If you don't get bitten by a mosquito, you won't get malaria.

All malarial diseases are transmitted by the bite of an infected female Anopheles mosquito, and she feeds at night. The most dangerous infections occur with those of one of the four malaria strains, Plasmodium falciparum, which in the most dangerous areas in this world is present in as much as 90% or more of all infected mosquitoes. Two hundred million clinical cases of malaria occur each and every year. Thirty thousand cases occur among European and American travelers.

SymptomsTop

The disease is characterized by fever and flulike symptoms, including chills, headache, body aches and malaise, but can even present as diarrhea. Malaria may be associated with anemia and jaundice, and P. falciparum infections may cause kidney failure, coma and death. Deaths due to malaria are preventable.

Malaria is the most important parasitic disease that you will face in most tropical and subtropical countries. A delay in diagnosis and treatment can have serious or fatal consequences. More soldiers have been put out of action by malaria than by bullets. If you travel to a malarious region, there are five things you must do:

1. Become informed about your risk of acquiring malaria in that particular region.

2. Take measures to prevent mosquito bites. (See Insect Protection Measures.)

3. Take a prophylactic (preventative) drug.

4. Know the symptoms of malaria.

5. Seek immediate medical care if those symptoms occur.

ChemoprophylaxisTop

Before departing for a malarious area, you and your doctor will decide if prophylaxis is indicated and which drug, if any, you will take. In general, selection of a drug is dependent on your age, itinerary and exposure to resistant strains of malaria-causing organisms. One of the following three options may be selected:

1. Chloroquine Phosphate (Aralen®) This is the older, long-used medicine which now can only be used in areas where the dangerous falciparum strain has not become resistant (see mefloquine).

Adult dosage: Take 1 tablet, each containing 500 mg salt, once a week starting 1 week before entering a malarious area, each week while there, and 4 weeks after leaving the area.

Child dosage: 8.3 mg/kg salt (6 mg/kg base) once a week, up to a maximum adult dose of 500 mg salt/week.

Please note: Chloroquine may be harmful if there is severe psoriasis, porphyria, problems involving the retina of the eye, or certain kinds of anemia.

2. Doxycycline (Vibramycin) For some travelers to Southeast Asia, whose journeys take them very close to border areas. Almost all the large cities of Southeast Asia are free of malaria.

Adult dosage: Take 1 tablet (100 mg) daily starting 1 to 2 days before entering malarious area, each day while in the area, and daily for an additional 4 weeks after leaving.

Child dosage: Greater than 8 years old, consult your pediatrician or your travel service. Not for children under 9 years of age.

Please note: Not to be used by pregnant women or children under 8 years of age, and due to increased sensitivity to the sun, wear a sunscreen.

3. Mefloquine (Lariam®) This prophylactic drug is recommended for almost all travelers world-wide except for Central America above Panama and the Middle East. These are areas where chloroquine can still be used.

Adult dosage: Take 1 tablet (250 mg salt) once a week starting 1 week before travel, then weekly during travel, and for 4 weeks after returning.

Child dosage: Consult your pediatrician or your travel service.

Please note: In the past, this medication has not been recommended for children under 33 lbs. or for women in the first 3 months of their pregnancy. Enough experience has been gained to allow the use of this medicine in both groups when the risk of disease is great. In children, the bitter taste of the medicine makes it difficult to administer. However, chocolate milk or cocoa makes it more tolerable for the young people. Those taking quinidine and patients with heart rhythm problems should check with their physician about taking mefloquine.

Important Note: Taking prophylactic antimalarial drugs is not a 100% guarantee that you will not develop malaria, but it's close, when combined with your adherence to proven effective insect protection strategies. However, if you suspect you are having an attack of malaria, urgently seek medical care. If medical care is not readily available, and if you are carrying standby antimalarial drugs, start self-treatment immediately.