Significant risk

The risk of malaria, for those traveling to affected areas is significant, and so it is very important to take precautions to prevent it. On average, 12 people die each year from the disease.

Many cases of malaria can be prevented by checking whether or not the area you are visiting is at risk, taking anti-malarial medicines in the correct way, and getting prompt medical advice if you become ill.

You can check whether you need to take preventative malaria treatment for the country that you are visiting by looking at the 'destinations' section of the fit for travel website.

If you have taken anti-malarial medicine in the past, you should not assume that they will be suitable for future trips. The medicine that you require may need to be altered depending on the strain of malaria carried by the mosquitoes in the particular area that you are traveling to.

Anti-malarial medicines

Taking medicine to prevent catching malaria (anti-malarials) is essential for all travelers who are visiting areas that are at risk from malaria. However, anti-malarials are not 100% effective and, therefore, preventing bites is very important (see 'preventing mosquito bites' below).

If you need to take anti-malarial medicine, it is important that you carefully follow the instructions included with them.

• You should start taking mefloquine (Lariam) 2-3 weeks before traveling, and doxycycline and Malarone 1-2 days before travel. You should start all other anti-malarial medicine one week before travel.
• You should remember to take the medicine regularly, preferably after a meal to help prevent stomach upsets.
• You should continue to take the medicine for four weeks after returning (apart from Malarone which you can stop taking one week you after return).

Possible side effects of anti-malarial medication can include:

• nausea,
• diarrhea,
• headache,
• rash,
• mouth ulcers, and
• dizziness.

Before you start taking any medicine to prevent catching malaria, you should make sure that none of the situations outlined below apply to you:

Epilepsy

If you have epilepsy (fits), you should avoid chloroquine and mefloquine because they can cause convulsions (fits). You should consult you doctor before taking doxycyline because some medicines that you may be taking to control your epilepsy can make doxycyline less effective.

Psoriasis

Chloroquine can make psoriasis worse. You can take proguanil, mefloquine, doxycycline, or Malarone if you suffer from psoriasis

Psychiatric history

Some people taking mefloquine have experienced anxiety and depression. Therefore, if possible, you should avoid taking mefloquine if you have a history of serious psychiatric illness.

Liver problems

If you have any problems with your liver you should discuss the choice of anti-malarial medicines with your doctor.

HIV or AIDS

If you have HIV, or AIDS, you should speak to your doctor about your travel plans and choice of medicine.

Kidney problems

If you have kidney problems, you should not take proguanil. You should see your doctor if other malaria prevention medicines are necessary.

Irregular heart rate

If you are taking beta-blockers, or other medicines which help to control your heart rate, you should avoid mefloquine.

Oral contraceptive pill

For the first three weeks of taking doxycyline, you will need to use an extra method of contraception, such as a condom, as doxycycline can reduce the effectiveness of the oral contraceptive pill. You should also continue taking your pill without your normal seven day break. You should discuss this with your doctor.

Porphyria

If you have porphyria (an inherited condition that causes sensitivity to sunlight and sometimes abdominal and nerve pain), you should avoid taking doxycyline. See your doctor for advice about alternative anti-malarial medicine.

Spleen removed (splenectomy)

If you do not have a spleen, you may become seriously ill if you get malaria. You should therefore discuss your travel plans with your doctor.

Warfarin

If you are taking proguanil, you should discuss this with your doctor before you travel because sometimes proguanil can alter the effectiveness of warfarin.

It is very important that you are aware that any flu-like illness, or anemia, that occurs within three months of returning from traveling in places where malaria is present, may be malaria, even if you took your medicine. If you become ill when you get back, you should see your doctor and mention where you have been on holiday, and that you may have been exposed to malaria.

If you have any concerns about the information above, or need any help understanding it and relating it to your own situation, you should talk to your doctor, or pharmacist.

Preventing mosquito bites

Below are a number of measure that you can take to help prevent being bitten by mosquitoes while traveling in countries where there is a risk of malaria.

• Use insect repellent on your skin and in sleeping environments. The most effective repellents contain diethyltoluamide (DEET). Insect repellents are available in a variety of forms including, sprays, roll-ons, sticks, plug-in devices and creams. You can also get sun protection lotions that contain insect repellents.
• Wear trousers , rather than shorts, and shirts that have long sleeves. This is particularly important during early evening and night time, as this is the mosquitoes preferred feeding time.
• Stay in accommodation that has screen doors, and close gasows . In addition to this (or if this is not possible), sleeping under a mosquito net that has been treated with insecticide will help you to prevent being bitten.