It Only Takes One Mosquito

Malaria. Not something to which most in the United States give much thought. Sunday, April 26th is World Malaria Day… a day to take a moment to learn and to think about a disease which is prevalent in other parts of the world, but one about which you might know little or nothing.

To much of the underdeveloped and developing world, the parasitic disease of malaria is a disease that is dealt with on a near constant basis. It is estimated that there are 300-500 MILLION clinical cases of malaria worldwide per year. Malaria takes 2.5 million lives every year, many of those the lives of the most vulnerable: the elderly, the chronically ill, and children. For every death from HIV/AIDS there are fifty deaths from malaria. Malaria affects over 40% of the world’s population.

Malaria is a disease which is carried by the female anopheles mosquito from person to person through its “stinger”, which is actually a tube through which blood is “sucked” out of its victim. While having its meal, the mosquito can introduce the protozoa which cause malaria into the body of its victim. There are a number of different organisms which cause malaria: Plasmodium falciparum, P.vivax, P. ovale and P. malariae. The most deadly of these is P. falciparum. Complicating the current world malaria situation is the emergence of drug resistant and multi-drug resistant malaria. At this time, though work continues to find one, there is no vaccine fro malaria.

So, just how much exposure to these protozoa does it take to cause malaria? How many times does a person need to be “bitten” to contract the disease? The answer might surprise you. It only takes one mosquito “bite” from one infected mosquito to cause malaria. Those who live in malarial areas may acquire a level of immunity to various disease (malaria included) to which they are exposed on a regular basis, but many who live in these areas battle malaria on a regular basis nonetheless. Children are especially at risk for malaria as it takes time for this acquired immunity to develop. Even in areas that have a winter when the temperatures are colder and the potential for contracting malaria is decreases, the risk is still present.

Malaria, when identified early and treated appropriately, is completely curable. It is a common misperception that once you have malaria, you always have malaria. Some who have had malaria treated early and well go on the be free of malaria, even to the point where they are able to donate blood. Although there is no vaccine for malaria, there are medications available that are taken prophylactically that disrupt the malarial protozoa’s life cycle and its ability to cause disease. For those who live with the constant threat of malaria, it is not reasonable to take medications to keep from getting the disease. It is only reasonable to take other preventative measures and to treat the diseas when it is contracted. A difficulty of life added to life which is already usually difficult enough. That is “them”.

YOUR life becomes potentially directly affected by malaria when traveling internationally. When traveling to areas where there is malaria, it is an important part of your travel plans to seek assistance from travel health professionals to determine appropriate prophylaxis to help protect you from contracting malaria. While a person who is taking prophylactic medications can still contract the disease, the chances of doing so are decreased dramatically. Anti-malarials when chosen and taken appropriately are very effective. Because of the rise of drug resistance forms of the disease, it is important to get the most up-to-date information on which drug is the most appropriate for your itinerary. All types of malaria medications need to be taken for a time prior to entering a malarial region, the entire time the traveler is in a malarial region, and for a prescribed amount of time after leaving the malarial region. The lengths of times take before and after being in the malarial region will very depending on the type of medication to be taken.

Symptoms of malaria include fever, chills, rigor, nausea, vomiting, loss of appetite, diarrhea, muscle aches, sweating, flu-like symptoms, fatigue and headache. Onset of the diseas is usually between 7-14 days after exposure. For shorter trips, this can mean that symptoms may appear after you have already returned home. Should you develop these symptoms during or after a trip to a malarial area, it is important to be checked for malaria as earlier treatment gives the best outcome. Symptoms can come and go as the parasite goes through its life cycle. Symptoms which might be malaria should be evaluated as such for up to a year or even longer after diagnosis and treatment of malaria, so it is very important to specifically request screening for the disease even though it might seem unlikely to be the cause.

In addition to taking prophylactic medications, it is important to take other measures to protect yourself from insenct bites. There are many other diseases which insencts transmit for which there are no vaccinations or prohylactic medications. Mosquito nets, permethrin-treated clothing, spray insecticides, bug repellents containing DEET, and clothing which covers most of the body are important elements to limiting exposure risk. DEET is not an insecticide. DEET works by making you “invisible” to mosquitoes. The higher the DEET concentration, the longer it is effective. The female anopheles mosquito feeds between dusk and dawn, so even at night, it is most most important to be vigilant in personal protection. There are other mosquitoes which carry dengue fever and yellow fever which bite at other times during the day. It is important to protect yourself around the clock against mosquito and all other insect bites using a number of different approaches. Anti-malarials alone are not enough. DEET alone is not enough. Mosquito nets alone are not enough.

The Travel Health Specialists at Passport Health Colorado will assist you in determining your level of risk and make recommendations for appropriate medications and personal protection to help you keep as safe from malaria as possible. Information is power. The information your Travel Care Specialist gives you is designed to help you be a confident, healthy, and safe traveler.

Please call our offices at: 303-442-8728; 719-387-5528 or at 970-484-2148 to set up your appointment for your journey overseas, and to allow us to serve and help you in determining what your risks would be at your destination.

What can YOU do to help? There are organizations whose focus is on the distribution of sleeping nets, vector spraying, malaria treatment, and the development of a vaccine. Inform yourself. Act. You might not be able to solve the malaria problem for the whole world, but you can help one person, and to that person, their world would be a better and safer place. Find an organization you like and be generous in your support. You could be saving a life.

Written by: Linda R. Norris, R.N.; Nurse for Passport Health Colorado