Prevention of Malaria – Information for Travellers

Malaria is a disease caused by a malaria parasite called Plasmodium. There are five species and any of these can cause malaria. It spreads to humans commonly through the bite of an infected female Anopheles mosquito.

​What is Malaria?​

Malaria is a disease caused by a malaria parasite called Plasmodium. There are five species and any of these can cause malaria. It spreads to humans commonly through the bite of an infected female Anopheles mosquito.

Although uncommon, malaria can also spread through

  • Pregnancy: from mother to the unborn child
  • Transfusion of blood infected with malaria
  • ​Contact with an infected person’s blood e.g. through sharing of hypodermic needles by drug abusers

The disease is found most often in the tropics, particularly in the less developed areas. In some countries, the city areas might be free from malaria while it might be common in other parts of the country.

The risk of infection for travellers will be different depending on the area within the country they will be travelling in and the types of activities they will be doing.


What are the symptoms of Malaria?​

The symptoms of malaria may appear in cycles every 24, 48 or 72 hours. This is due to the life cycle of the malaria parasite as the parasite is reproduced and released into the body.

The symptoms include:

  • High fever (more than 38.5⁰C)
  • Chills with uncontrollable shivering and excessive sweating
  • Headache
  • Muscle ache
  • Tiredness or weakness
  • Jaundice (yellow eyes and skin) in some cases
  • ​Mental confusion / coma

​​​

What are som​​e personal protection measures you can take?

General protection is the most important step to prevent malaria and other mosquito-borne diseases. As Anopheles mosquitoes are more active at night, the malaria parasite would be passed on to the humans mainly between sunset and sunrise. Therefore, it is important to take steps to reduce contact with mosquitoes, especially during these hours.

The following are some examples of what you can do:

  • Wear long-sleeved shirts and long trousers to cover most parts of your body.
  • Use insect repellents which contain more than 30% DEET (diethyltoluamide) on exposed skin.
  • Burn mosquito coils or hang a mosquito net over the bed when sleeping.
  • Spray insecticide where the mosquitoes may rest. Mosquito larvae survive well in clear, slow-flowing streams.
  • ​Avoid going to an area where malaria is common.


What else should you take note of?​​

Malaria symptoms can develop as early as 7 days after you first get exposed to the parasite. It can also develop as late as a few months after you leave the area where malaria is present.

Hence, it is important to know that any illness that happens within one year and especially within three months after you return might be malaria, even if you followed all recommended steps to prevent malaria. If you develop any illness, especially within three months of your return from your trip, you should see a doctor immediately and inform your doctor that you went to a country where malaria is present.

​​​​

Advice for Pregnant Women and Women who want to get pregnant​

Pregnant women:

  • Malaria in a pregnant woman increases the risk of death for the baby from malaria, miscarriage, stillbirth and low birth weight which is associated with risk of death in new born babies.
  • Do not go to an area with malaria unless you really need to.
  • Pay extra attention to prevent yourself from getting mosquito bites.
  • Seek medical help immediately if you suspect that you have malaria.

Non-pregnant women who want to get pregnant:

  • Avoid getting pregnant during the period when you are taking medicines to prevent malaria.
  • Pregnancy should also be avoided for 3 months after your last dose of mefloquine or 1 week after your last dose of doxycycline.
  • If you get pregnant during the period when you are taking your medicines to prevent malaria, please inform your doctor.
  • In cases where your pregnancy is not planned, there is no need to end your pregnancy to take medicines to prevent malaria.

​​

Advice for Parents of Babies and Young Children​

  • ​​​Avoid taking babies and young children to an area where malaria is common unless really required.
  • Protect babies and young children against mosquito bites by using mosquito nets, especially between sunset and sunrise.
  • Medicines to prevent malaria should be given to both breast-fed and bottle-fed babies.
  • You can crush the medicine and mix it with jam, banana or similar food before feeding the baby or young child.
  • Keep all anti-malarial medicines out of reach of babies and young children. The medicines should be stored in childproof containers.
  • You should see a doctor immediately if your child falls sick. The symptoms of malaria in children may be different from that of adults and malaria should be suspected.

​​

What medicines can you​​ take to prevent malaria?

​​​​Mefloquine ​Doxycycline
Atovaquone / Proguanil
(Malarone®)
​Availability of this medicine in NHG Pharmacy​Yes. Needs pharmacist’s consultation​Yes. Needs doctor’s prescription​No. Needs doctor’s prescription
​When to start taking the medicine​1-2 weeks before departure​1-2 days before departure​1-2 days before departure
​When to stop taking the medicine​4 weeks after returning​4 weeks after returning​7 days after returning
​How often to take the medicine​Once a week​Once a day​Once a day
​Dose for Adults​250mg (one tablet)​100mg (one capsule)​250mg atovaquone / 100mg proguanil (one tablet)
​Dose for Children​By body weight
  • 45kg: one tablet
  • 31-45kg: ¾ tablet
  • 20-30kg: ½ tablet
  • 10-19kg: ¼ tablet​
​Please check with your doctor or pharmacist
Not recommended for children below 8 years old
​Please check with your doctor or pharmacist
​Possible side effects of the medicine
  • ​Nausea
  • Headache, dizziness
  • Anxiety, intense dreams
  • Rarely: seizures, depression, psychosis
  • ​Nausea, stomach discomfort
  • More sensitive to sunlight​
  • ​Nausea, vomiting, stomach discomfort
  • Headache​
​​Longest period you can take this medicine1 year2 years 28 days

Medicines to prevent malaria need to be started before you leave Singapore for a country where malaria is common. This allows the medicines to reach effective levels in your body before you get into contact with malaria parasites. These medicines also need to be completed for the recommended period after you return to Singapore for it to act on any parasites that are still present in your body.

If you are taking Mefloquine

  • Take the tablet on a full stomach with a full glass of water, on the same day every week.
  • If you miss a dose, take it as soon as possible and continue taking as planned.
  • If you experience side effects from mefloquine that you cannot tolerate, you may need to see a doctor for other medicines to prevent malaria.

Do you need medicines to prevent malaria?

You should check with your pharmacist if you need any medicines to prevent malaria. Let your pharmacist know which places you will be travelling to. You should also include information such as the province, state or district of the country. The risk of malaria and resistance to malaria medicines might be different within a country.

Medicines to prevent malaria do not offer complete protection and you should still prevent yourself from getting bitten by mosquitoes.

The following table gives you information of medicines available for areas of different malaria risk.

​​​Risk of Malaria​Very low risk of malaria​Malaria risk exists​Malaria risk exists, with mefloquine resistance
​Recommended medicine to prevent malaria
  • ​No medicine required to prevent malaria
  • ​Atovaquone/ proguanil ​
  • Doxycycline
  • Mefloquine
  • Atovaquone/ proguanil
  • Doxycycline
​Prevent mosquito bites
  • ​Yes
  • ​Yes
  • ​Yes

​​

How do I know if I am allergic to these medicines?​

The symptoms of a drug allergy include one or more of the following:

  • Swollen face/eyes/lips
  • Difficulty in breathing
  • Itchy skin rashes over your whole body

If you experience any of these symptoms, you should stop your medicine immediately and see your doctor.


This article answers some common questions about this medicine. It does not contain all the available information. It also does not take the place of talking to your doctor or pharmacist.


PH005-004-E-0316-V2

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Prevention of Malaria – Information for Travellers

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