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Malaria
(See the World
Health Organization's (WHO) web site for
a map of countries with moderate to high risk
of infection)
According to the WHO, malaria is found in more
than 100 countries in the tropics and sub-tropics
visited by over 125 million travelers each year.
Since the 1970s, malaria has been on the rise
reappearing even in areas where it was thought
to be eradicated. Current statistics indicate
that worldwide, there are an estimated 2.7 million
deaths, and 300 to 500 million cases of malaria
annually. (Keystone, Preventing Malaria in International
Travelers, Journal of Travel Medicine, Vol 8;
3; Dec 2001)
While several drugs are available for the prevention
and treatment of malaria, different drug resistance
patterns have emerged around the globe. It is
therefore extremely important to consult a travel
medicine specialist who is familiar with the
resistance patterns in your destination. A false
sense of security fostered by taking the wrong
preventive drug can increase the risk of exposure.
Malaria is caused by any one of four parasites
from the Plasmodium family, transmitted through
the bite of the female Anopheles mosquito, which
bites mainly in the evening and night hours.
The risk of infection is highest at the end of
the rainy season. Infection at altitudes over
1500 m (approx. 4921 ft.) is rare.
Symptoms of malaria are similar to the flu,
with fever, chills, head-and-muscle aches, and
possibly vomiting and diarrhea. Jaundice (yellowing
of the skin) and anemia (too few red cells in
the blood) may also occur. Symptoms will develop
no sooner than seven days after exposure, but
may take months to appear. WHO recommends that
travelers who visit affected countries and develop
a fever within three months of returning home
be tested immediately for malaria The CDC recommends
being tested for malaria if fever develops within
one year of returning home.
Early diagnosis and treatment are essential — the
most severe form of malaria, called falciparum
malaria (caused by Plasmodium falciparum), can
be rapidly fatal if treatment is delayed by more
than 24 hours. Other forms of malaria are usually
not life threatening, though the symptoms can
come and go for years.
Malaria is especially severe in pregnant women,
where it can prove fatal to the mother and the
baby she's carrying. For this reason, it is strongly
recommended that pregnant women not travel to
malarious areas.
Several drugs are available to prevent or treat
malaria. The choice of drugs will depend on several
factors including the destination of travel and
the health status of the traveler. It is extremely
important to take the medicine exactly as directed,
and for the length of time specified. Failure
to follow instructions accounts for many cases
of malaria in travelers.
In cases where access to medical facilities
may not be possible in a timely manner, travelers
will be given a "stand-by" drug (different
from the one used for prevention). The stand-by
drug should be taken as directed if fever develops
while away from medical facilities, but medical
help should be obtained as soon as possible.
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