Malaria is a serious tropical disease spread by mosquitoes. If it isn't diagnosed and treated quickly, it can be fatal.
A single mosquito bite is all it takes for someone to become infected.
Symptoms of malaria
It's important to be aware of the symptoms of malaria if you're travelling to areas where there's a high risk of the disease. This means that you can get medical attention quickly.
Symptoms are similar to those of flu and usually appear 6 to 30 days after the mosquito bite, but it can sometimes take up to a year for symptoms to start.
The initial symptoms of malaria include:
- a high temperature (fever)
- muscle aches or pains
- vomiting and or diarrhoea
These symptoms can start mild and may be difficult to identify as malaria.
When to seek medical attention
Malaria is a serious illness that can get worse very quickly. It can be fatal if not treated quickly.
The effects of malaria are usually more severe in:
- young children
- pregnant women
- older people
Urgent advice: Call 111 or go to A&E if:
- you or your child develop symptoms of malaria during or after a visit to an area where the disease is found, even if it has been several weeks, months or a year after you return from travelling.
You must tell the healthcare professional that you have been in a country with a risk of malaria, including any brief stopovers.
What causes malaria?
Malaria is caused by the Plasmodium parasite. The parasite is spread to humans through the bites of infected mosquitoes.
There are 5 different types of Plasmodium parasite that cause malaria in humans. They are found in different parts of the world (but do overlap in certain areas) and vary in terms of how severe the infection can be.
All malaria infections cause the same symptoms and require immediate medical attention. It's not possible to find out which type of malaria you have from symptoms alone.
Types of malaria parasite
- Plasmodium falciparum – mainly found in Africa, it's the most common type of malaria parasite and is responsible for most malaria deaths worldwide, though treatment does cure the infection.
- Plasmodium vivax – mainly found in Asia and South America, this parasite causes milder symptoms but it can stay in the liver for years which can result in symptoms reoccurring if it isn’t treated properly.
- Plasmodium ovale – fairly uncommon and usually found in West Africa.
- Plasmodium malariae – this is quite rare and usually only found in Africa.
- Plasmodium knowlesi – this is very rare and found in parts of southeast Asia.
How malaria is spread
The Plasmodium parasite is spread by mosquitoes. These are known as 'night-biting' mosquitoes because they most commonly bite between sunset and sunrise.
When a mosquito bites a person already infected with malaria, it becomes infected and spreads the parasite to the next person it bites. Malaria can't be spread directly from person to person.
When an infected mosquito bites, the parasite enters the blood and travels to the liver. In the liver, it develops for days to weeks before re-entering the blood. This is the point where symptoms develop and urgent treatment is required.
Although it is very rare, malaria can also be spread from a person with the infection through blood transfusions and sharing needles.
Where is malaria found?
Malaria is found in tropical and subtropical regions of the world. It is not found in the UK or Europe.
The fitfortravel website has more information about the risk of malaria in individual countries.
Complications of malaria
Malaria is a serious illness that can be fatal if not diagnosed and treated quickly. Severe complications of malaria can occur within hours or days of the first symptoms. This means it is important to seek urgent medical help as soon as possible.
The destruction of red blood cells by the malaria parasite can cause severe anaemia.
Anaemia is a condition where the red blood cells are unable to carry enough oxygen to the body's muscles and organs. This can leave you feeling drowsy, weak and faint.
In rare cases, malaria can affect the brain. This is known as cerebral malaria which can cause your brain to swell, sometimes leading to permanent brain damage. It can also cause fits (seizures) or coma.
Other complications that can arise as a result of severe malaria include:
- liver failure and jaundice – yellowing of the skin and whites of the eyes
- shock – a sudden drop in blood pressure
- pulmonary oedema – a build-up of fluid in the lungs
- acute respiratory distress syndrome (ARDS)
- abnormally low blood sugar – hypoglycaemia
- kidney failure
- swelling and rupturing of the spleen
Malaria in pregnancy
If you get malaria while pregnant, you and your baby have an increased risk of developing serious complications like:
- premature birth – birth before 37 weeks of pregnancy
- low birth weight
- restricted growth of the baby in the womb
- death of the mother
Pregnant women are advised to avoid travelling to regions with a risk of malaria.
Visit your GP, midwife, obstetrician or travel health advisor for a full discussion if you're pregnant and are thinking of travelling to a high-risk area. Not all antimalarial tablets are safe in pregnancy and it's important you get specific advice.
Preventing and treating malaria
If you travel to an area that has malaria, you are at risk of the infection. It's very important that you take precautions to prevent the disease and get treatment immediately if symptoms do develop.
Malaria can often be avoided using the ABCD approach to prevention, which stands for:
- Awareness of risk – find out whether you're at risk of getting malaria
- Bite prevention – use insect repellent, cover your skin with clothing, and use a mosquito net to avoid mosquito bites
- Check whether you need to take antimalarial prevention tablets by visiting a travel health clinic - if you do, make sure you take the right antimalarial tablets at the right dose and finish the course
- Diagnosis – seek immediate medical advice if you have malaria symptoms, including up to a year after you return from travelling
Being aware of the risks
To check whether you are travelling to a malaria risk area see the fitfortravel or National Travel Health Network and Centre (NaTHNaC) websites.
Visit your local travel clinic for malaria advice as soon as you know that you are travelling to a risk area.
If you grew up in a country where malaria is common, any natural protection will be quickly lost when you move. This means you need to protect yourself from infection if you're now travelling to a risk area, even if that’s where you grew up.
Further information about travel health and vaccinations.
Preventing mosquito bites
Avoiding mosquito bites is one of the best ways to prevent malaria. This is particularly important during early evening and at night when mosquitoes bite.
There are several steps you can take to avoid being bitten.
- mosquitoes can’t bite through clothing so wear light, loose-fitting clothing that will cover your arms and legs
- apply insect repellent to all areas of your skin that are not covered by clothing, including your face and neck
- remember to reapply insect repellent frequently
- sleep under a mosquito net that’s been treated with an insecticide, or in a room with effective air conditioning
The most effective repellents contain 50% diethyltoluamide (DEET). These are available in:
There's no evidence to suggest that other remedies protect against malaria, such as homeopathic remedies, electronic buzzers, vitamins B1 or B12, garlic, yeast extract spread (Marmite), tea tree oils or bath oils.
Further information on mosquito bite prevention is available from the fitfortravel or National Travel Health Network and Centre (NaTHNaC) websites.
Antimalarial tablets can help prevent you from developing a malaria infection. For the best protection, you must also follow mosquito bite prevention advice.
You must start taking antimalarial tablets before travel and continue taking them whilst travelling in the risk area. Antimalarial tablets must also be taken for a period of time after you have left the risk area.
How long antimalarial tablets should be taken will depend on which tablet is used.
Antimalarial tablets don’t stop malaria from entering your body. However, they do stop the infection from developing inside your body and prevent you from getting ill.
If you stop taking your antimalarial tablets early (even when you are back in the UK) you could still become ill with malaria.
Taking antimalarial medication
You may need to take a short trial course of antimalarial tablets before travelling. This is to check that side effects do not occur and that you do not have an adverse reaction. If you do, alternative antimalarials can be prescribed before you leave.
- make sure you get the right antimalarial tablets before you go – visit a travel health clinic for advice on which is the best antimalarial for you
- follow the instructions included with your tablets carefully
- make sure you complete the full course of tablets
There's currently no vaccine available that offers protection against malaria.
Types of antimalarial medication
The type of antimalarial tablets that you will be recommended is based on the following information:
- where you're going
- any relevant family medical history
- your medical history, including any allergies to medication
- any medication you're currently taking
- any problems you've had with antimalarial medicines in the past
- your age
- whether you're pregnant
If you've taken antimalarial medication in the past, don't assume it's suitable for future trips.
The type of antimalarial that you will need to take depends on which strain of malaria is carried by the mosquitoes in an area. It will also depend on whether they're resistant to certain types of antimalarial medication.
The main types of antimalarials used to prevent malaria are:
- Atovaquone plus proguanil (also known as Maloff protect or Malarone)
- Doxycycline (also known as Vibramycin-D)
- Mefloquine (also known as Lariam)
To find out what type of antimalarial medication is best for you, visit your local travel clinic.
If malaria is diagnosed and treated quickly, you should fully recover. Treatment should be started as soon as possible.
Treatment begins in a hospital to make sure complications don’t suddenly develop. Treatment is with tablets or capsules. If someone is very ill, treatment will be given through a drip into a vein in the arm (intravenously).
Treatment for malaria can leave you feeling very tired and weak for several weeks.
The type of medicine and how long you need to take it will depend on:
- the type of malaria you have
- the severity of your symptoms
- whether you took preventative antimalarial tablets
- your age
- whether you're pregnant
25 January 2023
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