please contact your physician, saman, or anyone you can trust for your health. It is important to know that each person body is unique, so this guide --or whatever-- can be misleading because your body is different than mine --or other 99.9% of human being on the planet. So, keep that "visiting a doctor" idea on top of your list before you travel, OK? The bottom line is: You cannot sue me for giving any wrong information; Keep this in mind!

How This Horrible Thing Can Reach Us
Since I was a small kid, I have been always wondering why in the world that God --or evolution, or whatever-- created this tiny super-annoying creature. Now I'm somewhat sure that mosquitoes existed to destroy humans and make our lives miserable.

OK, time to meet our bad guy, Anopheles!

damn, he does look badass! (image)

This anopheles (but no other mosquitoes) is the carrier of the parasite, known as Plasmodium, that causes malaria. Yeah OK it's not entirely its fault when this anopheles is just enjoying its day biting and sucking blood from innocent human beings. The bad thing is if that innocent human is happened to be infected by malaria. The parasites from his/her blood were also taken and stayed on anopheles' saliva for a couple of days. And since it's really unlikely that they fast for couple of days, they will bite another innocent, yet healthy, human being. When it bites, the parasites from its saliva are then transfered to this unfortunate human's blood. And infection begin a couple of days later when the parasites reach liver and begin multiplying.

if you prefer visual (image)

Then The Worst Thing Happened
When the parasites multiply and break out from red blood cells, we got fever. This repeat every 48 to 72 hours. Like I explained on my malaria story, the fever stayed for 3-4 hours and you'd feel that the room was really cold that made your body shiver (eventough you had 39 degree Celcius temperature!). But when the fever is gone, you'd feel normal and healthy until the next cycle of the paracites multiply.

You should be (really) worried if this kind of fever happen, because if you failed to get treated, the risk of death is extremely high. Ask the medical staffs to test your blood when you're having fever and chill for any malaria. If they did otherwise, they cannot detected the malaria, and might misdiagnosed you for dengue fever because of the low thrombocytes level on blood.

Anyway if you even got some funny feeling and flu-like fever when you come back home after visiting malaria endemic area, it is really wise to be worried and go to seek medical consultation and tell them about the malaria thing. It might get ugly if you ignore this flu, I tell you. And BTW, please remember that the parasites can stayed months, even years on your body and then struck when you are least expected. The longest record was this 74-year old Greek woman, who got malaria 70 years after exposed. You read it right, 70 fucking years.

So Where Is This Malaria Again?
While Dengue fever is a risk in urban area, malaria is a huge problem in the rural. Anopheles dislike cold weather, so it's most likely endemic in tropical, warm and rainy area. To get a bit more detailed than that, you can check this site. That site is really handy to get to know more about the risk places you'd like to travel to.

not pictured again: malaria

OK Now What?
There are some effective ways to prevent malaria. First is to stop the damned mosquito biting you. One of many ways you can achieve this is by wearing clothes that covers your body, not on a space suit way, but more into long-sleeve tees and long trousers. "It's too hot!" you'd say? Well, think also other small insects that destined to kill you beside Anopheles. These clothes protection are only half effective if you don't also spray insect/mosquito repellants on them or put anti-mosquito lotion on your body. Sleeping on a bed covered with nets are also another great idea to protect you from the bites.

Note: DEET is probably bad for environment and health, but it's really effective ingredient for insect/mosquito repellants, so make sure that yours have it.

your protection (image)

Anti-Malaria Pills
After you got protected from the outside, you should protect yourself from within. Antimalarial preventive tablets are available. It's important to consult with your doctor before you take any. There are several popular types, like Lariam, Malarone, and Chloroquine. Each has different effectiveness on your body, and different side effects.

I did tried to use Lariam on one of my trips, and I kinda regret it. The side effects such as nausea, mild hallucination and nightmare were persisted for the whole trip. This made my trip less enjoyable. But then again, some people who took Lariam claimed that they don't feel any different and these terrible side effects weren't present. On the other side, my girlfriend took Malarone and she was happy as normal. I should have knew and took Malarone too if it wasn't three times the price of Lariam.

So it's actually your call, which suit you the most. These are a perfect comparision from CDC site, the table help you consider or avoid certain type of anti-malaria pills.

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Atovaquone/Proguanil (Malarone)
+ Good for last minute travelers because the drug is started 1-2 days before traveling to an area where malaria transmission occurs
+ Some people prefer to take a daily medicine
+ Good choice for shorter trips because you only have to take the medicine for 7 days after traveling rather than 4 weeks.
+ Very well tolerated medicine – side effects uncommon
+ Pediatric tablets are available and may be more convenient

- Cannot be used by women who are pregnant or breastfeeding a child less than 5 kg
- Cannot be taken by people with severe renal impairment
- Tends to be more expensive than some of the other options (especially for trips of long duration)
- Some people (including children) would rather not take a medicine every day

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Chloroquine
+ Some people would rather take medicine weekly
+ Good choice for long trips because it is taken only weekly
+ Some people are already taking hydroxychloroquine chronically for rheumatologic conditions. In those instances, they may not have to take an additional medicine.

- Cannot be used in areas with chloroquine or mefloquine resistance
- May exacerbate psoriasis
- Some people would not prefer a weekly medication
- For trips of short duration, some people would rather not take medication for 4 weeks after travel
- Not a good choice for last minute travelers because drug needs to be started 1-2 weeks prior to travel

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Doxycycline
+ Some people prefer to take a daily medicine
+ Good for last minute travelers because the drug is started 1-2 days before traveling to an area where malaria transmission occurs
+ Tends to be the least expensive antimalarial
+ Some people are already taking doxycycline chronically for prevention of acne. In those instances, they do not have to take an additional medicine.
+ Doxycycline also can prevent some additional infections (e.g., Rickettsiae and leptospirosis) and so it may be preferred by people planning to do lots of hiking, camping, wading and swimming in fresh water.

- Cannot be used by pregnant women and children <8 years old
- Some people would rather not take a medicine every day
- For trips of short duration, some people would rather not take medication for 4 weeks after travel
- Women prone to getting vaginal yeast infections when taking antibiotics may prefer taking a different medicine
- Persons planning on considerable sun exposure may want to avoid the increased risk of sun sensitivity
- Some people are concerned about the potential of getting an upset stomach from doxycycline

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Mefloquine (Lariam)
+ Some people would rather take medicine weekly
+ Good choice for long trips because it is taken only weekly

- Cannot be used in areas with mefloquine resistance
- Cannot be used in patients with certain psychiatric conditions
- Cannot be used in patients with a seizure disorder
- Not recommended for persons with cardiac conduction abnormalities
- Not a good choice for last minute travelers because drug needs to be started at least 2 weeks prior to travel
- Some people would not prefer a weekly medication
- For trips of short duration, some people would rather not take medication for 4 weeks after travel

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Primaquine
+ It is the most effective medicine for preventing P. vivax and so it is a good choice for travel to places with > 90% P. vivax
+ Good choice for shorter trips because you only have to take the medicine for 7 days after traveling rather than 4 weeks.
+ Good for last minute travelers because the drug is started 1-2 days before traveling to an area where malaria transmission occurs
+ Some people prefer to take a daily medicine

- Cannot be used in patients with glucose-6-phosphatase dehydrogenase (G6PD) deficience
- Cannot be used in patients who have not been tested for G6PD deficiency
- There are costs and delays associated with getting a G6PD test done, however it only has to be done once. Once a normal G6PD level is verified and documented, the test does not have to be repeated the next time primaquine is considered.
- Cannot be used by pregnant women
- Cannot be used by women who are breastfeeding unless the infant has also been tested for G6PD deficiency
- Some people (including children) would rather not take a medicine every day
- Some people are concerned about the potential of getting an upset stomach from primaquine

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