FOR THOSE WHO TRAVEL

Mechanical protection

The first defense to be activated to avoid malarial risk is to avoid mosquito bites. The female Anopheles mosquito, the vector of the malarial parasite, uses thermal and olfactory, but also visual, stimuli to locate the host to be stung to make his blood-based meal. In particular, it is attracted to carbon dioxide concentrations. The dark colors attract the insect in question which it uses to sting at sunset and during the early hours of the night. Some natural perfumes or fragrances can attract mosquitoes and cause them to sting.

Inside homes: protecting windows with insecticide-treated nets and using mosquito nets impregnated with insecticides on the beds can provide good protection; the use of air conditioning considerably reduces the risk of insect bites.

Outdoors: use clothes that cover well, preferably shirts with long sleeves and long trousers, in particular from sunset to evening; it is advisable to pass repellents or insecticides on clothes to further decrease the risk of stings.

The repellents

Most repellents contain DEET (N, N-diethyl-methyl-toluamide) very active substance in use for over 40 years. Other synthetic repellents are active for about 3-4 hours and must be applied periodically (about every 3 hours) during exposure to malaria risk. Repellents must not be inhaled or ingested and are dangerous on irritated skin or on the eyes. They should be used with caution in children and never applied on their hands because they are easy tools for contaminating the eyes and mouth. Water can easily remove different types of repellents from the skin.

The repellent must be applied to the whole exposed part of the body: it is proven that mosquitoes can sting less than an inch from a covered area.

The use of repellents is not recommended:

• in children under one year of age;
• to residents for long periods (storage toxicity);
• to pregnant women.
   

Pregnancy

The risk of death from malaria of the woman increases in pregnancy. Do not go to malaria areas unless absolutely necessary. WHO (World Health Organization) advises pregnant women not to go on vacation to areas where there is transmission of chloroquine-resistant P. falciparum.

In case:

• be very diligent in the use of protective measures against mosquito bites;
• use chloroquine and proguanil for prophylaxis;
• in the areas with chloroquine resistance of P. falciparum the combination chloroquine-proguanil must be used in the first trimester of pregnancy; mefloquine can only be used from the 4th month of pregnancy onwards;
• do not use Doxycycline for prophylaxis;
• seek immediate medical attention if malaria is suspected and do self-treatment in emergency (the drug of choice is quinine) only if a doctor cannot be found immediately. However, a doctor should be sought after self-treatment.

Children:

The WHO does not recommend taking infants and young children on holiday to malarial areas, particularly where there is transmission of chloroquine-resistant P. falciparum unless absolutely necessary.

In case:

• protect children from mosquito bites; mosquito nets are available for cots and beds: keep young children under the protection of mosquito nets in the period from sunrise to sunset;
• give anti-malarial prophylaxis to breast-fed and bottle-fed babies as they are not protected from prophylaxis that the mother has possibly done before;
• chloroquine and proguanil can be safely administered to infants and young children. For the administration the drugs can be gilded with jam, bananas and other foods;
• do not give sulphadoxin-pyrimetamine or sulphalene-pyrimetamine to infants under three months of age;
• do not give doxycycline for chemoprophylaxis to children under 8 years of age;
• keep all antimalarial drugs out of the reach of children locked in containers that cannot be opened by children themselves. Chloroquine is particularly toxic to children if the recommended dose is exceeded;
• consult a doctor immediately if a child develops a febrile illness. Malaria symptoms in children may not be typical so malaria should always be suspected. In children under the age of three months malaria must be suspected even in the case of non-febrile illness;
• fever in a child returning from a trip to the malaria area should be considered a symptom of malaria unless the opposite is proven;
• in the case of self-treatment, quinine can be administered without weight or age limit. Mephloquine can be used above 15 kg in weight.