Dr. Christian Heesch comments on Malaria Prevention for Travelers to West Africa
Malaria, especially falciparum malaria, is a significant concern for people traveling from the United States to West Africa. We asked Dr. Christian Heesch how to prevent this potentially lethal disease.
“Prior to traveling, an assessment needs to happen whether the risk of acquiring malaria, and the risk of taking preventive medications, is acceptable for the individual”, Dr. Christian Heesch said. “Small children, very old persons, pregnant women, and people with underlying health conditions are especially vulnerable. I strongly recommend a consultation with the personal physician and with a travel medicine specialist to discuss such travel plans. Once in the destination country, it is important to avoid being bit by mosquitoes if possible. Female Anopheles mosquitoes tend to bite from the beginning of dusk to and including the end of dawn – but the daytime isn’t necessarily safe either. It certainly would make sense to stay indoors from right before sunset to after sunrise”, Dr. Christian Heesch observed.
“Use effective insect repellents whenever possible. DEET (N,N-diethyl-m-toluamide) has long been used and seems safe to use for people older than two months. I recommend using a concentration of at least 25%, although 50% concentration products are more effective and longer lasting. Long-sleeved shirts and long pants are recommended for after dark. Remember that clothing can be sprayed with permethrin to prevent bites, and pre-treated clothing can also be purchased. I strongly recommend the consistent use of mosquito bed-nets, including pyrethroid impregnated nets.” Dr. Christian Heesch added: “Keep in mind that treated bed-nets and clothing will lose their effectiveness over time, especially with washing, and re-application of insecticide will become necessary.”
“Chloroquine-resistant falciparum malaria has now been reported from most regions of the world where malaria occurs”, Dr. Christian Heesch observed, “and this drug is ineffective for single agent prophylaxis in West-Africa, where falciparum malaria is a major threat. For prevention, Atovaquone/Proguanil (Malarone) is taken daily, it is usually well tolerated and effective. It must not be taken by pregnant or breastfeeding women, and it is contraindicated in severe renal insufficiency. Doxycycline is cheaper, but there is a risk of sun-sensitivity. Children below the ages of 8 years (some guidelines say 12 years) should not take the drug, and it cannot be taken by pregnant or breastfeeding women. Mefloquine (Lariam) has the advantage of only once-weekly administration, but there are many contraindications, such as seizure disorder, many psychiatric conditions, cardiac arrhythmias, a history of Blackwater fever, and significant hepatic impairment. Also, Mefloquine’s metabolism through CYP3A4 may lead to potential problems when other drugs inhibiting this enzyme are also administered.” Dr. Christian Heesch added another important consideration: “Make sure to obtain all of your preventive drug supply in the United States before leaving. Medications bought on-site might be counterfeit, impure, and even harmful.”
Dr. Christian Heesch emphasized again: “Malaria prevention and travel plans in general should always be discussed with the personal physician and with a travel-medicine specialist.” For general information, he recommends http://www.cdc.gov/malaria/ and https://www.gov.uk/government/publications/malaria-prevention-guidelines-for-travellers-from-the-uk
For more detail viisit at: http://drchristianheesch.weebly.com
Discussion reported by Internet Journalist Duke Hammerton