Thursday, January 3, 2013

Malaria 101

Ever since my battle with malaria, we’ve been getting many great questions from friends in the U.S.
For those who are curious, here is a brief introduction to malariaJ

Prevalence: Unfortunately, malaria is very prevalent here in Tanzania, which is why the Lutheran Malaria Initiative is very active here. Malaria is most dangerous for pregnant women, children under the age of 5, elderly and those with compromised immune systems, such as those with HIV. Malaria causes about 60,000 deaths in Tanzania each year. About 80 percent of these deaths are children under five years old. When I got malaria, I joined the 14-18 million clinical malaria cases reported by Tanzanian public health services each year.[1]

Prevention: We sleep under a bed net every night and try to avoid mosquitoes by using bug spray and spraying our room periodically. Yet, despite our best efforts, sometimes they still get us. The malaria parasite is carried by the female anopheles mosquito, which is not longer found in the U.S. This type of mosquito was eradicated in the U.S. in 1949-1951, mainly through the use of DDT. It was only later that people began to realize the negative effect that DDT has on the environment, and its use is no longer recommended.  

Prophylaxis: Many people have asked “How did you get malaria if you were on prophylaxis?”

1)  Prophylaxis is not the same thing as a vaccine. Prophylaxis is basically putting a little bit of the treatment medicine in your system over time so that if you do get the parasite, your body is better able to fight it. It is not a guarantee that you will not get malaria. Prophylaxis can help a person avoid the most dangerous form of malaria called cerebral malaria, and it greatly reduces the chance of getting malaria. For example, the prophylaxis I was on, Malarone (atovaquone-proguanil hydrochloride), is typically 95-100% successful at keeping the malaria parasite from running rampant. In spite of my getting malaria while on prophylaxis, I would still highly recommend prophylaxis for those taking short-term trips. It’s not a guarantee, but it does help. Just remember to also take steps to avoid being bitten in the first place.

2)  There is a possibility that the prophylaxis I bought here in Tanzania might have been a different concentration than what I purchased in the U.S. There are three standard options for prophylaxis: atovaquone-proguanil hydrochloride (a.k.a. Malarone), doxycycline, and mefloquine (a.k.a. Larium). Eric is currently taking the Doxy, but it isn’t an option for me because it interferes with my other medications. I tried mefloquine when we went to Nigeria, but I had too many negative side effects.  That left me with Malarone. Unfortunately Malarone is terribly expensive in the United States. Because of the expense of Malarone, we only bought 3 months worth of it in the U.S., and then bought another month here in Tanzania. It is impossible for us to tell whether what we bought here was the same as what we bought in the U.S. 

Regardless, prophylaxis is not a long-term solution. We won't be able to stay on it forever, because it isn't good for the body in the long term. Our initial thought was to stay on it for our first 6 months, so that it could help our bodies start fighting the malaria as we are building up antibodies. Then we will determine how best to proceed.

Types of Malaria: There are five different kinds of malaria parasites-- P. falciparum, P. vivax, P. ovale, P. malariae, and P. knowlesi. Of those, the most common in Africa and unfortunately the most dangerous is the P. falciparum. Of all the African malaria, about 80% are P. falciparum, 10% are P. vivax, 8% are P. ovale, and 2% are P. malariase.

We aren't sure what type of malaria parasite I got. The good news is that if it was P. faciparum, then it probably isn't still living in my liver. However, if it was the P. vivax or P. ovale, it can live in the liver and pop out again at any time (i.e. I could have a malaria relapse). If it does seem that I have recurrent malaria, there is a medicine called primaquine that can be used to clear the malaria out of the liver. It's not something one wants to do unless necessary, because it is hard on the liver and has unpleasant side effects. However, it is effective at eliminating the malaria parasite from the liver.

Treatment: The symptoms of malaria are very similar to the flu—fever, headache, vomiting, diarrhea, aches, etc. The fever was our first sign that this was, in fact, malaria and not just some stomach bug. A classic feature of malaria is that the fevers and symptoms will often cycle. Therefore, someone with malaria may feel significantly better one day and then feel wretched again 24-48 hours later.

After I was diagnosed through a blood test, I began a three-day combination treatment of artemesinin and mefloquine. Unfortunately, I had some of the same negative side effects to the mefloquine treatment that I had when I was using mefloquine as a prophylaxis in Nigeria—anxiety, insomnia, depression, heart palpitations, etc. Next time (if there is a next time), we will try to get a combination treatment that does not use mefloquine.

After the three-day treatment, I was still becoming severely dehydrated, so we made a trip to the hospital for IV fluids and an antibiotic called ciprofloxicin (often used to treat traveler’s diarrhea). Since this was my first time to have malaria and I had no natural immunity, I required a second treatment course. Therefore, I followed up my first round with another five-day artemesinin treatment. It seems to have finally kicked the malariaJ

For more information about malaria, Wikipedia has a pretty extensive page on the subject ( )

If you want to help keep the malaria death-toll down, especially among children, please go to the Lutheran Malaria Initiative website ( LMI is doing great work here in Tanzania and in other parts of Africa! For just $10, you can buy a bed net that will protect a family and reduce their chances for getting this terrible disease.