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VOL: 100, ISSUE: 11, PAGE NO: 31

- Malaria is a serious and sometimes fatal disease.

- It is transmitted by the bite of female anopheline mosquitoes.

- Malaria is caused by one of four types of plasmodium:

- Plasmodium vivax;

- Plasmodium malariae;

- Plasmodium ovale;

- Plasmodium falciparum.

- Malaria is widespread in many tropical and subtropical countries.

- There were 847 cases reported in 2002 in England and Wales.

- Fever.

- Flu-like illness.

- Backache.

- Diarrhoea.

- Joint pain.

- Sore throat.

- Headache.

- The principles to follow for malaria prevention are:

- Awareness of the risk;

- Reduction of bites;

- Use of prophylactic medication;

- Prompt diagnosis and treatment.

- Wear long-sleeved clothing and long trousers.

- Apply insect repellents to exposed skin.

- Use insecticide sprays, burn pyrethroid coils or heat insecticide-impregnated tablets indoors to control mosquitoes.

- If sleeping in an unscreened room or outdoors, a mosquito net (which should be impregnated with insecticide) is a sensible precaution.

- Different antimalarial prophylactic medication is appropriate according to the place of travel and the parasite's local resistance.

- Medication should be started before travelling to ensure that any drug sensitivity can be managed and that the correct levels of chemicals are circulating in the body.

- It is extremely important to continue to take medication for up to four weeks (depending on the manufacturer's guidelines) after returning from a malaria-risk zone, to cover the incubation period of the disease.

- Treatment depends on the type of plasmodium, prior chemoprophylaxis, known allergies, presence of medical conditions other than malaria, age, pregnancy, and risk of re-exposure to malaria after treatment.

- If the species is not known, or if the infection is mixed, initial treatment should be as for P. falciparum.

- Quinine, mefloquine, proguanil with atovaquone, artemether with lumefantrine and doxycycline are all used in treatment.

- P. falciparum malaria can progress rapidly in unprotected individuals and antimalarial treatment should be considered in anyone with features of severe malaria and possible exposure, even if the initial blood tests for the organism are negative.

- Careful adherence to preventive measures may not guarantee complete protection.

- Any fever experienced between one week after first exposure and up to two years after returning from a malaria-risk zone should be investigated because of the possibility of malaria.

- Most deaths due to malaria are related to a delay in diagnosis and treatment.

- The MRL is part of the Health Protection Agency (HPA). It provides:

- Reference and diagnostic parasitology of malaria;

- Surveillance of all incidences of imported malaria reported in the UK;

- Advice for the prevention of malaria given to health care professionals and the public.

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