infections
Malaria
Prevention of Malaria
Prevention involves Controlling mosquitoes Avoiding mosquito bites Taking preventive medications (malaria prophylaxis) Mosquito control measures, which include eliminating breeding areas and killing larvae in the standing water where they live, are very important. Also, people who live in or travel to areas where malaria is prevalent can take precautions to limit mosquito exposure: Using insecticide (permethrinor pyrethrum) sprays in homes and outbuildings Placing screens on doors and windows Using insecticide-treated mosquito netting over beds Applying mosquito repellents containing DEET (diethyltoluamide) on exposed areas of the skin Wearing long pants and long-sleeved shirts, particularly between dusk and dawn, to protect against mosquito bites If mosquito exposure is likely to be long or involve many mosquitoes, applyingpermethrinto clothing before it is worn Treating clothing and gear with products containingpermethrinhelps.Permethrinremains protective through several washings. Pretreated clothing to whichpermethrinis bonded is available and can protect through many wash cycles. 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 their hands after application. Not allow children to handle repellents (adults should apply the repellent to their hands first, then 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. Medications should be taken to prevent malaria during travel in areas where it is present. The preventive medication is started before travel begins, continued throughout the stay, and extended for a time (which varies for each medication) after the person leaves the area. Preventive medications reduce but do not eliminate the risk of malaria. Several medications can be used to prevent (and treat) malaria. Drug resistance is a serious problem, particularly with the dangerousPlasmodium falciparum, and in a few areas of the world withPlasmodium vivax. Thus for prevention, the choice of medication varies by geographic location. Information about travel to specific sites is available from the Centers for Disease Control and Prevention (CDC:Malaria and TravelersandMalaria Information and Prophylaxis, by Country). The medications that are used most frequently for preventing malaria are The combination ofatovaquoneand proguanil (in one tablet) Doxycycline (see Side effects of medications used for malaria ). given in one tablet, is taken daily starting 1 to 2 days before a trip. People continue to take the medication while they remain in an area where malaria is known to occur and for 7 days after they leave. It is the best-tolerated medication, but it can have Side effects of medications used for malaria . It is not given to women who are pregnant or breastfeeding or children who weigh less than about 11 pounds. It does not prevent recurring attacks of malaria caused by is taken daily starting 1 to 2 days before a trip to an endemic region. People continue to take the medication daily while they remain in an area where malaria is known to occur and for 4 weeks after they leave the area. It is usually tolerated well but has Side effects of medications used for malaria . It is not given to women who are pregnant or breastfeeding or to children under 8 years old. It does not prevent recurring attacks of malaria caused by Other medication options for preventing malaria includechloroquine,hydroxychloroquine,mefloquine,primaquine, andtafenoquine. Chloroquineis taken once a week starting 1 or 2 weeks before a trip. People continue to take the medication weekly during their stay and for 4 weeks after they leave the area.Chloroquineis used to prevent malaria in the few parts of the world wherePlasmodiumspecies have not developed resistance to it.Chloroquineis the only preventive medication that can safely be taken by pregnant women. Thus, doctors advise pregnant women not to travel to areas wherePlasmodiumspecies are resistant tochloroquine. which is also used to treat certain Autoimmune Disorders , is effective against the same Mefloquineis taken once a week starting 2 weeks before the trip. People continue to take the medication during their stay and for 4 weeks after they leave the area.Mefloquineis effective for prevention in many areas, but it is rarely used because it can have severe psychiatric and other side effects. It is ineffective or less effective for prevention ofPlasmodium falciparumin Southeast Asia and occasionally elsewhere. Primaquineis another alternative for prevention, primarily for people traveling to areas where malaria is mainly due toPlasmodium vivax. However, before people start the medication, they need to have their blood tested for a relatively common enzyme deficiency called glucose-6-phosphate dehydrogenase (G6PD) deficiency (see table). People with this deficiency should not takeprimaquinebecause the medication may cause their red blood cells to break down.Primaquineis administered once a day starting 1 to 2 days before the trip. People continue to take it daily during their stay and for 7 days after they leave the area.Primaquinetaken daily for 14 days is also used to prevent recurring attacks of malaria in travelers who are taking other antimalarial medications (such asdoxycyclineoratovaquone-proguanil) and who have had heavy exposure toPlasmodium vivaxorPlasmodium ovale. Tafenoquineis an alternative for prevention of malaria for people (18 years of age and older) traveling to any area where malaria is common. However, as withprimaquine, before people start the medication, they need to have their blood tested for a relatively common enzyme deficiency called glucose-6-phosphate dehydrogenase (G6PD) deficiency. People with this deficiency should not taketafenoquinebecause the medication may cause their red blood cells to break down.Tafenoquineis taken once a day for 3 days before the trip. People continue to take it every 7 days during their stay and once after their return, 7 days after the last dose taken during the trip. A single dose oftafenoquineis used to prevent recurring attacks of malaria in travelers who are taking other antimalarial medications (such asdoxycyclineoratovaquone-proguanil) who have had heavy exposure toPlasmodium vivaxorPlasmodium ovale. Vaccination:The World Health Organization (WHO) recommends use of the RTS,S/AS01 (RTS,S) malaria vaccine among children in sub-Saharan Africa and in other regions with moderate to highPlasmodium falciparummalaria transmission. (SeeWHO recommends groundbreaking malaria vaccine for children at risk.) 