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Does the traveller need anti-malaria prophylaxis?

A quick guide to help you make your decision as to whether a traveller really needs anti-malaria prophylaxis.

A quick guide to help you make your decision as to whether a traveller really needs anti-malaria prophylaxis.

Although advising on anti-malaria prophylaxis is complex, expert guidance is not usually necessary. The Pulse charts comprise basic information to stimulate the use of additional resources and should not be the sole basis for making a recommendation. Remember the following.

1 There are five malaria species that affect man; four benign. Benign species may cause relapse months or years later if inadequately treated.

2 The primary aim of prophylaxis is to prevent serious illness and deaths from malignant falciparum malaria. No prophylactic agent gives 100% protection.

3 Prophylaxis may be causal or suppressive. Causal prophylactics (Malarone and primaquine) kill parasites incubating in the liver and only need to be given for a week after leaving. Malarone only has a causal action for falciparum malaria.

Suppressive prophylactics only kill parasites when they appear in the blood and need to be given for 4 weeks after leaving a malaria zone. Doxycycline, mefloquine, chloroquine and proguanil are suppressive agents. Vivax and ovale malaria may reappear months or years after prophylaxis has stopped.

4 Risk areas are classified as a low ­ prophylaxis not usually necessary b variable ­ where there is a wet season increase in risk and prophylaxis is sometimes necessary c high ­ where it is always advised.

Short-term travellers to variable-risk areas may not need prophylaxis depending on the season, type of accommodation and whether travel is urban or rural.

5 Cities often carry a low risk and prophylaxis will only be necessary if the traveller is straying outside the city boundary. Examples are Nairobi and most cities in SE Asia.

6 Look at a good web-based malaria risk map (HPS constantly updates its one on www.travax.nhs.uk) and view it on screen with the traveller. Give a copy to the traveller to reinforce verbal advice.

7 There are some apparently risky areas where the actual risk is very low.

India and Nepal are prime examples in Asia, and the Inca Trail in South America is another ­ here most travellers will only need anti-malarial drugs if they divert to the Amazon.

Mosquito

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