Malaria: tips on malaria prophylaxis

In advanced age, time and financial resources finally allow to travel to distant countries. If you are flying to the tropics, you should be aware of malaria beforehand. Because the disease is not to be underestimated and runs untreated deadly. We show how you can protect yourself with a malaria prophylaxis and where the malaria areas are located. Also: important info about the course of the disease, infection, subsequent damage and symptoms of malaria.

➠ Contents: What to expect

Is malaria contagious?

Malaria is a serious disease, which is transmitted in large parts of Africa, Asia, Central and South America by crepuscular and nocturnal Anopheles mosquitoes. Colloquially, these mosquitoes are often referred to as malaria mosquitoes.

The parasitic malaria pathogens, the so-called plasmodia, which these mosquitoes carry, enter the body during the bite and multiply there. A direct infection from person to person is therefore not possible, only over the detour of the mosquitoes.

Malaria pathogens require humans and malaria mosquitoes

In order to develop further, the malaria pathogen needs both the malaria mosquito and the human being. The spread of the disease therefore corresponds to the habitat of this mosquito as a vector. Wherever their habitat overlaps with that of humans, malaria is to be expected.

Theoretically, the pathogens can even be transmitted via infected blood transfusions or hypodermic needles. Even in malaria areas, however, this way is rather the isolated case, since in the vast majority of hospitals care is taken to disinfection.

Spread of malaria: Germany not affected

In contrast to the Egyptian tiger mosquito, which has already been seen in isolated cases in Germany, the malaria mosquito is not (or no longer) endemic in this country.

The areas where malaria is prevalent tend to be tropical and subtropical regions. The greatest spread is mainly in sub-Saharan Africa. It is also widespread in Latin America and Asia. The same applies to some West Pacific islands.

The World Health Organization and the German Foreign Office regularly publish maps showing the current distribution of the disease.

It is worth taking a closer look at your travel destination

However, these maps can only give a first general indication. Regional differences must always be taken into account. For example, the risk of infection in Tanzania is very high almost everywhere, with the exception of areas above an altitude of 1.800 meters or in Zanzibar, where it is considered low.

In southern Africa there are also differences. If we take the popular tourist destination of Namibia as an example, only the northern, somewhat wetter region is affected due to the desert nature of large parts of the country. In the rainy season this is the area around the Etosha National Park and all year round the Caprivi Strip. The capital Windhoek and the entire southern part of the country are considered malaria-free.

These examples prove that you should inform yourself exactly where and at which time of the year the risk of malaria is at the moment. Therefore, always seek advice from a tropical medicine specialist.

These types of malaria exist

It is estimated that approximately 200 million people worldwide contract malaria each year, of which about 600.000 die due to lack of or inadequate treatment options. The disease is therefore life threatening.

In the case of the disease, a distinction is made between four types, depending on the type of pathogen:

• Malaria tropica
• Knowlesi malaria
• Malaria tertiana
• Malaria quartana

The most common type is the most serious: malaria tropica. The other three types occur less frequently and are much milder in their course.

Malaria: course of the disease and symptoms

What happens when you have malaria? What are the symptoms of malaria? Those who are infected with the pathogen do not notice this immediately. Symptoms appear at the earliest one to two weeks after infection. In some cases the incubation period can last up to half a year. Therefore, even long after returning from a risk area, you should still consider the possibility of contracting malaria. This is especially true if you experience the following symptoms:

• Fever
• Chills
• Diarrhea
• Sweating
• Muscle pain
• Vomiting

Therapy is mostly medicinal and stationary

If malaria is suspected, the first step is a blood test. This allows to see if and which pathogens can be detected.

This is followed promptly by drug therapy against the identified parasites. This is done either in tablet or infusion form. The active ingredients chloroquine and hydroxychloroquine are frequently used in the process. In Germany these agents are known as the drug Resochin.

In addition, the symptoms are treated as needed. In severe cases, respiration with oxygen must be prescribed.

The length of treatment depends on how early the disease is detected and how severe it has already become. It usually ranges from a few days to several weeks in severe cases where intensive medical care is required.

Is malaria curable?

Can malaria be survived? Is malaria completely curable? The disease can be fatal if left untreated. Therefore: As soon as malaria symptoms appear, they must be treated quickly.

Anyone who suspects that they have contracted the disease should seek medical treatment immediately. It is best to go to a clinic with a tropical medicine department.

If the disease is treated in time, the statistical mortality rate is well below one percent. Malaria is therefore considered curable if it is detected early and action is taken against it.

Causes malaria sequelae?

Despite rapid treatment, complications and even consequential damage can still occur in individual cases. This applies primarily to Malaria Tropica. Some patients never really recover from it again. Some of the possible after effects include:

Prevention: Is there a malaria vaccination?

There is no vaccination against malaria. There is, however, the possibility of a medicinal malaria prophylaxis with tablets. There are basically three different active ingredients that can be considered.

Mefloquine

The most common drug containing this active ingredient is called Lariam. It is the cheapest preparation for malaria prophylaxis and at first glance also the most practical, as you only have to take one tablet a week.

However, it has significant side effects. In about 25 percent of cases, severe sleep disturbances, hallucinations, mental changes or confusion occur.

Doxycycline

Doxycycline is an antibiotic against various infectious diseases, including malaria. One tablet per day, but never in combination with dairy products. The active ingredient is then bound and immediately excreted from the body.

Doxycycline also has side effects. Despite sunscreen, it leads to an extremely increased UV susceptibility of the skin, which can be a significant limitation, especially in tropical sunny regions. In addition, it is recommended to continue taking the medication for at least two, preferably four weeks after returning home.

Atovaqoun/Proguanil

These two agents are offered as a fixed combination in tablet form. The most famous drug bears the name Malarone. It is by far the most expensive medicine, but the most tolerable one.

In rare cases, the ingestion is accompanied by nausea. This is especially true when taken on an empty stomach. At times there are slight skin rashes, headaches or inner turmoil, but they are kept within tolerable limits. Many travelers have had good experiences with this combination preparation, especially since it only needs to be taken for a maximum of one additional week after a stay in a risk area.

All three drugs for malaria prophylaxis require a prescription and must be taken two to three days before entering a risk area. They do not offer one hundred percent, but nevertheless quite reliable protection. Under no circumstances should you rely on homeopathic remedies for malaria prophylaxis in this context.

Malaria prophylaxis: What else you should consider

The best way to prevent malaria is to avoid being bitten by mosquitoes as much as possible. Therefore, anyone traveling to a malaria area should definitely have the following items in their luggage:

• Long and light clothes
• Flawless and undamaged mosquito net
• Insect repellent with the ingredient DEET or Icaridin
• Spray for impregnation for clothing

In addition, when choosing accommodation, make sure that it is mosquito proof and has good air conditioning and insect screens on doors and windows. Both can not completely eliminate the risk of being bitten, but can minimize it significantly.

Self-therapy through standby medication

If you are only traveling for a short time in a malaria area or if the risk of infection in the area you are traveling to is considered low, you can carry one of the following medications with you as a standby therapy.

This means that it is taken only when symptoms occur after entering a risk area and no doctor can be reached. You should discuss this in advance with your tropical medicine doctor in Germany.

Travel etiquette: Correct behavior on the plane& at the vacation resort

Everyone wants to feel good on vacation. However, some people forget that they are not at home. Depending on the destination country, other cultural customs may prevail. In general, your behavior toward fellow travelers, staff and locals should be polite and considerate. This also applies in case of travel defects. Always keep calm and communicate in a friendly manner. You are also on the safe side with our travel etiquette guide:

When boarding, take your seat quickly, but without jostling. Some airlines let travelers board according to priority or seating. Stow the hand luggage in your foot space. For large carry-on items, use the overhead compartment above your seat.

Before doing so, make sure you are not holding up other travelers: If a line forms behind you, wait until those people have taken their seats.

Greet the person sitting next to you in a friendly manner if someone is already sitting in your seat row. Ask the person to stand up briefly if you have to pass them to get to your seat. The same applies if you want to go to the toilet during the flight.

Ideally, half of the armrests of the middle seat should be used by the passenger and the other half by the fellow passenger. If there is no non-verbal agreement, a friendly hint can help: Tell the person sitting next to you that you also want to use the backrest.

Travelers should be aware of opening hours. Means: If breakfast is not offered until 8 a.m., showing up earlier is impolite. Conversely, you must leave the pool area at 10.50 a.m. expect reduced service when breakfast time ends at 11 a.m.

Show up in such a way that you can easily finish your meal within the specified times. It is not allowed to take food from the buffet for later. Also absolutely taboo: To load umpteen courses on the table and leave half untouched.

Vacation clothes should be comfortable and practical. Still, there are some things to keep in mind depending on the time of day and hotel category: In the morning and at noon, shorts and a T-shirt or beach dress can be worn to meals in beach hotels.

At dinner, men should appear in long pants and shirt or T-shirt, women in skirt or dress. Especially for 4 stars and above, shorts are undesirable for both sexes. Also taboo: beach or sportswear.

When traveling in Europe and North America, the service staff in restaurants expects a tip from the guest. Usually you pay at least ten percent of the total amount. In some countries it is customary to leave your tip on a small plate.

Tips are also given to the room service in the hotel and the cab driver. In the hotel 1 euro per night is usual. For cab rides, you can round up or pay 10 percent as well. If there is a porter, you also pay one or two euros for the service.

Reserving a lounger at the pool with a towel is a common bad habit, especially among Germans and Brits. Especially if you are not at the pool, but perhaps still at the buffet.

Blocking couches is rude. Therefore you should only spread out your towel when you are there. If you leave the pool area (exception: a short toilet visit), you should also take your towel with you.

Toplessness is most common in Scandinavia, Belgium and Germany. For nudists there are specially designated beaches. Make sure you know what is allowed before swimming nude or topless abroad.

In Muslim countries like Egypt or Turkey, topless bathing or bare-breasted sunbathing is forbidden. But even in Europe it is not necessarily welcome: In countries like Spain or Greece, such behavior is only tolerated on tourist beaches.

If you are a tourist visiting a church, synagogue, mosque or temple, you should be dressed appropriately. Means: covered shoulders and knees for places of worship. In synagogues, men must wear a head covering (kippah). You are only allowed to enter mosques without shoes. Women should cover their head and shoulders with a scarf.

By the way, in some places beachwear (bikini, swimsuit) is too skimpy even for the old town: in Mallorca you can expect a fine of up to 200 euros. So make sure to wear appropriate clothing outside the hotel room.

Handshake is common in Central and Western European countries. In southern countries such as France, Spain and Italy, the implied kiss on the cheek (sometimes double) is also customary.

Especially in Asian countries, there is a greater distance in greeting than in Europe and North America. In Thailand, the wai salute is typical: with your hands closed in front of your chest, bow your head to others. In Islamic countries the handshake can be done, but only between men.

In many places the room must be vacated by 12 noon at the latest. Sometimes it takes several hours before departure. If you still want to use the remaining time, many hotels provide their service under certain conditions.

Usually you can still leave your luggage at the reception desk. There you can ask if you are still allowed to use the swimming pool and the sauna. However, the hotel may charge an additional fee for this.

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Important note

This article does not claim to be complete and only gives you general information. It cannot and should not replace a medical/medical consultation. Before taking any medication, please read the package insert carefully and consult your doctor or pharmacist.