Malaria in Malaysia.
Malaria is a life-threatening blood disease caused by a parasite that is transmitted to humans by the Anopheles mosquito. Malaria is a preventable and treatable disease.
If malaria is diagnosed and treated early on, the duration of the infection can be considerably reduced, which in turn lowers the risk of complications and death.
How does a human become infected with malaria?
The Anopheles mosquito taking a blood meal.
- The female Anopheles mosquito transmits the parasite to a human when it takes a blood meal - it bites the human in order to feed on blood.
- Only the female Anopheles mosquito can transmit malaria, and it must have been infected through a previous blood meal taken from an infected human.
- When the mosquito bites an infected person a minute quantity of the malaria (plasmodium) parasite in the blood is taken.
- Approximately one week later that same infected mosquito takes its next blood meal. The plasmodium parasites mix with the mosquito's saliva and are injected into the host (human being).
Human-to-human transmission of malaria
- As the parasite exists in human red blood cells, malaria can be passed on from one person to the next through organ transplant, shared use of needles/syringes, and blood transfusion. An infected mother may also pass malaria on to her baby during delivery (birth) - this is called 'congenital malaria'.
- People cannot "catch" malaria from others just by being near them. You can sit next to an infected person quite safely, with no risk of infection, even if they cough or sneeze.
Symptoms
Symptoms of Malaria
- chills The transmission of Malaria
- headache
- vomiting
- tiredness
- nausea
- fever
- muscle ache
- back pain
- P. falciparum - 9 to 14 days
- P. vivax - 12 to 18 days
- P. ovale - 12 to 18 days
- P. malariae - 18 to 40 days
- Malaria in Malaysia: The two East Malaysian states of Sarawak and Sabah contribute up to 60 per cent of the country's total malaria cases detected and treated annually.
- As there are a lot of primates or monkeys in the forested areas of the two.states, from 2009, with proper diagnostic procedures, more cases of the 'monkey malaria' or Plasmodium knowlesi malaria were detected as more humans ventured into the natural habitat of the animals in the timber, hunting, tourism and plantation sectors.
- Prophylaxis is recommended for rural areas of Malaysian Borneo (Sabah and Sarawak Provinces) and peninsular Malaysia, particularly the forested, hilly, and underdeveloped interior areas. There is no risk in urban or coastal areas. Either mefloquine (Lariam), atovaquane / proguanil (Malarone) or doxycycline may be given.
- Malaria prophylaxis is not necessary for the urban or coastal areas (outside Sabah) visited by most travelers.
- Specific antimalarial treatment is available and must always be started as soon as malaria is diagnosed. There is increasing resistance to currently available drugs and treatment should be carried out by an infectious diseases specialist or other expert in the field.
Pregnancy
- Pregnant women, especially primigravid women, are up to 10 times more likely to contract malaria than nongravid women. Gravid women who contract malaria also have a greater tendency to develop severe malaria. Unlike malarial infection in nongravid individuals, pregnant women with P vivax are at high risk for severe malaria, and those with P falciparum have a greatly increased predisposition for severe malaria as well.
- For these reasons, it is especially important that nonimmune pregnant women in endemic areas use the proper pharmacologic and nonpharmacologic prophylaxis.
- If a pregnant woman becomes infected, she should know that many of the antimalarial and antiprotozoal drugs used to treat malaria are safe for use during pregnancy for the mother and the fetus. Therefore, the medications should be used, since the benefits of these drugs greatly outweigh the risks associated with leaving the infection untreated.
Pediatrics
- In children, malaria has a shorter course, often rapidly progressing to severe malaria. Children are more likely to present with hypoglycemia, seizures, severe anemia, and sudden death, but they are much less likely to develop renal failure, pulmonary edema, or jaundice.
- Cerebral malaria results in neurologic sequelae in 9-26% of children, but of these sequelae, approximately one half completely resolve with time.
- Most antimalarial drugs are very effective and safe in children, provided that the proper dosage is administered. Children commonly recover from malaria, even severe malaria, much faster than adults
Diet and activity
- Patients with malaria should continue intake and activity as tolerated.
Monitoring
- Patients with non– P falciparum malaria who are well can usually be treated on an outpatient basis. Obtain blood smears every day to demonstrate response to treatment. The sexual stage of the protozoan, the gametocyte, does not respond to most standard medications (eg, chloroquine, quinine), but gametocytes eventually die and do not pose a threat to the individual's health.
Prevention and Control
1. Determine your level of risk
- Inform yourself about your destination and the risk for getting malaria. Things you should consider are: The time of year you are travelling, the duration of your stay, the activities you plan to do and where you will be staying. The risk for an infection can vary considerably, even within a single country. Successful malaria prophylaxis depends on your knowledge - make sure you are in the know before you go.
2. Stay in well-screened areas at night
- Avoid sleeping outside or in the vicinity of areas where mosquitoes like to live, e.g. standing water (tyres, lakes, waste dumps). If you are sleeping in a tent, make sure that there are no holes anywhere and keep the door closed at all times. These may be very basic rules, but they can significantly increase the success of your malaria prevention effort.
3. Always use a bed-net impregnated with insecticides
- Check that the net is not damaged and always ensure it is properly tucked underneath your mattress. The room itself should have additional nets attached to the windows and doors. Keep the air conditioning on, as mosquitoes tend to stay out of cool, air-conditioned rooms.
* Bed nets which are impregnated with an insecticide can help reduce infections by mosquitoes, which carry malaria.
4. Use mosquito repellent
- Use an insect spray containing pyrethroids in all living and sleeping areas, especially during evening and nighttime hours.
5. Go for long sleeves
- Wear long sleeve shirts and trousers in the evening and at night. The less skin that is exposed, the better. Additionally, you can treat your clothes with permethrin in order to increase your protection.
6. Insect repellent again
- Insect repellent creams or lotions should be applied to any remaining exposed parts of the skin, especially in the evening and during the night. It is advisable to apply the repellent during the daytime as well. You never know, a particular mosquito might decide to bite you in broad daylight.
7. Sunscreen comes first - repellent second
- If you are using sunscreen, it should be applied first and the insect repellent second. The repellent will not work if you cover it with a thick layer of sunscreen. Alternatively, use a sunscreen that contains a repellent.
8. Check the malaria risks - Get an antimalarial (if necessary)
- Depending on the overall malaria risk at your destination, it might be necessary to practise malaria prophylaxis, either on a daily or a weekly basis. Consult with a travel clinic, healthcare provider or an online doctor service like ours (www.dred.com) well before your departure to discuss your specific preventive needs.
- Depending on the medication you use, you will have to start taking the medication up to two weeks before entering the risk area. In areas of intermediate risk, it might be sufficient to carry a treatment course with you as a stand-by medication. You would only start taking the medication if you experience any flu-like symptoms during your journey.
9. Follow your prescription carefully
- Do not forget to take the anti-malarial every day during your trip (or as advised) and do not stop taking it too early after your return. Most medications have to be continued for 4 weeks after you leave the malaria-affected area.
10. Be on the safe side
- If you experience any flu-like symptoms within 6 months after your return, always inform any doctor treating you about the journey and the areas you have been to. Although an infection with malaria usually causes symptoms within 1 or two weeks, it could take a lot longer (months) for the disease to break out. Even if you have done everything right, there always remains a small risk of getting malaria.
- Looking for malaria tablets before you take off? You can order your prescription online from DrEd.com and our London-based NHS-regulated doctors will dispatch your malaria tablets if you are suitable.
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