Interview with Christian Heesch - Prevention of Malaria infection in West Africa

US travelers to West African countries are at significant risk for malaria infections, especially falciparum malaria. We asked Christian Heesch, a physician who has worked in West Africa, about current recommendations to prevent this potentially lethal disease.

“Every person planning travel to West-Africa should evaluate the individual risk of problems due to diseases acquired there, or due to preventive medications. As always, the very young, the very old, and pregnant women belong to a vulnerable group. A consultation with the personal doctor and with a specialist in travel medicine is very helpful prior to departure. Then, once arrived in the country of destination, it is important to avoid being bit by mosquitoes. The chance of bites by female Anopheles mosquitoes is highest from right before dusk to the end of dawn, however, the daytime isn’t entirely safe either. Stay indoors from right before sunset to after sunrise”, Christian Heesch suggested.

“Using effective insect repellents is of paramount importance. DEET (N,N-diethyl-m-toluamide) has an established safety record for people older than two months. I suggest at least 25% concentration, preferably 50%. Consider wearing long-sleeved shirts and long pants if you have to go outside after dark. Fabric can be impregnated with permethrin to prevent bites, and some sellers offer pre-treated shirts and pants. I very much recommend consistently using mosquito bed nets, including pyrethroid-impregnated nets,” Christian Heesch said: “Also, note that washing impregnated bed-nets or clothes lowers their effectiveness over time, and re-application of insecticide is necessary.”

“At present, Chloroquine-resistant falciparum malaria has been observed in most countries where malaria is transmitted”, Christian Heesch said, “and this drug is ineffective as single agent prophylaxis in West-Africa. Atovaquone/Proguanil (Malarone) for the prevention of malaria needs to be taken daily. It is very effective and generally well tolerated. Malarone cannot be taken by pregnant women or those that are breastfeeding, and it is contraindicated in severe renal insufficiency.

Doxycycline is lower priced, but increases the risk of sun sensitivity. It also cannot be taken by pregnant or breastfeeding women, and it should not be taken by children below the age of 8 (some guidelines say 12). Mefloquine (Lariam) is taken weekly, but has more contraindications. Mefloquine is contraindicated in patients with seizures, cardiac arrhythmias, most psychiatric patients, those with a history of Blackwater fever, significant liver impairment and some other conditions. In addition Mefloquine is metabolized in by CYP3A4, and problems may arise in patients taking drugs inhibiting this enzyme.” Christian Heesch also emphasized: “Buy all your medicines in the US. Drugs purchased locally may be counterfeit.”

Christian Heesch concluded: “The need to discuss malaria prevention and prophylaxis with the personal physician and/or a travel-medicine specialist cannot be overemphasized, as every person’s medical background and needs are different. Your own doctor knows what preventive malaria drugs will go along with your long-term medication, if any.”

For further information, Christian Heesch recommends and as good sources for people planning safe travel.