Malaria, an infectious parasitic disease, is a deadly threat to travelers to the tropics. In Poland, someone dies because of it every year. Therefore, before traveling to the areas where malaria occurs, you need to take care of prophylaxis – travel medicine experts remind.
People who go to the endemic areas of malaria (i.e. the areas of its natural occurrence – PAP) and do not use anti-malaria prophylaxis, interrupt it or use poor prophylaxis, are at risk of death – warns Dr. Piotr Kajfasz from the Provincial Infectious Hospital in Warsaw.
Statistics show that the mortality from malaria among Poles is several times higher than in many Western European countries (even 10 times higher than in France). According to experts, the reason for these differences is the fact that Poles disregard the most effective prophylaxis in the form of antimalarial drugs.
This can be confirmed by the story of two Polish missionaries who went on a mission to Sierra Leone in February 2011 and did not apply drug prophylaxis. They both contracted malaria, and one of them died while returning to Poland – in Berlin. The other was saved only by the fact that he took 4 tablets of the most effective anti-malaria drug on his own (it was one of the three doses of the whole therapy). He was cured in Poland.
Our country was declared free from native malaria in 1963. However, since 1984, someone in Poland dies every year from malaria, which he contracted while traveling. Besides, deaths of Poles due to this disease also occur outside the country.
Malaria is found in over 110 countries. Many of them are frequent travel destinations. This includes, among others southern Mexico, Central America, the Caribbean, South America (especially the Amazon basin and the Orinoco), all of Sub-Saharan Africa and Madagascar, Central Asia (Tajikistan, Afghanistan, Azerbaijan), India, Indochina, Indonesia, Papua New Guinea and the islands of Oceania.
A tourist going to the tropics can never be sure that he will not be exposed to malaria – says Dr. Kajfasz. For example, the disease theoretically does not threaten tourists going to Egypt or Tunisia, but we can get infected with it if we are close to the Egyptian border with Sudan or Tunisia with Iraq (Kurdistan).
Approximately 3,5 billion people live in malaria endemic regions, and about 30 million tourists visit them every year. 30 thousand of them (ie one in 1000) contract malaria, half of them are Europeans.
Malaria (in Polish dab) is caused by a protozoan – malaria parasite (genus Plasmodium), which is transmitted by female mosquito mites. So far, four species of the plague have been known to cause malaria, but in recent years a fifth has appeared – Plasmodium knowlesi (monkey plague), which has passed from monkeys to humans.
Reducing the number of mosquito bites is one of the most important elements of anti-malaria prophylaxis in the tropics, emphasizes Dr. Kajfasz. We are most vulnerable to them at the end of the rainy season, near mosquito breeding sites, such as wetlands – explains the specialist. Mosquitoes that carry malaria are most active from sunset to sunrise, but those that carry dengue or yellow fever are most active during the day.
Therefore, for 24 hours. daily repellants must be used, i.e. preparations containing insect repellent compounds. Most often it is DEET (meta-N, N-diethyltoluamide), which is non-toxic and does not irritate the skin. In the case of children, its content should not exceed 30 percent. The repellent should be thoroughly spread on the body, because mosquitoes can sit on the skin as little as 4 cm from the place covered with the preparation. It should be reapplied after showering, swimming in the sea, strong winds, or when we sweat.
Dr. Kajfasz points out that, contrary to popular belief, aromatic oils and vitamin B1 have a very low effectiveness in repelling mosquitoes. Drinking large amounts of alcohol will also not protect you against malaria.
In addition, you should use mosquito nets purchased from a professional store, soaked in insecticide. If there is a fan in the room where we live, turn it on, because it will be more difficult for mosquitoes to find the target. It is best to kill all the mosquitoes in the room before going to bed.
It’s a good idea to cover your whole body – wear blouses and long-sleeved pants, and socks, although in the tropics this can be difficult. You should also wear light clothes, because dark ones in the evening convey the warmth that attracts mosquitoes.
However, all these methods will not protect us completely against infection. And because there is still no effective vaccine against malaria worth recommending to tourists. The basis is the use of the so-called chemoprophylaxis in the form of anti-malarial drugs. It includes older agents such as chlorokine, mefloquine, proguanil, doxycycline and the newest and most effective preparation, which is a combination of two drugs – proguanil with atovaquone.
Information on the selection of an anti-malaria drug, as well as vaccinations against other infectious diseases, should be consulted with a travel medicine doctor in a professional center before departure. He has knowledge of the areas where malaria occurs and the effectiveness of individual drugs. This is very important because in many parts of the world embryos have acquired resistance to older antimalarial drugs. When prescribing prophylaxis, the doctor must also take into account the age, sex and health condition of the patient as well as other medications taken by him.
The most dangerous malaria parasite – Plasmodium falciparum, which is responsible for the majority of deaths from this disease – is best protected by a drug, a combination of proguanil and atovaquone. It is the only drug recommended by the World Health Organization (WHO) for both the prevention and treatment of P. falciparum maralia. Its advantages also include a small number of side effects and the convenience of use. It is taken the day before departure, during the stay in the malaria zone and a week after returning from it, while other drugs must be taken for 28 days after returning – explains Dr. Cajfasz. The drug does not worsen psoriasis, has no effect on the psoriasis and motor coordination (like mefloquine, which can cause a drop in mood), does not cause nightmares, and does not trigger symptoms of decompression sickness in divers. It can be used in children, but only a doctor can choose the dose.
As Dr. Caiaphas points out, there is no alternative to chemoprevention in sub-Saharan Africa and Oceania. In other regions, it is allowed – after consulting a doctor – to use the so-called expectant therapy – explains the specialist. It involves the use of drugs – but in a much higher dose than the prophylactic one – only when we get sick. Therefore, every tourist must know what the symptoms of malaria are (they appear after a week at the earliest, and after two months at the latest, but in the case of two species of plague – even after a year).
The first symptoms – fever and chills, general pain in the body, joints, muscles, severe headache – are indistinguishable from colds and flu. Characteristic for malaria is that a person feels in danger and feels a cold incomparably greater than with a cold. However, these are subjective symptoms, so it is difficult for a doctor to assess them, explains Dr. Kajfasz. Sometimes there is also a cough, vomiting, diarrhea.
According to Dr. Kajfasz, if someone has used anti-malarial prophylaxis, it is unlikely that they will get sick, but you have to remember that there are no drugs in 100%. effective and that we may have missed a dose of the drug, e.g. after playing at night. Therefore, if after returning from the tropics you develop symptoms that may suggest malaria, it is necessary to consult a doctor at a specialized travel medicine center.
When going to the tropics, do not underestimate the risk of malaria. Remember that we are on vacation, but the mosquito is not – sums up Dr. Kajfasz. (PAP)