Transcript  Malaria is the most important parasitic disease of man. Approximately 5% of the world's population is infected.  It causes over 1 million deaths.


Malaria is the most important parasitic disease
of man. Approximately 5% of the world's
population is infected.

It causes over 1 million deaths each year.

The disease is a protozoan infection of red
blood cells transmitted by the bite of a bloodfeeding female anopheline mosquito.

Generally, without prophylaxis, the risk of malaria is highest in subSaharan Africa, intermediate in South Asia, and lowest in the
Americas and South-east Asia.

Other considerations include:
• Type of travel – backpacking versus air-conditioned, wellscreened urban hotels.
• Traveller's exposure to bites, adherence with prophylaxis.
• Duration of stay – the cumulative risk of contracting malaria is
proportional to the length of stay in the transmission area.
• Region visited.
• Altitude of destination – malaria is not transmitted above 2000
m.
• Season of travel – the rainy season is associated with higher
transmission.
• Awareness: recognizing the risk.
• Bites by mosquitoes: prevent and avoid.
• Compliance with appropriate
chemoprophylaxis.
• Diagnose malaria swifty and treat promptly.

The use of long clothing to reduce exposed skin
during biting periods (dusk through to dawn) .

The use of topical repellents :DEET , picaridin ),
PMD ,MGK-326, MGK-264 , IR3535 and oil of
citronella .

Other repellents: mats, coils, lotions and
vaporizers .

Mosquito nets :most mosquito nets are made of polyester and
rarely last longer than 2–3 years under field situations.
Conventional nets treated with pyrethroids such as alphacypermethrin, cyfluthrin, deltamethrin, lambda-cyhalothrin or
permethrin, need to be re-treated after three washes, or at
least once a year to ensure continued insecticidal effect. Longlasting insecticidal nets [LLINs] are factory-treated mosquito
nets, made with netting material that has the insecticide
incorporated within or bound around the fibres and the
insecticide is progressively released so that the net retains the
efficacy after repeated washings. The LLINs are expected to
retain their effective biological activity without re-treatment
for at least 20 standard washes and for three years of
recommended use under field conditions.

Indoor Residual Spraying :IRS is an integral
component of the Global Malaria Action Plan
and currently DDT, pyrethroids (Deltamethrin
2.5% WP, Cyfluthrin 10% WP, Alphacypermethrin
5% WP and Lambdacyhalothrin 10% WP) or
Malathion 25% are used in different parts of the
world for this purpose. All the interior walls and
ceilings as well as the underside of furniture,
back of the doors and porches of permanent
human dwellings

Space sprays: These insecticides instantly kill
the mosquitoes, but lack any residual effects.
They are therefore sprayed into the air. By
killing adult mosquitoes, not only bites are
prevented, but breeding is also prevented,
resulting in net reduction in the mosquito
population. Space sprays must be repeated
often, at least once every week. Pyrethroids are
commonly used for this purpose.
Female mosquito develops eggs, nourished with
human blood
Personal Protection deny the blood meal
Close windows and doors to prevent entry; Protect
humans against mosquito bite by using bednets
(insecticide treated), mosquito repellents
Eggs laid on water collections
Source Reduction deny breeding ground
Prevent water logging, destroy unwanted water
collections, keep water containers closed
Eggs hatch and develop into larvae and pupae in
a week
Larvicides Chemical, biological
Kill the larvae with larvicidal agents, Guppy or
Gambusia fish or bacteria or fungi
Adults can live up to 4-10 weeks or more
Insecticides
Kill the adults with space sprays (for instant kill) and
residual sprays (for lasting effect)
Adults enter the human dwellings between 5 pm
and 10 pm and early morning, hide in dark
corners
Prevent entry
Close the doors and windows at that time; clear
hiding places if possible
Adults bite human beings at night, maximum at
11pm-4am
Personal protection by covering the body with
clothes; use of mosquito nets and repellents.
It must be remembered that no
chemoprophylaxis regime provides 100%
protection.
 Primary Prophylaxis: Use of antimalaria drugs
at recommended dosage, started 2-20 days
before departure to a malarious area and
continued for the duration of stay and for 1-4
weeks after return.

1-Causal prophylaxis: This prevents the
establishment of infection in the liver by inhibiting
the pre-erythrocytic schizogony. Primaquine
malaron and proguanil are effective as causal
prophylactic drugs.
2-Suppressive prophylaxis: Use of blood
schizonticides suppresses the blood forms of the
malaria parasite and thus protects against clinical
illness. However, P. vivax and P. ovale may cause
relapses from the hypnozoites and to prevent this,
terminal prophylaxis may be needed.

Terminal Prophylaxis: Terminal prophylaxis is
the administration of primaquine for two weeks
after returning from travel to tackle the
hypnozoites of P. vivax and P. ovale that can
cause relapses of malaria.

Chemoprophylaxis is NOT recommended for
residents of endemic area.
Chemoprophylaxis for Long Term Travelers:
Long-term travelers intending to stay for more than 1-3 months
should seek the advice of local health care professionals
familiar with the management of malaria in non-immune
foreigners. The risk of serious side effects associated with long
term use of chloroquine and proguanil are low. However, twice
yearly screening for the detection of early retinal changes
should be performed in anyone who has taken 300 mg of
chloroquine (as base) weekly for over five years and requires
further prophylaxis. If changes are observed, an alternative
regimen should be considered. Data indicate no increased risk
of serious side effects with long term use of mefloquine. The
risk of long term use of doxycycline are not known. These two
latter drugs should be reserved for those with greatest risk of
infection.

Chemoprophylaxis for Frequent Travelers:
Frequent travelers such as members of the aircraft
crew may reserve chemoprophylaxis for high
risk areas only. They should maintain rigorous
self-protection against mosquito bites and be
prepared for an attack of malaria and should
carry a course of antimalarials as stand-by.


Malaria infection in pregnant women may be more
severe than in non-pregnant women. In addition, the
risk of adverse pregnancy outcomes, including
prematurity, abortion, and stillbirth, may be increased.
For these reasons, and because chloroquine has not
been found to have any harmful effects on the fetus
when used in the recommended doses for malaria
prophylaxis, pregnancy is not a contraindication to
malaria prophylaxis with chloroquine or
hydroxychloroquine. However, because no
chemoprophylactic regimen is completely effective in
areas with chloroquine resistant P. falciparum, women
who are pregnant or likely to become so should avoid
travel to such areas

Chloroquine and Proguanil are the preferred
chemoprophylactic drugs against malaria in the first 3 months
of pregnancy. Mefloquine can be given during the second and
third trimesters if the situation demands.

Mefloquine and doxycycline can be used in non-pregnant
women with child bearing potential, but pregnancy should be
avoided for 3 months after mefloquine use and for one week
after doxycycline use.

Doxycycline, a tetracycline and malarone, are generally
contraindicated for malaria prophylaxis during pregnancy.
Adults: Adult tablet of 250 mg atovaquone and 100
mg proguanil - 1 tab. daily
 Children: Pediatric tablet of 62.5 mg atovaquone
and 25 mg proguanil:
5-8 kg: 1/2 tablet daily
>8-10 kg: 3/4 tablet daily
>10-20 kg: 1 tablet daily
>20-30 kg: 2 tablets daily
>30-40 kg: 3 tablets daily
>40 kg: 1 adult tablet daily
 Daily dosing; only have to continue for 7 days after
exposure; not in pregnancy and lactation

Adults: 300 mg base once weekly
 Children: 5mg/kg base weekly;
maximum 300 mg
 Long-term safety known; chloroquine resistance
reported from most parts of the world;except in
north Iraq, south of turkey, north of syria
 Not for persons with epilepsy, psoriasis or visual
disturbances.
 Safe in pregnancy.

< 2 yrs: 50 mg/day;
2-6 yrs:100 mg/d
7-9 yrs: 150 mg/day;
>9 yrs: 200 mg/d
 Proguanil is used in combinations.
 Safe in pregnancy.
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
(Vibramycin 100mg cap)

100mg once daily for adults.

1.5mg base/kg once daily
(max. 100 mg)
<25kg or <8 yr: Not given
25-35kg or 8-10 yr: 50mg
36-50kg or 11-13 yr: 75mg
>50kg or >14 yr: 100mg
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Its not used in pregnancy or lactation.
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
(Lariam Tablet with 250mg base, 274mg salt):
250 mg base once weekly for adults
 <15 kgs: 5mg of salt/kg;
15-19 kg: 1/4 tab/wk;
20-30 kg:1/2 tab/wk;
31-45 kg: 3/4 tab/wk;
>45 kg: 1 tab/wk
 Avoid in psychosis and epilepsy.


Preferably, it should be started 1-2 weeks prior
to travel to a malarious area. In addition to
assuring adequate blood levels of the drug, this
regimen allows for evaluation of any potential
side effects. Chemoprophylaxis should continue
during the stay in malarious area and for 1-4
weeks after departure from the area.
Areas with chloroquine sensitive P. falciparum:
Chloroquine
Start one week before exposure, continue during exposure and for 4 weeks
thereafter
Areas with chloroquine resistant P. falciparum (low degree, not wide spread):
Chloroquine Plus
Start one week before, continue during exposure and for 4 weeks thereafter
Proguanil
Start 1-2 days before, continue during exposure and for 4 weeks thereafter
Areas with chloroquine resistant P. falciparum (High degree, widespread):
Chloroquine Plus Proguanil
As above
OR Mefloquine
Start 2-3 weeks before, continue during exposure and for 4 weeks thereafter
OR Doxycycline
Start 2 days before, continue during exposure and for 4 weeks thereafter
OR Atovaquone Plus Proguanil(Malaron)
Start 2 days before, continue during exposure and for 7 days thereafter

Following the success of IPT in pregnancy (IPTp),
the strategy of providing a treatment dose of
antimalarials to all infants in high transmission
settings at the time of EPI immunizations
(usually given at 2, 3 and 9 months of age) has
been developed. The two drugs evaluated
mainly have been SP and, to a much lesser
extent, amodiaquine.
Treatment of the entire at-risk population has been
used in malaria elimination.
 However, when the incidence of malaria is very low,
this approach is sometimes considered as a method
of final elimination – particularly when the influx of
malaria from elsewhere can be well controlled (e.g.
islands, edges of transmission areas). Where
Plasmodium vivax and P. ovale are present,
primaquine 15 mg base adult dose given for 2
weeks has been used in several settings.
