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Is Malaria a Holiday Risk for You?

Wednesday, 11 June 2014
Is Malaria a Holiday Risk for You?

By Dr Eddy Bajrovic, Medical Director, Travelvax Australia.

“Dengue fever at record global levels”
“Chikungunya fever sweeps through Caribbean” 
“Zika virus returns to Pacific”
Headlines about the increasing number of cases of these three mosquito-borne diseases have been all too common this year.

Australia’s been lucky: our geographic isolation has meant that while outbreaks of dengue occur in North Queensland each summer (155 to date this year), we’ve had relatively few cases of Chikungunya (19) and Zika (2) – all of them involving people infected while holidaying overseas.
So, you could be forgiven for thinking that malaria – the most lethal of all the mozzie diseases – is off the radar. That’s not the case.

What’s true is that malaria mortality rates have fallen by 42% globally since 2000 and by 49% in Africa, where many of the estimated 600,000-plus cases occur each year. (Tragically, despite the strides made in controlling and even eliminating malaria, it kills one African child every minute.)

Hundreds of Aussies get malaria

However, 3 out of 4 people living in South-East Asia are also at risk of malaria. Around 2 million cases occur there each year.

That means, malaria is not only a significant threat to the lives and livelihoods of millions of people in the region, but also for many of the tens of thousands of Aussies who travel there.

To date, 107 Australians have returned home with malaria in 2014. Last year 414 were infected – mainly in Asia and Africa, and to a lesser extent in the Pacific and Latin America.

Those rising infection rates shouldn’t be surprising: the SE Asia-Pacific region is by far the most popular holiday region with Australians, accounting for 53% of all overseas holidays by Australians in 2010, with 2.9 million departures. 

Aussies most at risk are those travelling through rural areas and staying in budget accommodation. But, malaria doesn’t only occur ‘off the beaten track’: People staying in more ‘upmarket’ accommodation get infected, too.

So, if you are travelling overseas, it is vitally important that you know if you:
-  Are travelling to a country with malaria.
-  Will be at risk where you are staying (malaria is often only present in certain regions of malaria-endemic countries)
-  Are at high, moderate or low risk of infection.
-  Should consider taking anti-malaria medication.

Expert advice on malaria is vital

The best way to find out if malaria will be a significant risk is NOT to ask a friend or your travel agent. 
Instead, take your itinerary to an expert – a doctor experienced in travel medicine, who can access the latest information and maps.

If malaria is a risk, a travel medicine specialist can advise you:
-  Where and when you need to protect yourself.
-  Whether malaria prevention medication is warranted.
-  If so, which malaria medication is right for you. (Give yourself enough time, you can even trial one or more anti-malarial drugs to determine which is right for you. It’s another reason to have your pre-travel medical consultation with a specialist 6 weeks before departure.)

While the first malaria vaccine is undergoing trials, for now at least we still rely on oral medication to prevent or treat malaria. A variety of drugs are available for: CHEMOPROPHYLAXIS - taken while you are still well to prevent malaria, and TREATMENT - taken when symptoms appear and malaria is suspected or confirmed.

Your travel medicine specialist or GP will determine whether taking prevention medication or carrying a drug to treat malaria at the first sign of infection would be best for you, based on your itinerary, length of exposure, and level of risk.

Malaria can kill – rapidly

The reason such care is taken over determining if malaria is a risk during travel is that it can kill quickly (unlike dengue, Chikungunya and Zika virus, which can be debilitating but are only rarely fatal).
There are five parasite species that cause malaria in humans: Plasmodium falciparum, Plasmodium vivax, Plasmodium malariae, Plasmodium ovale, and Plasmodium knowlesi. The most common are P. falciparum and P. vivax, while P. falciparum is the most deadly. 

The symptoms of malaria usually appear 7 days or more (usually 10–15 days) after a bite from an infected mosquito. The first symptoms – fever, headache, chills and vomiting – may be mild (one reason why malaria is often misdiagnosed).

But, if not treated within 24 hours, P. falciparum malaria can progress to a severe illness which often leads to death. Adults with established malaria infection frequently experience multi-organ failure, while kids with severe malaria frequently develop severe anaemia, respiratory distress, or the more severe cerebral form of the disease. 

Last Friday was World Malaria Day, an annual World Health Organization (WHO) initiative which aims to highlight the need for continued investment and sustained political commitment for malaria control and elimination. Fittingly, the theme was: ‘Invest in the future. Defeat malaria.’

The WHO warns that the emergence of artemisinin resistance in Cambodia, Myanmar, Thailand, and Vietnam threatens the achievements made in controlling and eliminating malaria. Another danger lies in the fact that the Anopheles mosquitoes which spread malaria are becoming increasingly resistant to insecticides.


Take these steps to protect yourself

Beside medication, every traveller’s front-line defence against malaria and other mosquito-borne diseases should be:
- An insect repellent containing an effective ingredient such as DEET (30-50% formulations for adults, or 10% formulations for young children aged from 6 months, Picaridin, IR3535, or oil of lemon eucalyptus when outdoors.
- Long, loose-fitting, light-coloured clothing when mozzies are most active – after dark for malaria mozzies, any time of day, but especially around dawn and dusk for those that spread dengue fever and Chikungunya fever in Asia, and Ross River fever in Australia – you will make yourself an even harder target to hit.
- A bed net and clothing treated with permethrin, an insecticide that kills any insects that land on the impregnated material, especially if you are staying in budget accommodation without screened windows or air-conditioning. You can buy a net already treated or make up the solution and treat your net, clothing and hats, to give yourself a strong ring of protection against biting insects.
Read more about how to avoid biting insects.

To find out if malaria or any insect-borne diseases is present at your travel destination call Travelvax Australia’s free travel health advisory service on 1300 360 164.