Definitive Guide to Malaria for International Travellers

A form with the word "Malaria" appears next to a pills.

Malaria occurs in more than 100 countries around the world, primarily in tropical and subtropical regions of Asia, Africa, and the Americas.

The World Health Organization reports that more than 200 million people diagnosed with malaria each year. The disease claims nearly 450,000 lives annually, mainly children under the age of 5 in sub-Saharan Africa.

For Canadians undertaking international travel to malaria-endemic areas, the disease can be potentially fatal if left untreated. However, following malaria prevention recommendations and treatment with antimalarial drugs can prevent serious complications.

What is Malaria? How Does It Spread?

Malaria is an infectious disease caused by a protozoan (one-celled) parasite known as Plasmodium. Five types of Plasmodium cause malaria in humans. The parasite enters the blood and initially grows and multiplies in the liver and later in the red blood cells of the infected person.

The most common way for a malarial infection to spread from person to person is through a bite from an infected female Anopheles mosquito. These mosquitoes thrive in tropical climates and are usually active between dusk and dawn.

The mosquitoes get infected during a blood meal from an infected person and transfer the parasite to another person when they bite again. Rarely, malaria can spread from mother to fetus, during a blood transfusion, or by sharing needles. Malaria is not contagious and does not spread through casual contact or sexual activity.

Malaria symptoms

Symptoms of malaria include a flu-like illness with fever, chills, headache, muscle aches, and fatigue. Some people experience gastrointestinal symptoms such as nausea, vomiting, and diarrhea. Colonies of malarial parasites destroy red blood cells in infected individuals, which may cause anemia and jaundice.

Untreated, malaria can progress to kidney failure, respiratory failure, mental confusion, seizures, coma, and even death. Malaria requires urgent and aggressive treatment. Travelers should seek immediate medical attention if any of these symptoms are present up to 1 year after returning home.

Malaria Prevention and Treatment for Travellers

For travelers headed to malaria-risk areas, the following precautions are recommended:

• Prevent mosquito bites with insect repellants, insecticidal nets, and protective clothing, especially between sunset and sunrise.
• Take preventive medication before, during, and after travel to a malaria endemic country.

Malaria is diagnosed by identifying the parasite in a person’s blood sample with examination under a microscope. In areas where reliable laboratory diagnosis is not available, rapid diagnostic tests are a valuable alternative and can provide results in 2-15 minutes.

There are several medications that are effective against the malarial parasite, including chloroquine, mefloquine (Lariam), primaquine, quinine, and atovaquone-proguanil (Malarone, ATQ-PG).

A healthcare provider can decide on the best drug for the treatment of malaria, depending on the type of Plasmodium parasite identified in the blood, the area where the infection was acquired, and drug resistance, as well as the patient’s health status, allergies, and coexisting medical conditions.

It is worth remembering that an overdose of antimalarial drugs such as chloroquine can be fatal, so they must be stored carefully in child-proof containers.

Plasmodium parasite identified in the blood, the area where the infection was acquired, and drug resistance, as well as the patient’s health status, allergies, and coexisting medical conditions. It is worth remembering that an overdose of antimalarial drugs such as chloroquine can be fatal, so they must be stored carefully in child-proof containers.

Malaria Risk: Who Needs to Take Extra Precautions?

Certain individuals are at increased risk of malaria, including pregnant women, infants and young children, and people with compromised immunity. It is a good idea for such people to avoid traveling to areas where malaria transmission is common. However, if travel is unavoidable, malaria prevention medicines are available. For example, mefloquine can be started up to a month before travel, which provides an opportunity to identify any potentially serious adverse effects and change the drug if needed.

For the general population, the risk of malaria is higher when:
• Visiting a high-risk region such as West Africa or areas where Plasmodium falciparum is present (this species of the parasite is associated with a high death rate)
• Visiting a malaria endemic area for a longer period of time
• Spending time in remote or rural areas
• Visiting during the rainy season or soon after
• Spending time outdoors between dusk and dawn

Top Countries Where Malaria is Present

For international travelers from Canada and elsewhere, malaria risk is highest in regions where the disease is most prevalent.

The WHO reports that more than 90 percent of malaria cases occur in the African Region, followed by South East Asia (5 percent), and the Eastern Mediterranean Region (2 percent). The top 5 countries that carry nearly half the global malaria burden are:

• Nigeria
• The Democratic Republic of the Congo
• Mozambique
• India
• Uganda

If you are planning to travel to areas where malaria is present, talk to your local travel clinic today about precautions and preventive antimalarial medication.

References:

  1. https://www.who.int/malaria/travellers/en/
  2. https://www.cdc.gov/malaria/travelers/index.html
  3. https://www.cdc.gov/malaria/about/faqs.html
  4. https://www.canada.ca/en/public-health/services/diseases/malaria/causes-malaria.html
  5. https://www.who.int/malaria/media/world-malaria-report-2018/en/