Malaria

Malaria is widespread in many tropical and subtropical countries. It is transmitted by the bite of an infected female Anopheles mosquito usually between dusk and dawn, kills more people than any other disease and is on the increase.

In the United Kingdom there are 2000 new cases a year imported from overseas, (mostly from Africa) about 9 of whom will die. Tablets reduce the risk but are never 100% effective, so AVOID BEING BITTEN

• Use an insect repellent containing 30% DEET (Diethyl-Toluamide) on exposed skin and garments. It is safe and effective.

• Malaria mosquitoes are most active at night, so cover arms and legs between dusk and dawn.

• If your accommodation is not air conditioned or does not have insect screens or windows which close, sleep under a mosquito net.

• Mosquito nets are more effective if impregnated with insecticide such as permethrin. An electric mat to vapourise insecticide overnight can help.

• Scrupulously follow the advice for taking the medication you are prescribed (see below). Many of the cases in the UK occur due to people not continuing to take their anti-malarials on their return to Britain.

• If you develop fever or flu like symptoms, even several months after leaving a malarious region, see a Doctor immediately and ask if you might have malaria. The doctor you see might not know you’ve been away.

• If you are pregnant or planning pregnancy or taking young children please tell your doctor. Children require a lower dose.

Incubation period is usually 12-30 days. There are several different strains, so symptoms vary from a recurring flu-like illness with high fever and shaking chills to coma and rapid death. Diagnosis is only confirmed by examining a blood smear. Effective treatment is available if started in time.

Anti-Malaria Tablets

There is no suitable inoculation as yet, so prophylactic medication must suffice. There is rarely definitive advice on what tablets to take for many reasons including:

Advice rapidly changes because:

• New areas become endemic.
• New strains of malaria emerge and also drug resistance develops.
• New medication becomes available.

Therefore, up-to-date advice is essential, from your Occupational Health Department or the Malaria Reference Laboratory (recorded advice) on 09065 508908.

Usually there is a range of acceptable options, again remembering that none are 100% effective. Many can have adverse reactions, so this risk must be balanced against the risk of Malaria.

Side effects of some medications preclude their use by pilots though they may be recommended for travellers. Beware!

You may be offered one of the following options which are acceptable for pilots.

• Tablets

Either - Proguanil (paludrine) 100mg - 2 tablets daily

Plus - Chloroquine (avloclor 250 mg or Nivaquine 200mg) - 2 tablets weekly  - from at least 7 days before entering malarious zone, during your stay and for 4 weeks after return.

or - Malarone (atovaquone 250mg and proguanil 100mg) - 1 tablet daily - from 1-2 days before entering malarious zone, each day during your stay and for 7 days after return. Maximum stay 28 days.

or - Vibramycin (Doxycycline 100mg daily) - 1 tablet daily - from 1-2 days before entering malarious zone and continued daily until 4 weeks after leaving malarious zone.

All have their own advantages and disadvantages.

• Proguanil plus chloroquine  16 tablets per week-for a 3 day stay you will need 88 tablets! Now available in combined blister packs. Safe, but efficacy of protection decreasing (only 70% effective in Africa a decade ago, probably much less now). Limited value for standby roster.
• Malarone For a 3 day stay you will need just 12 tablets. New, few side effects yet reported. More effective than Proguanil and Chloroquine where the more serious strain P.falciparum is rife. Expensive per tablet, but compare cost for a short course.
• Doxycycline 38 tablets needed to cover a 3 day stay. 3% develop skin sensitivity to sunlight. Some indigestion.

REPORT RELEVANT SYMPTOMS TO DOCTOR