Malaria Prevention Tablets by Zone | Prices and Side Effects

Malaria is an infection spread by parasites that belong to the genus Plasmodium. Humans can become infected if they’re bitten by female Anopheles mosquitoes, which are themselves infected. They mostly bite between sunset and sunrise. Male mosquitoes don’t bite.

Malaria can’t be passed on from person to person, except in the case of pregnant women, who can infect their child.

Malaria symptoms usually start to appear between 8 and 30 days after becoming infected.

Symptoms include a high temperature, often accompanied by digestive problems, muscle pains, headaches, fatigue and a cough. Typical symptoms occur in the following alternating cycle: high temperature, shivering, cold sweats and severe sweating.

There are four types of malaria, each caused by a different parasite:

• Plasmodium falciparum: this is the most common (80% of cases and 90% of deaths). It can progress to cerebral malaria, which can be fatal if not treated quickly, as the infected red blood cells block the arteries and veins that supply blood to the brain.
• Plasmodium vivax: this is the most resistant to different climates. It’s found in many parts of the world, including some milder regions.

• Plasmodium malariae: isn’t prevalent all over the world. It isn’t fatal, but it can cause relapses up to 20 years after the first infection.
• Plasmodium ovale: this is the rarest type, except in West Africa. It isn’t fatal, but it can cause relapses 4 to 5 years after the first infection.

Malaria is mainly found in tropical regions.

• Sub-Saharan Africa is the highest risk area.
• Indian subcontinent is a moderate risk area.
• Latin America and Southeast Asia are low risk areas, even if certain regions, like the Amazon rainforest, are high risk.

Unlike dengue, the risk of malaria is much higher in rural or forest areas than it is in city centres. It decreases with altitude. Above 6,500 to 9900 feet (2,000 to 3,000 metres) the mosquitoes that spread the infection can no longer reproduce. The risk is also higher during periods of heavy rain and the following weeks.

Number of malaria cases per 1,000 population per country

Source: World Health Organisation: World Malaria Report 2019 p.50

P. falciparum parasite prevalence in Africa

Source: World Health Organisation: World Malaria Report 2019 p.140, 142, 144

Number of malaria cases per 1,000 population in Latin America

Source: World Health Organisation: World Malaria Report 2019 p.148

Number of malaria cases per 1,000 population in Asia

Source: World Health Organisation: World Malaria Report 2019 p.152, 154

You can find detailed malaria risk maps for every country on the Fitfortravel website. Click on the name of the country then on the “Malaria map”.

Young children and the elderly are at greater risk of contracting malaria and the effects can be more severe.

In pregnant women, malaria increases the rate of miscarriage and can lead to maternal death or delivery of low birth-weight infants.

According to the World Health Organisation, in 2018, there were 228 million cases of malaria and 405,000 deaths from malaria globally. Children aged under 5 years accounted for more than 60% of deaths.

Developing an effective vaccine could save hundreds of thousands of lives. However, it’s very difficult as the life cycle of the malaria parasite has many different stages.

In recent years, a lot of progress has been made in the search for a malaria vaccine. Several vaccines are currently being developed. The RTS,S/AS01 vaccine, developed with the support of the Bill and Melinda Gates Foundation, is now recommended for children at risk in some areas of the world. Source: World Health Organisation

At this particular moment in time there’s no vaccine available for travellers. Therefore, the only two ways to shield yourself from malaria are to protect yourself from mosquito bites and to take antimalarial medicine.

Prescribing preventative antimalarial treatment for long-term travellers is a medical procedure that needs to be personalised during a specialist consultation. Before leaving, rather than seeing your usual GP, make an appointment at a travel clinic (see the directory of travel clinics in the US and the UK).

Doctors there specialise in tropical diseases and can better advise you on whether or not you need to take preventative treatment depending on:

• The countries and areas you intend on visiting
• The seasons you’re travelling in
• The duration of your stays
• Your personal characteristics: age, sex, weight, medical history, medical contraindications (such as allergies)…

For long stays of several months in Asia or Latin America, some doctors will advise you against taking treatment.

This is because they consider the risk of undesirable side effects to be greater than the risk of malaria. Prevention methods vary greatly from one country to another. In Great Britain, Switzerland and Germany, for example, preventative treatment is no longer recommended in low risk areas.

According to a survey we carried out amongst 1,785 RTW travellers, only 32% of them took antimalarial treatment during their trip.

See our article on Vaccines for a Round-the-World Trip

What are the different antimalarial options?

If you’re taking antimalarial treatment during your trip, the type of medication your doctor prescribes you will depend on the area you’re visiting. There are three major zones in the world, based on the level of resistance to chloroquine (one of the antimalarial drugs).

Chloroquine-resistant zones

Source: Tulane University

What are the right antimalarials for each zone?

Here we specify the name of the drug with the trademark in brackets, as there are often cheaper generic (non-branded) versions.

Zone 1 :
Chloroquine (Avloclor® or Malarivon®)

Zone 2 :
Chloroquine + Proguanil (Avloclor® or Malarivon® + Paludrine®)
or Atovaquone and Proguanil (Malarone® or Maloff Protect®)

Zone 3 :
Atovaquone and Proguanil (Malarone® or Maloff Protect®)
or Mefloquine (Lariam®)
or Doxycycline (Vibramycin®)

Source: CDC

Characteristics of each drug

Most RTW travellers go through Southeast Asia which is in zone 3. If you decide to take antimalarial treatment, you’ll therefore have to choose between Lariam®, Vibramycin® or Malarone®.

There’s a ban on sales of Lariam in many countries because of its neurological side effects which can sometimes be serious. So, if you’re travelling in zone 3, Doxycycline and Malarone are the other options.

Doxycycline has the advantage of being extremely cheap, but there are also several disadvantages:

• You must continue to take it 4 weeks after exposure, which is inconvenient when you’re travelling around the world, alternating between malaria-free and malaria risk areas.
• It increases light sensitivity, which is annoying when you’re travelling in particularly sunny countries.
• It’s an antibiotic, so it increases the risk of vaginal yeast infections.
• It can cause heartburn.

Malarone is the drug with the fewest side effects. It’s the only preventative treatment that can also be used as emergency treatment in the event of infection (see below). It can’t be used for more than three months.

The Malarone brand is quite expensive, but you can now find the same drug in generic medication for a decent price.

Characteristics of each antimalarial drug

Drug	Malarone®	Maloff Protect®	Vibramycin®	Avloclor®	Malarivon®Syrup	Lariam®	Paludrine®
Active Ingredients	Antovaquone + Proguanil	Antovaquone + Proguanil	Doxycycline	Chloroquine	Chloroquine	Mefloquine	Proguanil
Dosage	1 tablet per day	1 tablet per day	1 tablet per day	2 tablets per week	1 dose per week (30ml)	1 tablet per week	2 tablets per day
First dose	1 – 2 days before travel	1 – 2 days before travel	1 – 2 days before travel	1 week before travel	2 weeks before travel	10 days before travel	1 week before travel
Length of treatment	7 days after leaving	7 days after leaving	4 weeks after leaving	4 weeks after leaving	4 weeks after leaving	4 weeks after leaving	4 weeks after leaving
Main side effects	Headache Stomach upset	Headache Stomach upset	Light sensitivity: avoid too much exposure and protect yourself from the sun. Headache Stomach upset It’s an antibiotic. Usual disadvantages such as thrush, amongst others. Not recommended for pregnant women and children under the age of 8.	Stomach upset Visual disturbances (reversible) Skin reactions	Headache Stomach upset Insomnia Skin reactions	Highly controversial drug. Some travellers don’t have side effects, but for those who do, they can be extremely dangerous. Neuropsychiatric disorders: convulsions, depression, anxiety, agitation, confusion, dizziness, which can lead to suicidal tendencies.	Stomach upset Mouth ulcers, inflammation of mouth mucous membranes.
Generic medication	Yes See the list	Yes See the list	Yes See the list	No	No	No	No
Price	around £50 for 16 branded tablets (1 week trip) and around £20 for 16 generic tablets	around £40 for 24 branded tablets (2 weeks trip) and around £20 for 16 generic tablets	around £38 for 30 dispersible tablets and around £12 for 37 generic tablets	around £12 for 20 tablets	around £12 for 60ml	around £23 for 8 tablets (1 week trip)	around £19 for 98 tablets

Source : FitForTravel

For children

It’s advised to avoid travelling in malaria risk areas with young children. However, children who weigh at least 25 lbs (11 kg) can take antimalarial medication.

Malarone is now available in pediatric tablets. Children who weigh at least 25 lbs (11 kg) can take it.

Dosage :

• from 25 to 44 lbs (11 to 20 kg): 1 pediatric tablet per day
• from 45 to 66 lbs (21 to 30 kg): 2 pediatric tablets per day
• from 67 to 88 (31 to 40 kg): 3 pediatric tablets per day

Doxycycline often isn’t prescribed for children under the age of 8.

Dosage :

• from 8 to 12 years: ½ of a 100 mg tablet

It’s recommended to protect children against mosquitoes and to quickly consult a doctor if they have a temperature, or even plain discomfort for infants without a temperature.

For pregnant women

Travelling in zone 3 isn’t recommended for pregnant women. However, if you still choose to go there, Malarone and Lariam can be prescribed, but Doxycycline can’t.

Is there a natural remedy for Malaria?

We’ve had several comments from readers who’ve seen the Malaria Business documentary which is about Artemisia annua. According to this documentary, this plant, which has been used in Chinese medicine for many years, contains artemisinin which can be used to treat malaria.

We urge you to be careful: in some forms, it can be used to treat malaria, but not to prevent it.

The World Health Organisation strongly recommends the use of combination therapies based on artemisinin to treat certain mild forms of malaria. However, the WHO doesn’t recommend the use of Artemisia annua herbal teas for the prevention and treatment of malaria because the amount of artemisinin in it isn’t enough. One litre of Artemisia annua infusion only contains 20%, at most, of the dose of artemisinin in a drug.

See the WHO report on the topic of Artemisia annua

Antimalarial treatments don’t guarantee full protection. Whether you take them or not, it’s therefore very important to protect yourself from mosquito bites to avoid contracting malaria, as well as other tropical diseases such as dengue, yellow fever, zika or chikungunya.

How to protect yourself from mosquitoes:

• At night, wear long sleeves and trousers. Soaking or spraying them with permethrin (an insecticide) makes it more effective.
• Use mosquito repellent on exposed body parts, face included, after the sun goes down. In higher risk areas, you can use a mosquito net, ideally soaked in permethrin. However, a mosquito net can be quite heavy and beds in hotel rooms in malaria zones often have them already.
• Use a plug-in mosquito repellent. It’s less effective than a mosquito net, but also a lot lighter.
• Air conditioning reduces the aggressiveness of mosquitoes, but it doesn’t stop them from biting. Budget bedrooms often don’t have air-con. Simple ventilation also slightly reduces the risk of bites, but it doesn’t stop them either.

• You can also use mosquito coils that you burn, but only outside as their vapours are toxic. You’ll easily find them when travelling.

Which repellent should I use?

We always think twice about putting chemical products on our skin. That’s why we see lots of alternative solutions popping up on the market: essential oil bracelets, citronella candles, herbal extract sprays, UV lamps, ultrasonic devices and even smartphone apps. However, a group of biologists at the New Mexico State University conducted tests and concluded that not all of these solutions are effective.

The only products that are actually efficient are made from:

• DEET: maximum efficacy, but don’t exceed a concentration of 30%
• Picaridin (or Icaridin): decent efficacy
• IR3535: decent efficacy, but variable
• Citriodiol (or PMD, p-Menthane-3,8-diol or PMDRBO): the only reputed natural repellent (made using the oil of lemon eucalyptus)

See the New Mexico State University’s study in detail

The maximum recommended concentration level differs depending on the product and the age of the person using the repellent, as well as for pregnant women. So check the concentration of a product before buying it.

Concentration and maximum number of applications of different repellents

Age	Maximum number of applications per day	DEET	Picaridin	Citridiol	IR3535
6 months – walking age	1	10% – 30%	–	20% – 30%	20%
Walking age – 24 months	2	10% – 30%		20% – 30%	20%
24 months – 12 years	2	20% – 30%	20% – 30%	20% – 30%	20% – 35%
> 12 years	3	20% – 50%	20% – 30%	20% – 30%	20% – 35%
Pregnant woment	3	30%	20%	20%	20%

Source: EWG, CDC, Drugs.com

If you have a fever for more than 24 hours during your trip or within three months of your return, see a doctor urgently.

A blood test will need to be done to determine if it’s malaria, as many other tropical diseases have the same symptoms.

If you plan on travelling in extremely remote areas, you can ask your doctor to prescribe emergency treatment that you can take with you. This self-treatment should only be taken if you can’t get a doctor’s appointment within 24 hours of the onset of the fever. In any case, you’ll need to see a doctor as soon as possible afterwards to check that it’s not another disease.

Emergency treatment shouldn’t be used:

• on children
• if symptoms appear after returning home
• in the first week in a risk area, as it can’t be malaria

Drugs that can be used in emergency treatment are:

• Atovaquone-Proguanil (Malarone®): 4 tablets in 1 dose per day, for 3 days
• Artemether-Lumefantrine (Riamet®, Coartem®): 4 tables in 1 dose, 2 times a day, for 3 days (not for pregnant women)

Halofantrine (Halfan®) shouldn’t be prescribed due to its potential cardiovascular toxicity.