Travelers to Haiti: prophylaxy against malaria
Malaria is really a deadly disease. Don�t spoil your vacation!
Protect yourself against mosquitoes� bites by using repellants (smoking spirals sold under the brand name "Plagatox", repellent spray like "Off", repellent cream, etc.), fans, screening towel or curtains. Have your blood tested each week during your trip (the incubation period of the acute attack is in 10 to 35 days)
PROPHYLAXIS & SUPPRESSION
For susceptible strains, use Chloroquine Phosphate (Aralen) prophylaxis: 2 tabs (2x250 mg) once a week, 2 weeks before the trip, every week during the trip, and 6 weeks (suppressive therapy) after the departure from the endemic country.
However, some strains of P. falciparum (mostly in endemic areas) are resistant to Chloroquine Phosphate. The addition of sulfadoxine (500 mg) and pyrimethamine (25 mg) to the weekly chloroquine regimen will prevent and suppress any P. falciparum infestation in heavy endemic areas.
Gametocytes usually appears 2 to 3 days after the onset of the erythrocytic phase and may persist for long periods, particularly in P. falciparum infections. They do not produce symptoms but indicate preexisting infections and serve as a source of infection for the same person (relapsing case), most often for another person. Therefore, chloroquine prophylaxis, when taken properly, should prevent any gametocyte development.
However, once gametocyte develop (as evidenced by blood tests, since the incubation period is long: 10 to 35 days), a suppressive dose of primaquine should be added to the prophylaxis in any case (susceptible or resistant). A combination of chloroquine (Aralen) (500 mg equivalent to 300 mg base) and primaquine (79 mg equivalent to 45 mg base), taken once, sterilizes the P. falciparum gametocyte. It is sold under that name on the drug market.
THERAPY OF THE ACUTE ATTACK
For susceptible strains, chloroquine phosphate 1 g stat, followed by 500 mg 6 hrs later, then 500 mg once a day for 2 days cures the acute attack. If gametocyte is present, add primaquine 15 mg a day or 45 mg as a loading dose.
For resistant strains, a combination of Pyrimethauine (25 mg) and Sulfadoxine (500 mg) often sold under the brand name "Fansidar" taken together with Quinine (600 mg tid) during 3 days cures the acute attack due to resistant strains.
However, some people are allergic to the sulfa drugs and severe reactions, including the Stevens Johnson Syndrome and the Acute Toxic Epidermolysis and, even fatalities have occured after the intake of this combination. Therefore, this drug should be given only to the people who are not allergic to the sulfa, to those planning prolonged stays (i.e., more than 2 weeks) in areas of intense malaria transmission and, only, under medical supervision. ECG monitoring is needed whenever Quinine is given and patient with visual field problems and hepatic susceptibility should be cautious about the pyrimethamine.
FOR THOSE WHO DO NOT WANT THE PROPHYLAXIS BY TAKING THE ANTIMALARIC DRUGS
It is important for them to have their blood tested for the parasites, at least every two weeks during the trip and at 2, 4 and 6 weeks after their trip in the endemic area (the period of maturation for the Parasite before it appears in the blood cells being 2 to 4 weeks in average but range from days to months).
It Is equally important to be alert to the apparition of the first signs of the illness that can be in average of 10 to 35 days after the mosquito�s bite. These signs are: irregular low grade fever, malaise, headache, myalgia and chilly sensations that can be mistaken for a cold.
EXTENDED CURATIVE THERAPY
Because p. falciparum (mostly responsible for the chloroquine resistance) and P malariae parasites do not have a persistent exoerythrocytic phase the treatment of the acute attack is usually curative. For other types of malaria, such as P. ovale a prolonged curative therapy is necessary with primaquine taken for 14 days after the treatment of the acute attack, Patients with G6PD deficiency are susceptible to intravascular hemolysis with that therapy