Download malaria prevention - Vancouver Coastal Health

TRAVEL CLINIC
Vancouver Coastal Health
L-5, 601 West Broadway, Vancouver, B.C. V5Z 4C2
APPOINTMENT BOOKING LINE: (604) 736-9244
MALARIA PREVENTION
Malaria is caused by a parasite that is transmitted by the bite of an infected mosquito. Malaria may
cause anemia, jaundice, heart failure, kidney failure, coma and in some cases death. The best way to prevent
getting malaria is to protect yourself against mosquito bites and to take medication that prevents malaria.
Anti-malarial pills do not give complete protection and there is a small chance that malaria may
develop, sometimes months later. The symptoms of malaria are headache, chills, shaking, fever, sweats and
feeling ill. If these symptoms develop, seek medical attention immediately and if you have already returned
home mention that you have travelled to countries where malaria is present.
MOSQUITO PRECAUTIONS:
- After sunset stay in rooms with screened windows and doors. If you do go outside, wear
insect repellent, and light coloured clothing with long sleeves and trousers and socks.
- Use insect repellent containing at least 20 - 30% DEET on exposed skin. (e.g. Bens,
Watkins). Children should use no more than 20% DEET and ideally should use 10% DEET
(e.g. Ungava).
- Apply sunscreen first, wait 20-30 minutes and then apply mosquito repellent.
- Sleep under an intact net that has been tucked under the mattress BEFORE nightfall.
- Treat clothing and mosquito nets with an insect repellent spray, or buy a commercially
treated bednet.
- Burn mosquito/insect coils during evening.
- Use unscented cosmetics and toiletries as mosquitoes are attracted to scented products.
MEDICATION - For ALL the following medications approximately 25% of travellers will experience mild
short lasting side effects such as nausea, abdominal discomfort, vomiting and diarrhea. Taking these drugs
with plenty of liquid and a meal may reduce these symptoms.
1.
Chloroquine Phosphate (Aralen) is a safe, well tolerated drug for malaria prevention.
The adult dose is 2 tablets weekly, on the same day of every week, starting one week before entering
the malarious area, while there, and for 4 weeks after leaving the area.
- Chloroquine may be taken by pregnant women and children.
Chloroquine should not be taken by persons with:
i)
ii)
iii)
iv)
v)
*
retinal injury or visual field problems;
liver disease or chronic alcoholism;
serious neurologic (i.e. epilepsy), hematologic or gastrointestinal disease;
psoriasis or porphyria (may make psoriasis worse);
used with caution in G-6-PD deficiency (blood test NOT required).
KEEP OUT OF CHILDREN'S REACH - 3 TABLETS COULD BE FATAL!
Revised November 2013
2.
3.
Doxycycline (Vibramycin) is a tetracycline based antibiotic. It is prescribed for travel to high risk
malarious areas at an adult dose of 100 mg daily, beginning 2 days before entering the malarious
area, while there and for 4 weeks after leaving the area.
- possible side effects include photosensitivity resulting in an exaggerated sunburn reaction
(occurs in about 1% of recipients), and vaginal yeast infection.
- it should not be taken by pregnant women and children under 8 years of age.
- may decrease the effectiveness of oral contraceptive pills and an alternate form of birth control should be considered during the first two weeks of doxycycline therapy.
- may cause nausea and abdominal pain which can be decreased by taking the drug with
food.
Malarone is an extremely effective antimalarial for travel to high risk areas. Malarone is taken at an
adult dose of 1 tablet daily, beginning 1 day before entering the malarious area, while there and for 1
day after leaving the area.
- The complaints of side effects are minor and infrequent (nausea and abdominal pain) but it
is an expensive drug ($35/week compared to $5/week for mefloquine and doxycycline).
- Malarone is not yet approved for pregnant women and children less than 11 kg.
- Take Malarone with food or a milky drink to ensure absorption.
4.
Primaquine (BLOOD TEST REQUIRED PRIOR TO TAKING THIS) – this is an effective and safe
antimalarial provided you do not have glucose – 6 – phosphate – dehydrogenose deficiency (G-6PD).
This is an enzyme deficiency of red blood cells that can cause a life threatening anemia if drugs such
as primaquine are taken. Millions of people have G-6PD deficiency and don’t know about it. It is
more common in people from Central Africa, the Eastern Mediterranean and Asia but everyone
needs to get a blood test done prior to taking primaquine.
Once you have had a blood test done and have been approved to take primaquine you take 2 tablets
once per day, beginning one day before entering the malarious area, while there and for 3 days after
leaving the area. (The cost for this drug is about $10 per week.)
- may cause nausea and abdominal pain which can be decreased by taking the drug with
food.
- should not be taken by pregnant women and people with G-6PD deficiency.
5.
Mefloquine (Lariam) - Travellers going to high risk malarious areas may be advised to take
mefloquine at an adult dose of 1 tablet (250 mg) per week, beginning one week before entering the
malarious area, while there and continuing for 4 weeks after leaving the area.
- Some travellers may experience dizziness, disturbance of balance, confusion, hair loss,
nausea, insomnia and bad dreams.
- The following individuals should NOT take mefloquine: Those with seizure disorders,
severe depression or psychosis or cardiac conduction abnormalities.
- Mefloquine should not be taken at the same time as chloroquine or other quinine-like
drugs.
- Some people taking mefloquine think about killing themselves and there have been rare
reports of suicides. It is not known whether mefloquine was responsible for these suicides.
- There have been occasional reports (1 in 3,000 - 13,000) of serious adverse effects such as
hallucinations and seizures. If signs of unexplained anxiety, depression, restlessness or
confusion appear, the drug should be discontinued.
- Pregnant women may take Mefloquine if the risk of malaria is high.
- Be careful driving or performing other activities needing alertness and careful movements.
- Alcohol consumption is not recommended while taking mefloquine.
Revised November 2013