Malaria

Transmitted through the bite of infected Anopheles mosquitoes, primarily between dusk and dawn.

Symptoms

Fever, chills, headache, muscle aches, fatigue. Symptoms typically appear 7–30 days after infection. Can be life-threatening if untreated.

Treatment

Artemisinin-based combination therapies (ACTs) are first-line treatment. Prompt diagnosis and treatment are critical.

Endemic regions

Sub-Saharan Africa (highest risk), South/Southeast Asia, Central/South America, parts of the Middle East and Oceania.

Prevention & prophylaxis

Atovaquone/Proguanil (Malarone)

1 tablet daily.

Start 1 day before entry, take daily during stay, continue 7 days after departure. Well-tolerated with fewest side effects. Most expensive option. Contraindications: severe renal impairment, pregnancy (relative). Take with or after food.

Mefloquine (Lariam)

1 tablet (250 mg) weekly.

Start 1–2 weeks before entry, take weekly during stay, continue 4 weeks after departure. Convenient weekly dosing. Contraindications: epilepsy, current or past psychiatric disorders. Can cause neuropsychiatric side effects (vivid dreams, anxiety, dizziness). Stop and consult a doctor if rash, vertigo, depression, or anxiety reactions occur.

Doxycycline

1 tablet (100 mg) daily.

Start 1–2 days before entry, take daily during stay, continue 4 weeks after departure. Most affordable option. Also provides some protection against bacterial infections. Contraindications: pregnancy, children <8 years. Side effects include photosensitivity (use sunscreen) and GI upset. Take with food.

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Nighttime mosquito protection

Anopheles mosquitoes bite between dusk and dawn. Three layers of protection: (1) Clothing — wear light-colored, long-sleeved clothes from dusk. Treat clothing with permethrin. (2) Repellent — apply DEET 20–50% or Picaridin 20% to exposed skin in the evening. (3) Sleeping — use air conditioning or sleep under an insecticide-treated bed net (ITN). All three measures are recommended in every malaria area, regardless of risk level.

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Emergency self-treatment (standby)

For medium-risk areas, a standby treatment may be prescribed to carry. If fever >37.5°C persists beyond 24 hours and no doctor is reachable: (1) Artemether/Lumefantrin (Riamet): 24 tablets over 3 days — 4 tablets immediately, 4 after 8 hours, then 4 tablets morning and evening on days 2–3. (2) Atovaquone/Proguanil (Malarone): 12 tablets over 3 days — 4 tablets immediately on days 1, 2, and 3. Take with fatty food. Always seek medical attention afterward — the infection may not be fully cleared.

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⚠ Fever after travel — urgent action

Malaria can appear from 7 days after first entering an endemic area, up to months after return. If you develop fever >37.5°C: seek medical attention within 24 hours and request a blood test for malaria — regardless of whether you took prophylaxis. If the test is negative or uncertain, repeat it. This applies even if you completed a full course of prophylaxis medication.