Prevention of Malaria

What is malaria? What are the symptoms?

Malaria is a serious and potentially fatal disease that is found in many tropical and subtropical countries. It is transmitted to humans through mosquito bites. If you are travelling abroad it?s important to know if you are going to be staying in, or travelling through, any areas which are known to have a risk of malaria, as there are many simple and effective measures you should take to prevent it.

The symptoms of malaria can develop from around 8 days after being bitten, and in some cases this delay can be much longer; occasionally even months to years later. They include many flu-like symptoms, such as a fever, headache, shivers, sweating, nausea, vomiting, backache, and joint or muscle pains.

Because the symptoms of malaria are so similar to those of influenza, anyone who has visited a country with a malaria risk who experiences these symptoms within a year of their trip ? especially within 3 months, and even if they took anti-malarial tablets at the time ? should seek medical attention straight away. The disease can be treated successfully in most cases if it is identified quickly.

How do I know if there is a risk of malaria at my destination?

There is a list of countries where the risk of malaria is such that malaria tablets (taken as a course to prevent malaria) are recommended for travellers. This list is updated regularly by UK malaria specialists, and is sent to doctors and pharmacists; it also contains recommendations about the most effective anti-malaria medicines for each country.

It?s therefore very important that you consult a pharmacist or doctor before you travel every time, even if you are going to somewhere you have been before, as the guidelines for your destination may have changed since the last time you were there. Sometimes websites, printed leaflets, or posters on walls may not carry the most up to date advice.

Sometimes malaria tablets are not required, but travellers will still be advised to take practical precautions to avoid bites.

How do I prevent malaria?

Depending on your destination, you will be advised to follow one of these courses of action.

No precautions required.

• For some countries, there is no current risk of malaria, and no additional precautions need to be taken.

Precautions required, but malaria tablets are not necessary.

• For countries where the risk of malaria is considered to be very low, malaria tablets are not recommended, however there are many practical steps that should be followed to prevent bites. See below for more details.
• Taking malaria tablets ?just in case? in this situation is not recommended, as this may increase the chance of malaria parasites becoming resistant to drug treatments in the future.

Malaria tablets recommended.

• Where the risk of malaria is higher, travellers will be advised to take a specific course of malaria tablets. These are started before entering the area, taken during your stay there, and finished after you leave. The amount of time you need to take them depends on the recommended medicine ? see below for more details.
• You should still follow the practical precautions detailed below, even if you are taking malaria tablets too. Malaria tablets are not 100% effective at preventing malaria, and are not a substitute for avoiding bites in the first place.

Practical precautions for avoiding mosquito bites

• Wear long-sleeved clothing, and long trousers and socks rather than shorts, after dark. Mosquitos can bite at any time of the day, but are most likely to bite at night.
• Use effective insect repellents. Repellents containing an ingredient called ?DEET? (diethyltoluamide) are recommended, at a strength of at least 20%; a strength of 50% is considered to be ideal for all individuals over 2 months. The effect can wear off after a few hours, so several applications each day may be needed. Mosquitos can bite through thin clothing, so any such items should be sprayed too. Click here to see the range of insect repellents available from Pharmacy2U.
• Use anti-mosquito devices in your room, such as a mosquito net impregnated with an insecticide if your room is unscreened or if you are sleeping outdoors, and plug-in insecticide products or room sprays, or similar items
• There is no evidence to suggest that taking any kind of vitamin B supplement, or garlic supplement, will prevent mosquito bites.

What are the medicines used to prevent malaria?

There are currently five medicines in the UK that are licensed for the prevention of malaria. It?s very important that you take the malaria tablets that are recommended for your destination(s), unless there is a medical reason that prevents this.

In some parts of the world, the malaria parasites are resistant to one or more of the malaria tablets below. Therefore, not all malaria tablets are as effective as each other in all countries. For example, in some countries, Malarone is most effective; however in other countries, Avloclor is more effective. Your doctor or pharmacist will consult the most recent guidance to advise you about the malaria tablets which are currently recommended for your trip.

The dosages mentioned below are for adults. For children?s dosages, please ask your pharmacist or doctor. Many of the tablets are also available as liquids, if you have difficulty swallowing tablets.

None of these tablets are 100% effective at preventing malaria. As above, if you experience any flu-like symptoms within 1 year (and especially within 3 months) of your trip, talk to your doctor at your earliest opportunity.

If you are pregnant, breast feeding, or have any other medical conditions or take any other medicines, tell your doctor or pharmacist before starting any of these medicines.

Malarone tablets (atovaquone plus proguanil tablets)

One Malarone tablet is taken once daily, starting 1-2 days before you enter the malaria area. They are continued while you are in the area, and are finished 7 days after you leave the area.

A lower strength form, Malarone Paediatric Tablets, are also available for children. Ask the pharmacist for more advice if necessary.

• What are the side effects of Malarone tablets?

Like all medicines, Malarone tablets can cause side effects, although not everybody gets them. Potential side effects include the following: headache, nausea and vomiting, stomach pain, diarrhoea, dizziness, insomnia, and allergic reactions such as rashes, itching, and tightness of the chest. If any of these are experienced and are troublesome please talk to your pharmacist or doctor straight away. The enclosed leaflet gives more details about side effects.

• How do I buy Malarone tablets?

Malarone tablets are a prescription-only medicine, and are only available from a pharmacy when you have been given a prescription (usually a private prescription) by your doctor.

If you have a prescription for Malarone tablets, Pharmacy2U can dispense it and send the medicines to your chosen address. Please click here for further details of how to use this service.

Lariam tablets (mefloquine 250mg tablets)

One Lariam tablet (mefloquine) is taken once weekly, on the same day each week, and is started 1-3 weeks before you enter the malaria area. They are continued while you are in the area, and are finished 4 weeks after you leave the area.

• What are the side effects of Lariam tablets?

Like all medicines, Lariam tablets can cause side effects, although not everybody gets them. Potential side effects include the following: nausea, diarrhoea, dizziness, stomach pain, rashes, itching, headache, dizziness, convulsions, and sleep disturbances. The enclosed leaflet gives more details about side effects.

• How do I buy Lariam tablets?

Lariam tablets are a prescription-only medicine, and are only available from a pharmacy when you have been given a prescription (usually a private prescription) by your doctor.

If you have a prescription for Lariam tablets, Pharmacy2U can dispense it and send the medicines to your chosen address. Please click here for further details of how to use this service.

Doxycycline 100mg capsules

One doxycycline 100mg capsules is taken once daily, starting 1-2 days before you enter the malaria area. They are continued while you are in the area, and are finished 4 weeks after you leave the area.

• What are the side effects of Doxycycline 100mg capsules?

Like all medicines, Doxycycline 100mg capsules can cause side effects, although not everybody gets them. Potential side effects include the following: heartburn, sensitivity to sunlight (sunscreens are recommended), nausea and diarrhoea. The capsules can make the oral contraceptive pill less effective. The enclosed leaflet gives more details about side effects.

Click here to see suncare products and sunscreens available from Pharmacy2U.

• How do I buy Doxycycline 100mg capsules?

Doxycycline 100mg capsules are a prescription-only medicine, and are only available from a pharmacy when you have been given a prescription (usually a private prescription) by your doctor.

If you have a prescription for Doxycycline 100mg capsules, Pharmacy2U can dispense it and send the medicines to your chosen address. Please Click here for further details of how to use this service.

Avloclor tablets (chloroquine 250mg tablets)

Two Avloclor tablets (chloroquine 250mg tablets) are taken once weekly, on the same day each week, and are started 1 week before you enter the malaria area. They are continued while you are in the area, and are finished 4 weeks after you leave the area.

• What are the side effects of Avloclor tablets?

Like all medicines, Avloclor tablets can cause side effects, although not everybody gets them. Potential side effects include the following: nausea, diarrhoea (can be helped by taking the tablets after food), headaches, rashes, itching, and visual disturbances. The enclosed leaflet gives more details about side effects.

• How do I buy Avloclor tablets?

Avloclor tablets can be purchased from pharmacies without a prescription. You will be asked a few questions about your destination first, so the pharmacist can tell you if they area not the recommended tablets for your trip.

Click here to buy Avloclor tablets from Pharmacy2U.

Paludrine tablets (proguanil 100mg tablets)

Two Paludrine tablets (proguanil 100mg tablets) are taken once daily, on the same day each week, and are started 1 week before you enter the malaria area. They are continued while you are in the area, and are finished 4 weeks after you leave the area.

• What are the side effects of Paludrine tablets?

Like all medicines, Paludrine tablets can cause side effects, although not everybody gets them. Potential side effects include the following: nausea, diarrhoea (can be helped by taking the tablets after food), and mouth ulcers. If you are taking warfarin tablets from the doctor, it?s important that you discuss this with your doctor or pharmacist before starting Paludrine. The enclosed leaflet gives more details about side effects.

• How do I buy Paludrine tablets?

Paludrine tablets can be purchased from pharmacies without a prescription. You will be asked a few questions about your destination first, so the pharmacist can tell you if they area not the recommended tablets for your trip.

Avloclor and Paludrine tablets together

Sometimes it will be recommended that you take a course of Avloclor, and Paludrine, at the same time as each other. Rather than buying the tablets separately, there is a product called ?Avloclor and Paludrine Antimalarial Tablets Travel Pack? which contains enough of both tablets for 1 adult for a 2-week trip. These can be purchased from pharmacies without a prescription as above.

Click here to buy the Avloclor and Paludrine Antimalarial Tablets Travel Pack from Pharmacy2U.

How do I obtain medicines to prevent malaria?

Malarone tablets, Lariam tablets, and Doxycycline 100mg capsules are prescription-only medicines, and are only available from a pharmacy when you have been given a prescription (usually a private prescription) by your doctor.

If you have a private prescription, that means you have to pay for the full cost of the medicine and also any dispensing fee the pharmacist chooses to charge. Big differences can exist depending on where you take your prescription to be dispensed. This means that it is important for you to find the best price available to you.

Highly competitive prices are available at Pharmacy2U. Click here for details.

Avloclor tablets, Palurdine tablets, and the Paludrine And Avloclor Antimalarial Travel Pack can be purchased from pharmacies without a prescription. Click here to visit the relevant page of the Pharmacy2U website.

Special situations

• If you require malaria tablets for a child, please ask your pharmacist or doctor for more advice. All of these malaria tablets have different dosage guidelines for children, depending on their age and body weight. It?s important that they take the right malaria tablets in the right dosage.
• If you are pregnant, breast feeding, or have any other medical conditions or take any other medicines (especially epilepsy, depression or other psychiatric condition, liver or kidney problems, or psoriasis; or if you have had your spleen removed), tell your doctor or pharmacist before starting any of these medicines.
• If your travel itinerary is going to take you to more than one destination, ask your pharmacist or doctor for more advice.
• If you are travelling overland between two or more areas, you will have to take into account the malaria guidance for the places you travel through on your journey.

Links to further information

Holiday and Suncare products available from Pharmacy2U ? click here

Fit For Travel is a public access website provided by the NHS (Scotland). It gives travel health information for people travelling abroad from the UK.
http://www.fitfortravel.nhs.uk

National Travel Health Network and Centre (NaTHNaC)
http://www.nathnac.org/travel/

World Health Organisation advice on international travel and health
http://www.who.int/ith/