Malaria? I thought we could cure that! Those were my exact sentiments when I toured Viet Nam and Indonesia for the same agency a few years ago. The malarone (anti-malarial) medicine was making me horribly sick so – I stopped taking it. Overconfidence, it might kill you.
Recently two tragic events rocked my world. The first, mentioned previously, was the death of my son’s 22 year old best friend in a hiking accident in Croatia. Within the same seven day period, a colleague at work (one of the world’s largest humanitarian and relief agencies) died of malaria.
Both deaths highlight how perilous travel can be when we are out and about in unknown territory. Brandon, a much experienced hiker, misstepped on a mountain climb and fell 120 feet. Mark trekked more than a million miles through numerous countries on two continents (Africa and South America) surviving extreme danger in Darfur, Sudan (civil war) only to be brought low by malaria.
For years now I have jetted this earth and visited some of its most public health challenged areas with the most blasé of attitudes. To me, malaria was one of those pesky diseases, like chicken pox, that might inconvenience you for a few weeks – I thought. This contempt might be partially attributable to the fact that I’m a member of the ‘Fix It’ generation – the one that assumes if we can put a man on the moon (and maybe Mars) and sequence DNA, and zip my thoughts around the world instantaneously on Twitter, that we are verging on invincible. Malaria – yeah, we can cure that. And we can, too, sometimes, but let’s not forget that there are no guarantees.
I don’t know how my co-worker contracted malaria or how it was treated once diagnosed, but given that our employer provides excellent health benefits (significantly expanded for those traveling in medically dangerous territories) and we all have access to western-style medical care, this was a big wake-up call. I consider myself pretty worldly, but this sad event proved that what I might describe as travel sophistication, might border on travel arrogance.
So, since malaria is prevalent in numerous countries around the world, here’s a primer from those traveling to affected areas. The basics – And what it means for you:
Malaria is a vector-borne illness caused by protozoan parasites –Its spread by mosquitoes and difficult to treat.
It’s widespread in tropical and sub-tropical regions – It’s common in Africa, Asia and Latin and South America, and possible anywhere standing water and mosquitoes are present. It’s considered to be eradicated in North America (through use of DDT in the 50s), Europe and the Middle East, but cases occasionally pop up there.
It’s one of the most common infectious diseases and an enormous public health problem – Outside our ‘civilized’ world, there’s an enormous risk.
The risks can vary according to location, available medical treatment, and type of disease – According to the CDC, travelers to sub-Saharan Africa experience the greatest risk of both contracting and dying from malaria.
Active malaria infection with P. falciparum is a medical emergency requiring hospitalization. While P. vivax, P. ovale or P. malariae are often treated on an outpatient basis. Treatment involves supportive measures and specific anti-malarial drugs. – There are different types of malaria strains, some more dangerous than others.
Elements that foster malaria conditions include low altitude, warm temperatures, abundant rain, and standing water. Females, which spread the disease, feed at night – Check the conditions of your destination country, cover up with clothes, apply repellant, and limit activities from dusk to dawn.
Malaria is spread when the mosquito ingests the blood of an infected person, taking in microscopic malaria parasites. When the mosquito bites another person, parasites mix with its saliva, are injected into the victim, and multiply within red blood cells – Transmission can be reduced by preventing bites with mosquito nets and insect repellents (anything containing DEET in high concentrations is especially effective), or by control measures such as spraying insecticides inside houses, and draining standing water where mosquitoes lay their eggs.
Symptoms of malaria include anemia (produces light-headedness, shortness of breath, tachycardia, etc.), and other general symptoms such as fever, chills, nausea, flu-like illness, and, in severe cases, coma, and death – Don’t confuse malaria with the flu, if you have been in an infected region – get medical attention.
There is no vaccine currently available (some are in development), and preventive drugs must be taken continuously to reduce the risk of infection – Take every precaution available to you – nets, sprays, adequate clothing coverage, and follow the instructions on any medication.
Prophylactics are helpful, but must be used appropriately – Most are difficult to acquire outside western countries, must be administered long before first exposure to an infected insect, can only be taken short-term, and must be taken rigorously according to instructions. They can also have unpleasant side effects (nausea, headache, even hallucinations) with long term psychiatric consequences for prolonged use: depression, anxiety, paranoia, seizures.
Infection is treated through the use of anti-malarial drugs such as quinine or artemisinin derivatives, but the parasites are becoming resistant to many of these drugs – Precaution and prevention can be key.
Malaria can cause real, long-term medical consequences such as brain damage, liver damage, and overwhelming fatigue- Don’t take chances, even if you respond to life-saving treatment, you may have life-changing after-effects.
Severe malaria can progress extremely rapidly and cause death within hours or days, and fatality rates can exceed 20% even with intensive care and treatment – Don’t be blasé like me, prevention is much better than relying on a cure.
Different countries have different endemic malarial strains, which react to different medicines. Make sure the preventive you are taking is the right one – Consider visiting a doctor that specializes in travel medicine before traveling to risky regions. You can also consult the State Department’s website for general information on specific countries, or WHO.
Many inhabitants of malaria hot spots have some low, chronic level of infection and may develop resistance or partial resistance to the disease, whereas citizens of developed countries where malaria has been mostly eliminated have no natural protection and are more susceptible– Don’t follow the ‘when in Rome’ rule for malarial prevention. The locals that walk about unprotected may not have the same risk factors you do.
Many countries are ill-equipped to diagnose and treat the disease – Buy travel insurance or otherwise ensure that if you become ill, you can receive adequate care, even if it means going home or traveling to another country.
There’s a counterfeit market in some countries (primarily Asian) for drugs to treat malaria – Get treatment in a quality medical facility. If symptoms persist, fakes can be detected through lab tests.
Some strains of malaria can remain dormant for a year, or longer. The longest incubation period for one type of malaria was 30 years! – If you feel funny even a long time after visiting a foreign country, see a doctor and be sure to mention your travels.
When it’s not malaria – In some malaria-prone third world countries, malaria is almost an assumed diagnosis when certain symptoms present, which can lead to other, life-threatening conditions being misdiagnosed. Seek quality medical care and get confirmation through the use of a blood film test.
If you want to make the world a better, safer place to live in and travel through– Donate to organizations like “Nothing But Nets.” After all, the third world country you are improving, may be the next place you want to visit.
Bonus Trivia:
A Frenchman first identified the protozoan causing malaria in1880 (he received the 1907 Nobel Prize in Medicine) – Vive la France!
Cuban and British doctors later documented the link with mosquitoes. Two Frenchman improved upon an ancient Peruvian preventive for malaria (cinchona tree bark) to produce quinine, which was introduced to control the disease in 1820 – Let’s hear it for international research and cooperation.
It wasn’t until the 1980s that the latent liver form of malaria was discovered, explaining why some ‘cured’ of the disease experienced a relapse years later – We’re still learning, folks.
