infectious diseases
Malaria
Prevention of Malaria
Travelers to endemic regions should be given chemoprophylaxis (see table). Information about countries where malaria is endemic is available from the Centers for Disease Control and Prevention (CDC) (seeCDC: Yellow Fever and Malaria Information, by CountryandCDC: Malaria); the information includes types of malaria, resistance patterns, geographic distribution, and recommended prophylaxis. Malaria during pregnancy poses a serious threat to both mother and fetus.Chloroquinecan be used during pregnancy in areas wherePlasmodiumspecies are susceptible, but there is no other safe and effective prophylactic regimen, so pregnant women should avoid travel tochloroquine-resistant areas whenever possible. Treatment of malaria during pregnancy depends on infectingPlasmodiumspecies and known resistance patterns in the area of acquisition (seeCDC: Treatment of Malaria: Guidelines For Clinicians (United States): Alternatives for Pregnant Women). The safety ofmefloquineduring pregnancy has not been documented, but limited experience suggests that it may be used when the benefits are judged to outweigh the risks.Doxycycline,atovaquone/proguanil,primaquine, andtafenoquineshould not be used during pregnancy. Artemisinins have a short half-life and are not useful for prophylaxis. Prophylactic measures against mosquitoesinclude Usingpermethrin- or pyrethrum-containing residual insecticide sprays (which have prolonged duration of action) Placing screens on doors and windows Using mosquito netting (preferably impregnated withpermethrinor pyrethrum) around beds Treating clothing and gear (eg, boots, pants, socks, tents) with products containing 0.5%permethrin, which remain protective through several washings (pretreated clothing is available and may protect longer) Applying mosquito repellents such as DEET (diethyltoluamide) 25 to 35% to exposed skin Wearing protective long-sleeved shirts and pants, especially between dusk and dawn, whenAnophelesmosquitoes are active People who plan to use repellents that contain DEET should be instructed to Apply repellents only to exposed skin as directed on the label and use them sparingly around ears (they should not be applied to or sprayed in the eyes or mouth). Wash hands after application. Not allow children to handle repellents (adults should apply the repellent to their hands first, then gently spread it on the child's skin). Apply just enough repellent to cover the exposed area. Wash the repellant off after returning indoors. Wash clothing before wearing again unless indicated otherwise by the product label. Most repellents can be used on infants and children < 2 months. The Environmental Protection Agency does not recommend additional precautions for using registered repellents on children or on pregnant or breastfeeding women. On October 6, 2021, the World Health Organization (WHO) recommended widespread use of the RTS,S/AS01 (RTS,S) malaria vaccine among children in sub-Saharan Africa and in other regions with moderate to highP. falciparummalaria transmission. (SeeWHO recommends groundbreaking malaria vaccine for children at risk.) 