MALARIA PREVENTION

People returning from holiday may develop malaria, which can be fatal. Over much of Asia, India, Africa and South America there is a high risk of malaria infection. Travellers to moderate- or high-risk areas should start appropriate medication one week prior to departure on holiday and continue for four weeks after their return.

Advice about malaria prevention varies according to the area and time of year. Up-to-date advice should be sought from our up to date country specific information.

However, no medication is completely effective in preventing infection, and it is extremely important to avoid being bitten by the mosquitoes which transmit malaria.

Protection against mosquito bites

• If possible, avoid going out between dusk and dawn when malarial mosquitoes commonly bite. Wear long-sleeved clothing and long trousers when going out at night, and avoid dark colours, which attract mosquitoes.
• Apply insect repellent to exposed skin, choosing one containing either DEET or dimethyl phthalate. The manufacturers' recommendations for use must not be exceeded, especially with small children. Insect repellents which contain DEET include Autan, Ultrathion and Jungle Formula. (A new preparation, Mosiguard, does not contain DEET but is useful for small children and those with skins sensitive to DEET.)
• Use an efficient air-conditioner at night, if available. Use screens over doors and windows; if no screens are available, windows and doors should be closed at night.
• If accommodation allows entry of mosquitoes, use a mosquito net over the bed, with edges tucked in under the mattress, and ensure that the net is not torn and that there are no mosquitoes inside. Protection is increased by impregnating the net with permethrin or deltamethrin.
• Use anti-mosquito sprays or insecticide dispensers (mains or battery operated) that contain tablets impregnated with pyrethroids, or burn pyrethroid mosquito coils in bedrooms at night.
• If possible, stay in a well-constructed and well-maintained building in the most developed part of town.
• Even transient visits of an hour or two to infected areas can result in infection. People in transit stops on air journeys have been infected in airports.
• If you develop a fever, seek medical attention promptly.

This paper first appeared in Travel Clinics - A primary care manual
It was sponsored by SmithKline Beecham Vaccines Group