FAQs: Malaria and anti-malaria tablets
How do you get malaria?
People get malaria by being bitten by a mosquito infected with malaria parasites. When the mosquito feeds on blood from an infected human, the malaria parasites develop in the mosquito and mix with the mosquito's saliva. When the infected mosquito bites another person, malaria can be transmitted.
Because the malaria parasite lives in the red blood cells of an infected person, malaria can also be transmitted via blood transfusion, or the shared use of needles. Malaria may also be transmitted from a mother to her baby before or during delivery.
Do all mosquitoes transmit malaria?
No. Of over 2000 species of mosquito, only the female Anopheles mosquito transmits malaria. Male mosquitos don't bite. Females need protein for their eggs, and find it in blood.
Are mosquitoes active all day?
No, actually they feed mainly between sunset and sunrise, thus mosquito nets and repellent coils burning overnight are useful.
Where in the world is malaria found?
Malaria is found where the Anopheles mosquito thrives i.e. hot, wet climates. These are large areas of Africa and South Asia as well as Central and South America, also the Caribbean, Southeast Asia, the Middle East, and Oceania. See www.traveldoctor.co.uk/malaria.htm.
Is malaria a contagious disease?
No. Malaria cannot spread directly from person to person. It does not spread via the air like the flu, nor can it be sexually transmitted. Spread is only via infected blood, generally via mosquito bites.
How long after being bitten do symptoms occur?
Usually between 1 week and 1 month, depending on the malarial strain.
P. Falciparum infection, which can be fatal, usually develops within a month and is very unlikely more than three months after the last possible exposure. It is found globally but most common in Africa.
P. vivax and P. ovale infection, while not fatal, can remain dormant in the liver for several months up to about 4 years, thus delaying onset of symptoms or causing relapses of malaria infection.
How do I know if I really have malaria?
Malaria is diagnosed by looking at your blood through a microscope (thick and thin films). If infected, parasites can be seen in the red blood cells. Self test kits are available for those travelling in remote areas away from medical care.
Are anti-malarial drugs safe to use long term?
In general, the drugs used to prevent and treat malaria have been shown to be well tolerated for at least 1 year or more.
Is it safe to buy my anti-malaria drugs in the country where I will be travelling?
Medicines need to be started before you travel, and must be in-date. Buying medications abroad is risky. They could be of inferior quality, contaminated or simply fake. Therefore they may not protect you against malaria and could be harmful.
Is there a malaria vaccine?
No, not yet. Scientists are working to develop one, but as the parasite constantly changes its surface to evade the immune system, it is proving difficult.
What if I am pregnant?
Malaria is more likely to be severe or fatal in women who are pregnant. Malaria increases the risk of miscarriage, prematurity, and stillbirth. Travel to malarial zones is best avoided. If travel is essential, anti-malarial medication is very important.
If I am taking an anti-malarial drug and breastfeeding, will my baby be protected?
No. The amount of medicine in breast milk is unlikely to be enough to provide protection against malaria for the infant.
If I get malaria, will I have it for the rest of my life?
In general, no. With the right medications malaria is curable. The disease can continue if it is not treated or if it is treated with the wrong drug. Some medications are not effective because the parasite is resistant to them. That is why different drugs are recommended for different parts of the world.
Infection with P. vivax and P. ovale, the parasites can remain dormant in the liver for several months up to about 4 years, thus delaying onset of symptoms or causing relapses of malaria infection as they reactivate.
P. malariae, if untreated, can stay in the blood for several decades.
Is malaria treatable?
Yes, the infection is curable, but it can be unpleasant to serious (including fatal). Prevention is better than cure.
How can I prevent getting malaria?
What are anti-malaria drugs?
Which anti-malaria drug should I take?
This depends on:
- Where you are going (the most appropriate anti-malarial medication varies with location due to local resistance patterns). See www.fitfortravel.nhs.uk/destinations.aspx.
- Any health issues you may have (as asked in Dr Fox online consultation).
- Personal choice. The medicines have different regimes (how often and how long they need to be taken), different potential side effects, as well as different costs.
How long do I have to take anti-malaria medicine for?
Malarone (atovaquone plus proguanil) has the simplest regime. The dose is one tablet a day taken once a day, starting only 1-2 days before you travel and for just 1 week after your trip.
Doxycycline has the most time consuming regime - taken as a tablet once a day, starting 2 days before your trip and continuing for 4 weeks after you get back.
Mefloquine (Lariam) has an easy regime. You only need to take one tablet weekly, starting 3 weeks before the trip (so the treatment can be stopped and changed if you experience side effects) and for 4 weeks after you return.
What are the side effects of anti-malaria medications?
Malarone (atovaquone plus proguanil) very rarely causes any side effects. When they do occur, tummy upsets and headache have been reported, also skin rash and mouth ulcers.
Doxycycline has possible side effects. Most common is that it can cause skin sensitivity to sunlight, as malarial areas are often sunny this can result in sunburn. Other side effects are stomach upset, indigestion and thrush.
Mefloquine (Lariam) can lead to vivid dreams and sleep disturbance, mood changes and anxiety. It is therefore best avoided if you or a close family member have mental health problems. Also to be avoided if you are epileptic.
More information about side effects can be found here.
What are the cost differences of the anti-malaria drugs?
Malarone (atovaquone plus proguanil) is expensive - the most expensive of the anti-malaria tablets, so may be better for short trips. A non-branded cheaper version has recently become available. Doxycycline is the low cost option.
Mefloquine (Lariam) is relatively cheap – not quite as cheap as doxycycline but significantly cheaper than Malarone.
Please see actual prices at the bottom of the anti-malaria tablet page.
Are some people immune to malaria?
Partial 'acquired immunity' to malaria builds up in people who live in malaria areas who become repeatedly infected with malaria, often from a young age.
Does immunity to malaria reduce with time?
People, such as long-term immigrants to the UK, will lose 'acquired immunity' rapidly when they are no longer living in malarious areas. Non-malarious areas where immigrants previously lived may also become malarious.
Authored 29 October 2013by Dr Tony Steele
Reviewed 14 August 2017 by Dr B. Babor, Dr A. Wood, Dr P. Hunt
Last updated 25 February 2019