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Travelers Beware: Malaria Is Making A Comeback

(March 2000)

It was the kind of thing no traveler wants to read before going on a trip, but there it was in bold print on the front page of the Pittsburgh Post-Gazette: "Local Man Catches Malaria in Cancun." I was a little taken aback because my family and I are leaving for Playa Del Carmen (50 miles from Cancun) at the end of March.

Concerned, I phoned my doctor for a prescription for the anti-malarial drug chloroquine, a frontline defense against malaria. The first pill is taken the week before arrival and once a week thereafter for the duration of the trip. One dose per week for a month after returning completes the prevention strategy. Even with today's medical miracles, though, there is still no drug or vaccination that can fight off malaria.

It ended up that the Pittsburgh man didn't have malaria, but rather another disease with very similar symptoms. Even with the Pittsburgh man's misdiagnosis, there is no doubt that malaria is still a hazard for all travelers visiting places where the ecology favors malaria transmission. Since my family and I will be hiking and visiting tropical, rural areas of Mexico, we plan on taking the anti-malaria prescriptions.

Malaria Is Growing

It seems that in the new century we are faced with both new and old diseases that have spread with a vengeance. Malaria is common in Africa, south and southeast Asia, and Central and South America. According to the Pan American Health Organization (PAHO), between 300 and 500 million episodes of malaria worldwide result in more than one million deaths each year.

The weather phenomenon known as El Nino has a lot to do with the growth of malaria. In addition, global warming was recently scientifically linked to heavy flooding. Floods create a perfect environment for mosquitoes, which carry and transmit malaria. Currently, the floods in Mozambique, Venezuela, and Ecuador have been catalysts for huge outbreaks of malaria which have killed thousands. With the continual changes in our global weather, malaria will more than likely spread to areas once thought to be malaria-free.

Due to the widespread geographical distribution of this infectious disease, and the increasing number of travelers, the opportunities to contract the infection are greater than ever before. The U.S. Centers for Disease Control (CDC) offers up-to-the-minute advisories on all travel-related health concerns around the globe. If you are traveling to a tropical location, it is best that you read the CDC's recommendations before planning your trip.

What is Malaria?

There are four strains of malaria, one of which is fatal. It is a serious illness for the very young and very old and is caused by four species of blood parasites. The parasite reproduces after the female Anopheles mosquito ingests it. When the infected mosquito bites a person, the parasite first enters liver cells without producing any symptoms. However, after one to two weeks, the liver cells rupture and release parasites that then invade red blood cells.

Malaria symptoms can develop as early as 6 to 8 days after a bite by an infected mosquito occurs or as late as several months after departure from a malarious area, after anti-malarial drugs are discontinued. Malaria can be treated effectively in its early stages, but delaying treatment can have serious consequences.

Diagnoses & Cure

Diagnosing malaria is relatively easy. If you have alternating high fevers and chills, headaches, and vomiting, you very likely have malaria. This can be quickly confirmed with a test. Taking first-line drugs like chloroquine and primaquine are still effective in 70% of cases.

Early diagnosis and immediate treatment of malaria by doctors are the best ways to combat the disease. However, the disease is often misdiagnosed because of the erroneous belief that only by traveling to poor countries can one acquire this infection. Disease in travelers is not a trivial matter, and often the problem is that many physicians lack information about diseases relevant to travelers and how to treat them.

Prevention

In spite of all protective measures, travelers may still develop malaria. With some simple precautions, you can greatly reduce malaria risk on your next tropical trip. Consult with your physician as soon as you begin planning your itinerary. This way you will have time to try out prescribed preventive drugs and repellents for possible reactions or side effects.

The CDC recommends that you protect yourself from mosquito bites. Prevent mosquito bites by wearing long-sleeved shirts and long pants; apply insect repellent to all exposed skin. Mosquitoes that transmit malaria bite between dusk and dawn. Use insect repellents that contain DEET, and be sure to follow these precautions

Always use according to label directions.

Use only when outdoors, and wash skin after coming indoors.

Do not inhale, swallow, or get repellant into the eyes.

Do not put on wounds or broken skin.

Use a concentration of 30-35%.

Spray living areas and sleeping areas with an insecticide to kill mosquitoes. If not sleeping in well-screened or air-conditioned housing, use a mosquito bed net. For greater protection, spray clothing with and soak bed nets in the insecticide permethrin. Permethrin will repel insects for several months. Portable mosquito bed nets, repellents containing DEET, and permethrin should be purchased before traveling and can be found in hardware, camping, and military surplus stores.

The old saying "an ounce of prevention is worth a pound of cure" is well-heeded advice whenever malaria is concerned.

Additional Resources:

Pan American Health Organization (PAHO) http://www.paho.org

Centers For Disease Control (CDC) http://www.cdc.gov

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