Possibilities of malaria prophylaxis
Consult a travel or tropical medicine doctor well in advance of your trip (several weeks) to determine which malaria prophylaxis makes the most sense for you.
Malaria prophylaxis: Avoid mosquito bites
The malaria pathogen is transmitted by the bite of the dusk/night active Anopheles mosquito. Therefore, effective mosquito protection is part of malaria prophylaxis. You should heed the following advice:
- If possible, stay in mosquito-proof rooms in the evening and at night (rooms with air conditioning and mosquito screens in front of the windows and doors).
- Wear light-colored clothing that covers the skin (long pants, socks, tops with long sleeves). If possible, impregnate clothing with an insecticide or buy pre-impregnated clothing.
- In high-risk areas, it may also be a good idea to wear a large but airy head covering. You can also attach a mosquito net to the brim.
Mosquito repellents
Repellents are applied directly to the skin in the form of sprays, ointments or creams. They only provide protection from a bite to the area of skin that has been directly treated with the agent. Therefore, apply the mosquito repellents over the entire area of the skin. Avoid contact with wounds and mucous membranes.
Effect and active ingredients of repellents
Repellents differ from insecticides in that they do not kill insects. The substances contained in repellents either have a deterrent effect on mosquitoes or mask the body odor in such a way that the bloodsuckers can no longer perceive humans. Various repellents are available for purchase in stores, differing in the type and concentration of the active ingredient they contain, for example.
A very common active ingredient in repellents for malaria prophylaxis is DEET (N,N-diethyl-m-toulamide or diethyltoluamide for short). It is highly effective and has been tried and tested over many years. The DEET concentration in repellents should be 20 to a maximum of 50 percent.
Another common repellent active ingredient against malaria mosquitoes is icaridin. Like DEET, it is well tolerated and, at a concentration of 20 percent or more in repellents, is similarly effective. Unlike DEET, however, icaridin does not attack materials such as plastic.
For malaria prophylaxis, various repellents on a plant basis or with essential oils (tea tree oil, citronella, etc.) are also available. They are considered to be better tolerated by the environment and the patient’s own health. However, their duration of action is shorter than that of classic repellents (such as those containing DEET). In addition, essential oils can irritate the skin and mucous membranes, especially when exposed to strong sunlight.
Drug-based malaria prophylaxis
Medicinal malaria prophylaxis (chemoprophylaxis) can be provided by drugs that are also used to treat malaria. The mode of action of the preparations is that they either disrupt the metabolism of the pathogens (plasmodia) or prevent the pathogens from multiplying. If the drugs are taken preventively as part of chemoprophylaxis, it is not the infection itself that is prevented, but the outbreak of the disease.
Malaria prophylaxis: Suitable active ingredients
Mainly the following active ingredients or combinations of active ingredients are used for medicinal malaria prophylaxis:
- Atovaqoun/Proguanil: Preparations with a fixed combination of these two active ingredients are suitable for malaria prophylaxis and therapy of uncomplicated malaria tropica and other forms of malaria.
Malaria prophylaxis with medication does not provide 100% protection against infection. Therefore, you should definitely heed the above-mentioned tips against mosquito bites (exposure prophylaxis) in addition.
- Destination
- Length of stay
- Style of travel (e.g. hotel-only, beach vacation, backpacking)
- age of the traveler
- possible pregnancy
- any previous illnesses
- any medication taken (such as anticoagulants or birth control pills)
- possible intolerance to certain substances
Discuss malaria prophylaxis with your doctor early! Then there is enough time to start taking an antimalarial medication in time and possibly switch to another preparation if you do not tolerate this first medication.
Malaria prophylaxis with medication: side effects
All medications used for malaria prophylaxis may have side effects. The type and likelihood of such adverse effects depend largely on the active ingredient:
Mefloquine may cause psycho-vegetative side effects such as nightmares, depressed mood, anxiety, agitation, and confusion. Less frequently, epileptic seizures and psychotic symptoms (such as hallucinations) occur – depending on the dosage and the individual tendency to such symptoms.
Doxycycline may make the skin more sensitive to UV light, so you should avoid prolonged sunbathing while taking it. Other possible side effects include ulcers of the esophagus (if you take doxycycline with too little water), nausea (if taken on an empty stomach), indigestion, vaginal thrush, and elevated liver enzymes.
Malaria prophylaxis: Standby therapy.
The dosage of medication for emergency self-treatment is based on a dosage schedule recommended by your doctor prior to travel, depending on your age, height, weight and travel-related hazards.
Malaria prophylaxis: costs
All medications for malaria prophylaxis and treatment require a prescription. In recent years, some insurance companies have started to reimburse the costs of malaria prophylaxis medication in addition to some travel vaccinations. Ask your health insurance company in advance whether the costs can be covered.
Why is there no malaria vaccination?
In addition to RTS,S/AS01, there are other malaria vaccine candidates, some with different approaches, that scientists are working on. It remains uncertain whether one of these projects will ultimately lead to a vaccine against malaria that is also suitable for travelers.
For the time being, therefore, effective malaria prophylaxis consists of avoiding bites from the Anopheles mosquito as far as possible and, if necessary, taking preventive antimalarial drugs!
