Travel: how antimalarial prophylaxis works for those traveling to risk areas
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Some are about to leave for Namibia, some for the Amazon rainforest, some for Indonesia, Zambia, or even Zanzibar and Tanzania. Holiday time after all, but how do you prepare for the trip, even from a health point of view? In addition to emergency medicines and possible vaccines, there are those who ask how best to protect yourself from malaria when moving towards areas at risk. Pharmacological prophylaxis yes or no? Because when we talk about malaria this is still the main prevention tool. In fact, there is no vaccine that can be used internationally and intended for travellers.
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Spread of the disease
Malaria is a disease caused by such parasites Plasmodium. It is transmitted to humans through the bite of mosquitoes belonging to the genus Anopheles infected. It is currently mainly widespread in tropical and subtropical areas: in Africa, where it is highly endemic, it constitutes a serious health problem. With varying degrees of endemic, it is also present in countries of South-East Asia, the Middle East, Central Asia, the Western Pacific and Central and South America. It is a potentially fatal disease – and it still is, with impressive numbers: over 600,000 a year – but fortunately it is also preventable and curable if recognized and treated promptly. Also for travelers traveling to risk areas.
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The malaria vaccine
In the past months, an important step forward has been made on the vaccine front: last April, Ghana approved the R-21/Matrix-M vaccine for use in children aged between five and 36 months, who constitute the segment of the population at the highest risk of dying from malaria. The excellent news is that it is the second vaccine in the world against this disease, but the first to exceed the 75% efficacy threshold set by the World Health Organization (WHO). R-21/Matrix-M has also shown a good safety profile in the clinical studies performed so far.
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However, he explains a Health Massimo Andreoni, scientific director of the Italian Society of Infectious and Tropical Diseases (SIMIT), “is still a vaccine in the experimental phase, which has been authorized in some parts of the world where there is an endemic state of extreme gravity”. R-21/Matrix-M, in fact, is not yet available in Italy and in the rest of Europe, because it has not yet been approved by the respective regulatory bodies.
How antimalarial prophylaxis works
Fortunately we have another important form of protection against this disease: pharmacological malaria prophylaxis. Which, Andreoni explains again, “is 80-90% effective in reducing the risk of infection, and which assures us even higher protection from the risk of developing the serious form of the disease”. That is, prophylaxis does not completely exclude the risk of infection, which however in most cases, if it occurs, resolves with a mild form of the disease. “Prophylaxis – continues Andreoni – consists of taking drugs orally that we usually use for therapy”. There are different types, each of which provides for a different therapeutic scheme: “Depending on the one used – continues the expert – the intake generally begins from one week to one-two days before departure and must continue for the entire period of stay in the malarial area. Normally the treatment is finished one week after the return”.
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The type of prophylaxis is chosen, in part, on the basis of the country to be visited, and in particular on whether or not the existence of plasmodia resistant to chloroquine (one of the active ingredients used in antimalarial drugs) is known to exist in this area. “Even if – continues Andreoni – chloroquine resistance today is so widespread that it is almost taken for granted, and the choice of the type of treatment is increasingly made on the basis of the tolerability of the drugs available and effective against chloroquine-resistant plasmodia”. For the choice of the most suitable type of prophylaxis, it is advisable to contact your doctor or specialized centres. And for those who are afraid of side effects, Andreoni reminds us that prophylaxis is done in relation to the degree of endemicness of the country being visited, but not only: “All drugs have possible side effects: those for malaria have few, mainly of the gastrointestinal type, such as nausea”. The length of the stay also counts.
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Not just medicines: mosquito nets and repellents on the go
Finally, it is also important to reduce the risk of bites as much as possible, for example by wearing clothes that cover the entire surface of the body, using mosquito nets and repellents, especially at dawn and dusk, when mosquitoes are more active and the risk of biting is higher. Furthermore, concludes Andreoni, it is good to keep in mind that the disease can develop even several weeks after returning: “In the event of the onset of fever or other ailments, it is advisable to inform your doctor of the fact that you have recently visited an area at high risk of contagion”.
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