Travel Guard® Health Advisory

man sparying bug repelent on arm

04/12/2018

General Information on Malaria

In December 2017, the World Health Organization (WHO) released its latest report estimating 216 million cases of malaria. Also WHO estimated approximately 446,000 deaths caused by malaria while 91 countries have been identified with ongoing malaria transmission. Of the countries, 15 countries–all in Sub-Saharan Africa–carry 80% of the global malaria burden. Kyrgyzstan and Sri Lanka were certified by WHO as malaria free in 2016 and more countries are moving towards elimination.

In 2018, malaria continues to plague most countries in Africa with more outbreaks in Namibia and South Africa in recent months. AIG Travel has assisted many customers with malaria symptoms over the past years, primarily in Asia and Africa. From our experience, the mortality rate for malaria is reduced when the disease is detected early; hence, it is important to be fully aware of the potential exposure to malaria when traveling to these endemic areas.

What is Malaria?

Malaria is a potentially fatal tropical disease caused by a parasite known as Plasmodium. It spreads through the bite of an infected female Anopheles mosquito. These mosquitoes are most active between 9 p.m. and 5 a.m. There are four parasite species that cause malaria in humans:

  • Plasmodium falciparum
  • Plasmodium vivax
  • Plasmodium malariae
  • Plasmodium ovale

Plasmodium falciparum and Plasmodium vivax are the most common, while Plasmodium falciparum is the most deadly. In recent years, some human cases of malaria have also occurred with Plasmodium knowlesi–a speciesthat causes malaria among monkeys and occurs in certain forested areas of Southeast Asia.

The parasites develop in the intestine and salivary glands of the mosquito and can be passed onto humans the next time the mosquito bites. In humans, the parasite travels to the liver via the blood and then out into the bloodstream again, where it invades the red blood corpuscles (the cells that carry oxygen in the blood). Malaria can also be spread through blood transfusions, and the use of infected needles.

Symptoms

Typically 7 to 30 days pass between being infected and the onset of the disease. Symptoms include:

  • Fever and shivering. The attack begins with fever, with the temperature rising as high as 40ºC (104 ºF) and falling again over a period of several hours.
  • Feeling unwell
  • Headaches
  • Diarrhea, nausea and vomiting

Once their temperature drops, the patient often sweats profusely and feels much better. Further symptoms may occur within a day or two. The symptoms diminish over the course of several weeks if the patient develops the ability to resist the malaria parasite. If proper treatment is given, the fever and parasites may disappear within a few days. If a case develops into severe malaria, the classic symptoms may be coupled with increased drowsiness and other complications including:

  • Low blood pressure (hypotension)
  • Kidney failure
  • Possible hemorrhage (bleeding)
  • Effects on the liver (e.g. infectious jaundice)
  • Shock and coma may also develop, and the condition may prove fatal
  • Cerebral Malaria
  • Anemia

Prevention of Malaria

Prevention requires A, B, C and D:

  • Awareness of risk
  • Bite avoidance
  • Chemoprophylaxis (taking preventive medicines if you are traveling to or living in a malaria region)
  • Diagnosis made promptly with early treatment of an infected case

Antiviral drugs are prescription medicines (pills, liquids or inhaled powders) and are not available for purchase over‐ the‐counter. These drugs should be used within the first two days of symptoms to treat people who are very sick (such as those who are hospitalized) or people with flu symptoms with an increased risk of severe flu illness (i.e., pregnant women, young children, people 65 and older and people with certain chronic health conditions).

Treatment

Early diagnosis and treatment of malaria reduces the disease and prevents deaths. It also contributes to reducing malaria transmission. WHO also recommends that all cases of suspected malaria be confirmed using parasite-based diagnostic testing (either microscopy or rapid diagnostic test) before administering treatment. Results of parasitological confirmation can be available in 15 minutes or less. Treatment solely on the basis of symptoms should only be considered when a parasitological diagnosis is not possible.

Preventive Medicines Include:

Mefloquine

  • Recommended by the CDC as useful for last minute travelers since the drug starts working one to two days before travel
  • Not recommended for people with certain cardiac conditions

Doxycycline

  • Recommended by the CDC as good for last-minute travelers since the drug is started one to two days before travel
  • Cannot be used by persons younger than 8 years old

Atovaquone/ proguanil (Malarone)

  • Well-tolerated; side effects uncommon
  • Cannot be taken by pregnant women or people with severe renal impairment

Chloroquine

  • Recommended by the CDC as a good choice for long trips because it is taken weekly
  • May exacerbate psoriasis

References

 

About AIG Travel and Travel Guard®

AIG Travel has eight strategically located assistance centers worldwide, and all medical cases are monitored and managed from one central online system. Customers are never more than a phone call away from AIG Travel’s multi-lingual and multi-cultural 24/7 assistance and medical professionals.

AIG Travel, Inc., a member of American International Group, Inc., is a worldwide leader in travel insurance and global assistance. Travel Guard® is the marketing name for its portfolio of travel insurance and travel related services, including medical and security services, marketed to both leisure and business travelers around the globe. Services are provided through a network of wholly owned service centers located in Asia, Europe and the Americas. For additional information, please visit our websites at www.aig.com/travel and www.aig.com/travelguard.

 

This product is confidential and for use only by the intended recipient(s). It cannot be distributed by the aforementioned recipients, to any other parties, without the prior express consent of AIG Travel. AIG Travel will use reasonable endeavors to ensure the accuracy of information contained herein as of the date this product is time stamped but all such information, given its nature, shall be subject to change or alteration at any time and the use of such information is at the sole discretion of the intended recipient(s). AIG Travel assumes no liability or responsibility for the use, interpretation or application of any of the information contained herein. The information contained in this material is for general informational purposes and is not intended as a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical problem. For reprints or digital reproduction rights, please contact: [email protected].