Malaria

What causes malaria?

Malaria is caused by the Plasmodium parasite. The parasite is spread to humans through the bites of infected mosquitoes.

There are 5 different types of Plasmodium parasite that cause malaria in humans. They are found in different parts of the world (but do overlap in certain areas) and vary in terms of how severe the infection can be.

All malaria infections cause the same symptoms and require immediate medical attention. It’s not possible to find out which type of malaria you have from symptoms alone.

• Plasmodium falciparum – mainly found in Africa, it’s the most common type of malaria parasite and is responsible for most malaria deaths worldwide, though treatment does cure the infection.
• Plasmodium vivax – mainly found in Asia and South America, this parasite causes milder symptoms but it can stay in the liver for years which can result in symptoms reoccurring if it isn’t treated properly.
• Plasmodium ovale – fairly uncommon and usually found in West Africa.
• Plasmodium malariae – this is quite rare and usually only found in Africa.
• Plasmodium knowlesi – this is very rare and found in parts of southeast Asia.

How malaria is spread

The Plasmodium parasite is spread by mosquitoes. These are known as ‘night-biting’ mosquitoes because they most commonly bite between sunset and sunrise.

When a mosquito bites a person already infected with malaria, it becomes infected and spreads the parasite to the next person it bites. Malaria can’t be spread directly from person to person.

When an infected mosquito bites, the parasite enters the blood and travels to the liver. In the liver, it develops for days to weeks before re-entering the blood. This is the point where symptoms develop and urgent treatment is required.

Although it is very rare, malaria can also be spread from a person with the infection through blood transfusions and sharing needles.

Where is malaria found?

Malaria is found in tropical and subtropical regions of the world. It is not found in the UK or Europe.

Travel Health Pro has more information about the risk of malaria in individual countries.

If you travel to a place where malaria is present, you can catch the infection there. It's very important to take precautions to avoid it, and to get treatment right away if symptoms appear.

Treating malaria

When malaria is diagnosed and treated quickly, you should recover fully. Treatment should start as soon as possible.

It usually begins in hospital, so doctors can watch for complications that might develop suddenly. Treatment is given as tablets or capsules. If someone is very unwell, medicine may instead be given through a drip into a vein in the arm.

Treatment for malaria can leave you feeling very tired and weak for several weeks afterward.

The type of medicine used and how long you need to take it depends on several things:

• the type of malaria you have
• how severe your symptoms are
• whether you had taken preventive antimalarial tablets
• your age
• whether you are pregnant

Preventing malaria

Malaria can often be avoided using the ABCD approach to prevention, which stands for:

• Awareness of risk – find out whether you’re at risk of getting malaria
• Bite prevention – use insect repellent, cover your skin with clothing, and use a mosquito net to avoid mosquito bites
• Check whether you need to take antimalarial prevention tablets by visiting a travel health clinic – if you do, make sure you take the right antimalarial tablets at the right dose and finish the course
• Diagnosis – seek immediate medical advice if you have malaria symptoms, including up to a year after you return from travelling

Being aware of the risks

Check whether you’re travelling to a malaria risk area on Travel Health Pro.

Visit your local travel clinic for malaria advice as soon as you know that you are travelling to a risk area.

If you grew up in a country where malaria is common, any natural protection will be quickly lost when you move. This means you need to protect yourself from infection if you’re now travelling to a risk area, even if that’s where you grew up.

Further information about travel health and vaccinations.

Preventing mosquito bites

Avoiding mosquito bites is one of the best ways to prevent malaria. This is particularly important during early evening and at night when mosquitoes bite.

There are several steps you can take to avoid being bitten.

Do

• mosquitoes can’t bite through clothing so wear light, loose-fitting clothing that will cover your arms and legs
• apply insect repellent to all areas of your skin that are not covered by clothing, including your face and neck
• remember to reapply insect repellent frequently
• sleep under a mosquito net that’s been treated with an insecticide, or in a room with effective air conditioning

The most effective repellents contain 50% diethyltoluamide (DEET). These are available in:

• sprays
• roll-ons
• sticks
• creams

There’s no evidence to suggest that other remedies protect against malaria, such as homeopathic remedies, electronic buzzers, vitamins B1 or B12, garlic, yeast extract spread (Marmite), tea tree oils or bath oils.

• make sure you get the right antimalarial tablets before you go – visit a travel health clinic for advice on which is the best antimalarial for you
• follow the instructions included with your tablets carefully
• make sure you complete the full course of tablets

There’s currently no vaccine available that offers protection against malaria.

Antimalarial tablets

Antimalarial tablets can help prevent you from developing a malaria infection. For the best protection, you must also follow mosquito bite prevention advice.

You must start taking antimalarial tablets before travel and continue taking them whilst travelling in the risk area. Antimalarial tablets must also be taken for a period of time after you have left the risk area.

How long antimalarial tablets should be taken will depend on which tablet is used.

Antimalarial tablets don’t stop malaria from entering your body. However, they do stop the infection from developing inside your body and prevent you from getting ill.

If you stop taking your antimalarial tablets early (even when you are back in the UK) you could still become ill with malaria.

Taking antimalarial medication

You may need to take a short trial course of antimalarial tablets before travelling. This is to check that side effects do not occur and that you do not have an adverse reaction. If you do, alternative antimalarials can be prescribed before you leave.

Types of antimalarial medication

The type of antimalarial tablets that you will be recommended is based on the following information:

• where you’re going
• any relevant family medical history
• your medical history, including any allergies to medication
• any medication you’re currently taking
• any problems you’ve had with antimalarial medicines in the past
• your age
• whether you’re pregnant

If you’ve taken antimalarial medication in the past, don’t assume it’s suitable for future trips.

The type of antimalarial that you will need to take depends on which strain of malaria is carried by the mosquitoes in an area. It will also depend on whether they’re resistant to certain types of antimalarial medication.

The main types of antimalarials used to prevent malaria are:

• Atovaquone plus proguanil (also known as Maloff protect or Malarone)
• Doxycycline (also known as Vibramycin-D)
• Mefloquine (also known as Lariam)

To find out what type of antimalarial medication is best for you, visit your local travel clinic.

Malaria is a serious illness that can turn fatal if it is not diagnosed and treated quickly. Severe complications can develop within just hours or days of the first symptoms appearing, which is why it is so important to seek urgent medical help as soon as possible if you suspect malaria.

Anaemia

When the malaria parasite destroys red blood cells, it can lead to severe anaemia. This is a condition in which the blood is no longer able to carry enough oxygen to your muscles and organs, leaving you feeling drowsy, weak and faint.

Cerebral malaria

In rare cases, malaria affects the brain. This is known as cerebral malaria, and it can cause the brain to swell, sometimes leading to permanent brain damage. It can also bring on fits (seizures) or coma.

Other complications

Severe malaria can also lead to a number of other serious complications, including:

• liver failure and jaundice, which causes yellowing of the skin and the whites of the eyes
• shock, a sudden drop in blood pressure
• pulmonary oedema, a build-up of fluid in the lungs
• acute respiratory distress syndrome (ARDS)
• abnormally low blood sugar, known as hypoglycaemia
• kidney failure
• swelling and rupturing of the spleen
• dehydration

Malaria in pregnancy

If you develop malaria while pregnant, both you and your baby face a higher risk of serious complications, such as:

• premature birth, meaning birth before 37 weeks of pregnancy
• low birth weight
• restricted growth of the baby in the womb
• stillbirth
• miscarriage
• death of the mother

Because of these risks, pregnant women are advised to avoid travelling to regions where malaria is a risk. If you are pregnant and thinking of travelling to a high-risk area, talk to your doctor, midwife, obstetrician or a travel health advisor for a full discussion beforehand. Not all antimalarial tablets are safe to use in pregnancy, so it is important to get advice specific to your situation.