Interview with Dr. Christian Heesch - Prevention of Malaria in Travelers to West Africa

The threat of malaria remains a significant concern for US travelers to West African countries. We asked Dr. Christian Heesch, a physician who has worked in West Africa, about current recommendations for malaria prevention specific to that region.

“Travel planning begins with an assessment whether a person is at increased risk for complications from both, disease and disease prevention measures”, Dr. Christian Heesch said. “The very young, the very old, and pregnant women are examples of especially vulnerable groups. For everybody, a consultation with the personal physician and with a physician specializing in travel medicine is strongly recommended prior to departure. Second, once in the country of destination, avoiding being bit by mosquitoes is important. The risk of bites by female Anopheles mosquitoes is greatest from the beginning of dusk to the end of dawn, although I would not consider the daytime to be safe either. Staying indoors from right before sunset to after sunrise is certainly prudent”, Dr. Christian Heesch added.

“The use of effective insect repellents is of paramount importance. DEET (N,N-diethyl-m-toluamide) has a good safety record for persons above the age of two months. I would recommend a concentration of at least 25%, preferably 50%. For clothing, consider long-sleeved shirts and long pants if you have to be outside after dark. Clothing can be sprayed with permethrin to prevent bites, and some manufacturers offer pre-treated clothing. Strongly consider the use of mosquito bed nets, especially pyrethroid-impregnated nets.” Dr. Christian Heesch added: “Remember that washing impregnated bed-nets or clothes reduces their effectiveness over time, and re-application of insecticide will become necessary.”

“Regrettably, Chloroquine-resistant falciparum malaria has long been reported from most countries where malaria is endemic”, Dr. Christian Heesch said, “making this drug ineffective for single agent prophylaxis in West-Africa, where falciparum malaria is a major threat.

Atovaquone/Proguanil (Malarone) needs to be taken daily, is very effective and usually well tolerated. It cannot be taken by pregnant or breastfeeding women and is contraindicated in severe renal insufficiency. Doxycycline is cheaper, but increases the risk of sun sensitivity. Further, it cannot be taken by pregnant or breastfeeding women and children below the age of 8 (some guidelines say 12) years. Mefloquine (Lariam) needs to be taken only weekly, but has many contraindications. Mefloquine must not be used by patients with seizures, cardiac arrhythmias, many psychiatric conditions, a history of Blackwater fever, significant liver impairment and some other conditions. Further, since Mefloquine is metabolized in the liver by CYP3A4, problems may arise in patients taking drugs inhibiting this enzyme.” Dr. Christian Heesch made another important point: “Obtain all your prevention drugs in the US before you travel. What you can buy on-site may be fake, impure, and harmful.”

Dr. Christian Heesch concluded: “The need to discuss malaria prevention and prophylaxis with the personal physician and also a travel-medicine specialist cannot be overemphasized, as every person’s medical background and needs are different. Also, and are excellent sources of additional information.”

Interview reported by ….