Malaria and the Irish Traveller
The travel opportunities open to Irish people nowadays are endless. While a couple of weeks in the sun in Costa del Anywhere is still a popular choice for many, for those with an appetite for the more unusual or indeed adventurous, the list of destinations is endless.
From safaris in Africa to backpacking around Asia, in recent years there has been a significant increase in the number of people travelling further afield than the more traditional Europe and North America.
However, with more destinations inevitably comes more risk. People are not only being exposed to tropical diseases that simply are not present in the more traditional destinations but they are also at risk of bringing these diseases back to Ireland, usually unknowingly. The recent outbreak of the new pneumonia threat, Severe Acute Respiratory Syndrome (SARS) fuelled through global travel is a case in point.
It is not surprising therefore to discover that every year, an average of 19 cases of malaria are notified to the National Disease Surveillance Centre in this country, despite the fact that this is a tropical disease. What may surprise people however, is that a person can be infected with malaria, but may not develop symptoms of the disease until months or even years later. And this is irrespective of whether they have taken anti-malarial medication or not.
A cautionary tale
This is exactly what happened to Joe Kearns, a computer systems manager from Clontarf in Dublin. Joe worked as a volunteer for Concern in Ethiopia for two years in the early 1980s. He took his anti-malaria medication as directed, took as many other precautions as one can (mosquito nets, insect repellents etc…) and returned to Ireland in what appeared to be 'pretty good health'.
Eighteen months after returning home, he developed a severe headache. A week later, he started experiencing flu-like symptoms. Within days he was fighting for his life, suffering from an illness which doctors could not identify. Joe had malaria.
"I remember it so well. I developed a severe headache while attending a wedding in August 1985. The following weekend, my wife and I were supposed to be going on holidays and I started feeling very flu-y and I just thought, typical, I am getting the flu just as I am about to go on holidays", Joe told irishhealth.com.
However a few days later, he developed a pain in his side which eventually became so bad, that he could not move. He was hospitalised a few days after that, but it would be another week before doctors would determine what was wrong.
"Originally they thought I had done damage to my rib. They also thought I may have had an abscess on my side. I was seen by seven different doctors during that time. By now my weight had plummeted from 11 to eight stone and I had undergone three blood transfusions", he said.
But in the meantime, one of the doctors had thought to send a blood sample to the tropical division of a nearby hospital. It was then that malaria was diagnosed and Joe was informed of the results.
"I couldn’t believe it. Up until this time, both the doctors and my wife thought I was going to die, but a diagnosis of malaria was still a total shock", he explained.
While Joe's experience is telling - how at risk from malaria is the international traveller? According to the Tropical Medical Bureau, which has several clinics around the country, most of the transmission of malaria occurs in tropical Africa, Asia and Central and South America.
"Travellers need to remember however that there is also a mild risk of the disease when visiting parts of North Africa and some parts of the Middle East", the bureau said.
Malaria is caused by a parasite, known as Plasmodium, which is usually transmitted to humans through the bite of an infected mosquito. There are four different species of this parasite that cause the disease. Three of these, Plasmodium vivax, P. ovale and P. malariae, are often referred to as 'benign' malaria, as they will not kill you, but can make you seriously ill. The fourth form, P. falciparum, is also known as 'malignant' or 'cerebral' malaria.
Risk of death
A person can die within 48 hours of developing the symptoms of this type of malaria. Early diagnosis and proper treatment are the most important factors that determine the survival of patients with this type.
Malaria is transmitted by the bite of an infected anopheline mosquito
However as demonstrated by the case of Joe Kearns, Irish doctors may be delayed in diagnosing malaria, simply because they are unused to dealing with such a disease.
This is a problem that has already been acknowledged by the NDSC. Last year, it advised all Irish GPs, public health doctors and hospital consultants to widen their knowledge of tropical illnesses, as recent surveys had indicated that many Irish tourists travelling to 'high risk' areas, were failing to seek medical advice prior to departure.
'High risk' areas are specific areas in which diseases such as malaria, typhoid, and yellow fever are endemic, i.e. they are commonly found there. Up to 200,000 Irish people travel to 'high risk' areas every year, however according to surveys carried out by travel vaccination website, travelvax.net, just 15% of these travellers receive the necessary vaccinations or medications.
The TMB has also expressed concern about the number of Irish people who book last-minute deals to 'high risk' areas, as vaccinations and medication, including anti-malarial medication, takes time to work. Therefore, even if taken prior to departure, their protective effects may not have kicked in properly yet.
Anti-malarial drugs must be taken a number of days, usually seven, before departure, as well as throughout the trip - even if it is long-term. In the early stages of malaria, anti-malarial drugs are useless because the parasite is 'hidden' from their effects. Therefore you must also take the pills for at least 28 days after your return.
Between January and November 2002, 20 cases of malaria were notified to the NDSC. Information on medication taken was available in 14 of the cases. Of these 14 cases, eight had not taken anti-malarial medication. Of the remaining six, all had discontinued their medication after their return to Ireland, although three of these had to discontinue due to illness or treatment for malaria.
Two-thirds of the cases notified in 2002 were due to most serious strain of the disease, P. falciparium.
Furthermore, while an average of 19 cases are notified to the NDSC each year, 'anecdotal reports would indicate that the notification figures available underestimate the true burden of the disease in Ireland', the centre said.
It is important to be aware of the fact that there is NO vaccine that protects against the disease. And while anti-malarial medication may give you added protection, you CAN STILL CONTRACT malaria, not least because of the emergence of multi-drug resistant strains of the parasite responsible for the disease.
This does not mean that there is no point in taking the medication, it is still most definitely recommended in order to reduce the risk. But even after you have returned home and even if you have taken your medication as directed, you may still develop the disease.
Because of this, it is essential to be aware of the symptoms of the disease. Common symptoms include fever, sweating, shivering and headaches - common flu-like symptoms. Probably the most important indicator of malaria is fever. If you have returned from an area with malaria and you develop a fever, even months or years later, you must be checked by a doctor and remember to alert him/her to your travel history.
"Remember that following any at-risk travel, fever equals malaria, until it is proven otherwise!", the TMB says.
Mosquito netting on a bed can reduce the risk of being bitten
The truth is that the only definite way of avoiding catching malaria is to avoid getting bitten by a mosquito, which realistically speaking, can be next to impossible in certain areas. However there are added precautions that can be taken. Mosquitoes that transmit malaria bite between dusk and dawn. Measures to reduce the risk at this time can include wearing protective clothing (long sleeved shirts etc…), using insect repellents and using a mosquito bed net.
Either take these precautions or choose another destination.
"The best advice I can give a person who is considering going to a region with malaria is don't. Go somewhere that doesn't have the disease. I am lucky in that I have not had a recurrence of the disease, which can happen. However the odd time, I still get bouts of feeling unwell because of it, despite having developed it in the 1980s ", Joe Kearns said.
* Going abroad on holidays or business - use the irishhealth.com Travel Vaccination Calculator to find out the vaccinations needed. See..
I'm sure the body of knowledge about malaria in Ireland is substantially greater than in the 1980s. Like Joe, I had malaria as well, and was diagnosed over 6 months after being infected. Luckily I was in Cape Town at the time, and while there was some uncertainty once it was diagnosed they were able to treat me very easily. It being as Asiatic strain didn't make it easier. The experience one can gain from travelling far outweighs any of the downsides of contracting malaria. In most cases (not mine or Joes) you will come down with it quite quickly after infection, so there is a greater chance of being able to tie your symptoms to recent experience. I would even go so far as to say the loss of quality of life you get from being ultra-cautious about medicines, creams, nets etc etc is more discommoding than the week or so you'll be sick. (That's including vomiting, fevers, enlarged spleen and temperature so high you can't see anymore!) As my South African doctor said as I left to head up towards Kenya. "If you get malaria again, you take quinine, you get better".
I hardly think the "loss of quality of life" equationg to the 10 minutes a day it takes to take tablets, but up a net and put on repellant could be equated to the rish of loosing your life. Malaria can and does kill.
This article neglects to mention the many side effects of some anti-malarial drugs including everything from vivid dreams to long-term depression. There is also the masking effect on the drugs which means that malaria may be diagnosed later while taking the drugs than would otherwise be the case - a bit more balance may be good. While there are many advantages the disadvantages cannot be ignored...
I recently too tetracycline based malaria tablets on holiday to india - and experienced extreme nausia for about 10 days until i realised that they were side effects of the medication. Out of about 50 peole travelling in the group about 10 had to discontinue the medication as the side-effects outweighed the possible risks. We consulted a doctor who advised us to be aware of the symptoms of malaria and contact our doctor/hospital if we developed any on our return
It is worth mentioning that the argument which says that malaria tablets hide the signs and symptoms and so make the diagnosis more difficult is very akin to saying that it is better to have a really serious accident and to be able to skip the queue in casualty rather than to have a very much milder illness and wait for some hours to be seen. Personally I would prefer the milder illness and the later diagnosis rather than the severe overwhelming illness and the strong possibility of death!
This has made me think of my own case. I visited Gran Canaria in March 2002, attended a concert in Maspolamas at a time when Mosquitos were prevalent. In the Concert Hall a person in the row behind me killed a mosquito on my shirt. I wonder if I had been infected. I came home in good health, had one swim in Irish polluted waters and became very feverish at a dinner towards the end of July. I slept for the week-end and was extremely feverish and weak. I went to my G.P....cert and stay in bed.....called for second opinion that evening and was advised to have blood tests. I drove to my local hospital the following morning, received excellent care for a mystery virus and was released from hospital in mid-October...very weak and put on medication for T.B. We did talk about my holidays, I didn't remember getting a pick from a mosquito, but having read your article,I must confirm if Malaria was ruled out in my case. In later blood tests (December) Q-Fever was diagnosed and I was taken off the TB medication,having lost some hair and three stone. Your article put me thinking as some sweats, not as severe, have returned once more, eventhough I was diagnosed clear in December. I would appreciate professional comments.
was there ever any cases in the west of ireland?? anyone
The only weay someone in the west (or any part) of Ireland couldcontrat Malaria is if they had visited a country where malaria carrying mosquios are prevalent. These exist in high temperatures in parts of Africa and the far east and are not like normal 'midges' or mosquitos that you would find in spain or the european continent. In short, no, you could not get malaria in the west of Ireland
what is the maximum period of giving chloroquine to a child as malaria prophylaxis
UK figures on cases of malaria over about 20 years showed that a lot of people contracted malaria in spite of taking prophylactic medication. However, as long as they continued the tablets for at least 28 days after returning home, they didn't die of the condition. All the deaths were in the groups who either took nothing or stopped treatment too soon.
I visited SE Asia some time ago for a dream holiday and my GP prescribed the Anti-Malarial drug Larium because my options were limilted due multi-drug resistence in the areas I was to visit. I have to say that I experienced significant side-effects, extreemly vivid nightmares, nausia and a strange metalic taste in my mouth. This did start to affect my ability to enjoy my holiday (Since one of my reasons for visiting SE Asia was to experience the cuisine) I have have to admit that I stopped taking the drug and although things improved immensely I realise now it was a risky decision to have made!! Are there any alternatives to Larium? or is there anyway to treat side-effects beacause it is probably due to these side-effects that most people discontinue taking the drug
Some not so nice facts about malaria. a) Not taking correct treatment (prophylactic or treatment) aids in malaria becoming more resistant to conventional drugs. b) Malaria was endemic in south east England until the turn of the 19th century (Plasmodium Malariae species). c) With increased resistance to conventional drugs and global warming malaria can return to the UK and 'hop' over into Ireland. d) Up to six people in the UK have contracted malaria without leaving the country. Some were congenital (passed from mother to child in utero), some were cases of 'airport malaria' (mosquito travelled in luggage or in plane)and some thro' blood transfusions. This is unlikely to happen here 'cos one cannot donate blood if one has been to a high risk area. e) Since the beginning of time malaria alone has killed more people than all other illnesses and wars combined. Good news is a) Knowledge of tropical disease is definately on the increase (thanks in part to our new population) - (I've just come from a training course in tropical disease diagnosis in the Tropical School of medicine in Liverpool - hence all the UK stats)b) The malaria genomes have been sequenced with the potential of new safer treatments. c)Priests and Nuns have been coming and going to tropical places from Ireland for many years and lived to tell the tale.
I contacted malaria nearly 30 years ago while on holiday in Kenya. While sick out there, it really blew up when I got home and had to spend some days in hospital in Drogheda. For years all was fine until I took a fall from my horse, held onto the reins and got about six kicks in the back for my trouble. She cracked a few ribs but the real damage was done when I stood up and eventually got back on. One of the ribs ruptured my spleen which had to be removed. I spent nearly two weeks in hospital and kept getting sweats which I eventually remembered reminded me of malaria! And it was. The trauma of the surgery had reactivated the disease while it it felt that having malaria had enlarged my spleen and that was why it was damaged. Having no spleen leaves me open to infection but have found that staying constantly on anti-biotics leaves me drained.
Latest research shows that 40% of people taking Lariam suffer moderate to severe neuropsychiatric side-effects. However, there are equally effective alternatives to Lariam and you should discuss them with your doctor. I should declare a conflict of interest, as I have been very ill and unable to work for the last seven years after taking Lariam (mefloquine), as have many others. The Irish Lariam support group is for people who have suffered long-term adverse reactions to this drug and can be contacted at: email@example.com
Another horror story of Lariam treatment. My boyfriend (at the time) went to Thailand for a well deserved several weeks break before starting on a major project in Australia. His doctor in Belfast prescribed Lariam for him to take although I was unaware of this until he was already well into taking it and in Thailand already. He suffered a severe personality change, depression, complete loss of emotions, problems with perception of his physical environment, and became hostile towards me and who knows who else. Once he told me that he was taking the lariam, i begged him through emails to stop. I was in fear for his life as he was alone backpacking there and knew no one and had no way to be contacted except through emails. Perhaps after reading your notes re: malaria occurrences after return to ireland, maybe i shouldnt have asked him to stop but, the press articles showing suicide attempts, violence and even murders committed by otherwise normal people on lariam scared me so badly I wanted to sue the doctor who prescribed this nightmare drug. This whole thing destroyed our relationship and to this day he has trouble registering emotion and experiences severe mood swings. This was a person with a great life, great situation, love, family and a positive personality who has since turned into someone I don't know anymore. I wish they would take this particular drug off the market.
It is certainly worth saying that Lariam is not a perfect drug. There again, how many are? Any time a doctor prescribes any medication which the individual has not taken before there is always a risk of an 'allergy' or an allergic type reaction. For instance, one of the most toxic drugs easily available on the market is Aspirin. How many Panadol does it take to kill an adult?
dear anonymous, posted 07,04,2004, regarding, aspirin, and panadol, these are two completly seperate drugs, aspirin taken in small amounts is very beneficial in certain cimcumstances, but it will, most defititely give you some stomach upset among other things, panadol on the other side is easier to take and does the same thing , but taken to excess it could kill you , or destroy you liver. this initself will kill you.
For a good many years I took anti malarial pills for business visits to Central Africa. However a few years ago I suffered severe depression on my return. It took 9 months to recover. It was a terrible experience. I will not travel to "malaria country" ever again
Liam, just for your information, aspirin will not definitely give you a stomach upset - only if taken over a long period in high doses on an empty stomach. Also it does not to the same thing as paracetamol. Aspirin also acts as an anti-inflamatory. Paracetamol does not.
I'm heading to Vietnam soon , travelling from North to South and into Cambodia (Ankor Wat) for 4 days. Have heard horror stories about Larium and my sister took Bymycium recently , which she discontinued as it made her so sick. Any advice ? I hate medication. Any "alternative medicine" available
I wouldn\'t risk going the route of alternative medicine with malaria. The disease can and does kill
The amazing thing about malaria and side effects of the pharmaceutical medications given to \\\"prevent\\\" malaria is that there is a natural remedy - NEEM - which has been used in India for 5,000 years as an insect repellent, do a search on the internet for \\\"neem malaria\\\" and do your research.
Hello all, I've traveled 1 year in africa and got malaria 3 times, all times got cured by simple choroquine (wich doesn't make your body very sick if you'd take it accidentally on wromg diagnosis, taking a single dose (curing malaria wit lariam requires 5!) makes evry single person feel sick or unwell for about a day. so imagine taking 5 when you think you might have malaria! I got well within 2 days all 3 times (compare to flu it's cured faster but the fever is higher) why? BECAUSE: I could take the medication within 2 hours of getting the fever (i happen to sense if i have fever) now listen carefully to be travelers: taking drugs to prevent you from retracting it is as unsafe as using the rithm method for anticonception! and dangerous as you will NOT notice you contracted malaria until maybe hours or days after the parasites spread !!! every hour after the outbreak starts you wait with treating it counts as one more day being sick. when not taking profilaxis you will find out you have malaria immediatly (high fever within 1 hour of feeling normal) and can proceed to cure it within 2 hours of getting the fever means you'll not be sick for more then a day or 2. when taking profilaxis it might be confused with diahrea, flu whatever as the fever develops more slowly. In my opinion the risk of serious problems is bigger taking profilaxis and thinking you are protected, then not taking it, avoiding mosquitoes and TAKING 2 DIFFERENT DRUG CURES WITH YOU (one like choloruine, you can take without diagnosis, let's say you develop fever in the middle of the night and the hospital is closed. (my gf got high fever while on lariam at 2 am newyears day in uganda, and all the doctors were drunk, after 3 hospitals i finally decided it was best just to take a cure of choloquine without diagnosis as sudden fever=malaria and if it's not, (she doesn't feel better next morning) the choroquine doesn't do any harm like lariam does to your body. profilaxis taking travelers usually wear short sleaves thinking their imune anyway. it's insane. i do advise taking an a 'stronger' cure too, in case you are in a place with no access and you tried the chloroquine, then have been properly diagnosed, and the fever doesn't go go down. But taking other drugs then chloroquine to cure yourself means you better be sure it is indeed malaria. especially for hollidays over 2 weeks profilactics are nonsense. they can avoid having to take 2 days to get better when you get it, and properly and timely cure it, but they do dot prevent danger of the disease. as it turns it into something more untetectable and easy to be misdiagnosed.
Pakmenu, you got better - you were lucky. Malaria can and does KILL.
It indeed does when the patient is given profilaxis on his trip, he thinks he's safe and then is not diagnosed timely. the story above mentions correctly THE MOST IMPORTANT THING IS TO GET TREATED AS SOON AS POSSIBLE. > patients should thus be given the cure with them on holliday and be told to take it within 2 hours of getting fever. even if no diagnosis is possible, as it's more dangerous waiting 4-5 hours for diagnosis then taking some choroquine on getting fever and getting diagnsed later. Malaria DOES KILL when treated ignorantly. I live near tibet at the moment, I've had people ask me if they should take malaria tablets (!) we are at 2200m above sealevel the only province in china that has malaria is near the Lao border. and yet dutch doctors see 'china' (almost a continent) on their list and prescribe profilaxis. they were NOT advised on how to treat it or how to cure it once retracted. nor told to try not to get bitten or take mosquito nets. etc. (or that malaria doesn't occur at high altitudes and is tropical desease) ALL they were told is that 'china has malaria' and that they should 'take the drugs' THAT is dangerous!
Greetings all.... All this talk about Chloroquine, Larium, mefloquine, etc... Has anybody considered SAFE medication? I read above that chloroquine \"doesn\'t harm like Larium does\". Sorry but that\'s outrageous and very irresponsible to say. Then again...it\'d be just as irresponsible to accept such statements as fact. Has anyone heard of Cinchona? or Artemisia annua? (cures without side effects - not a prophylactic) or about using volatile (essential) oils such as lavender, rosemary & garlic (and citrus plants).... Artemisia annua (Qing Hao - sweet wormwood) has been used to cure Malaria in China for THOUSANDS of years. Now we have the extract of the plant called ARTMENESIN........can\'t leave a perfectly good remedy alone....they extracted the Artmenesin and use only that compound......even though it has been discovered that there are other chemicals in the plant that are anti-malarial. I am moving back to Malawi in less than a month. I am managing a 3 year project building and sustaining a pre-school, workshop....and Medicinal Herb Farm. I\'d never take Lariam AGAIN. I had terrible nightmares and sweats, cramps and abdominal pains. I felt almost but not quite bedridden. These are side effects of Lariam (in some people).... As you may imagine.....I won\'t be on prophylactics for 3 years....nor would I even take any of these hard purging drugs into my system again... I will take every natural precaution. Perhaps even to the extent of NOT EATING BANANAS AT NIGHT (or drinking alcohol). Both bananas and alcohol GREATLY attract mozzies who are already romanticised by the carbon dioxide from your breath. (even chronic severe) Malaria can be cured in a 5day \"prescription\" of artemesia annua leaves alone. But drugs companies don\'t really want you to know about that. They say you need ARTMENESIN....(as in you \'need to BUY it\'! Perhaps the main reason for seeking natural cures comes from the fact that now, disease carrying mozzies are practically immune to drugs like Chloroquine, Mefloquine and Larium etc... Even the \"prophylactic tactic\" doesn\'t provide protection from Malaria. All i\'m stressing is: PLEASE LOOK INTO NATURAL PROPHYLACTICS AND CURES....you are doing yourself a favour, particularly your organs....they suffer immensely from these harsh drugs. The human body is not intended to have SUCH a high concentration of chemicals in the blood stream at one time.....it causes all manner of unexpected reactions and possibly long-term conditions. The BEST way, in my educated opinion is to take ORGANIC precautions.....and if it happens that you get Malaria....treat it with Artemesia annua tea....after which....your body has had a taste of these parasites and then develops increasing immunity upon future contractions of malaria. I am setting up a plantation of Artemesia annua Anamed (bred for 20X potency) in Malawi. Hopefully this will provide a VERY CHEAP solution to this terrible endemic. It\'s already going on in Ghana and Tanzania among others... Look it up....there may be some hope of staying healthy while trying not to catch malaria... Peace and Good Travelling.... firstname.lastname@example.org
I would also like to add that I think Irish drs are very ingnorant of foreign diseases. As more Irish people travel, they should be updating themselves. I had been travelling in Zambia and returned to Ireland for a holiday (I live abroad!). Less than a week after having been bitten,the headaches started. Travelling alot I was well aware of the symptoms. I'd arrived in Ireland on the Wednesday, on the Sunday I went to one of the regional hospitals eplaining what I thought I had. I was sent home by a patronising doctor having been told that I had the flu, though I did insist on a blood sample being taken,which was sent to St James Hosptial in Dublin. By the Tuesday I was unconsious and back in another regional hospital. They didn't know what was wrong with me, only for a Libyan doctor recognising some of the symptoms I suspect I would not have been diagnosed. Within a few hours after having been stablisied, I was transfered to Cherry Orchard, whereby I regained consiousness the following Saturday. In that time I had been treated by a Nigerian dr and also an Irish prof. I had P. Falciparum, at that time, which was a number of years ago, the microbiologists informed us that I had one of the highest concentrations of infections recorded in Ireland and was lucky to be alive. This is probably one of the reasons that it had taken hold so fast. A week after having first gone to the regional hospital, by blood report came back form Dublin!! I credit a substantial number of gin and tonics on the Saturday and a foreign dr, to me being here today writing this.... I have had numerous discussions with medical professionals in Ireland.. please don't be so complacent.. I come from a small town of 1,200 people.. living in the backwaters is no excuse to update yourself..
Anon 10.35, surely in this case a aubstatial number of tonics would have been just as effective as the substatial number of gin and tonics you give credit to - would they not?
Yes, the quinine would have been just as effective! Bear in mind, I was attending a wedding on the Saturday...
hi i have family in Kenya - nairobi and when they go to the coast Mombasa they recomend for us to take Metakelfin has any one heard of it?
too afraid to take malaria tablets and afraid not to take them . need advice. dont want to be sick with side effects on honeymoon
I'd rather be quesy from side effects than gravely ill
I'm a freelance health journalist and I'm researching an article on the rise in malaria cases among Irish travellers for the Daily Mail Ireland. I need to find a case study of somebody who contracted malaria abroad during their travels - perhaps because they travelled at short notice, chose not to take Larium or didn't realise they were heading for a malaria area. It involves a 20 to 30 minute telephone interview, having your picture taken and appearing in the paper. Please contact me asap at email@example.com Thanks
I have recently returned from a holiday in Tanzania. I and my friend took the new anti-malarial drug on the market Malarone and found it easy to take everyday with no side-effects. My friend's doctor recommended it as an alternative to Lariam. Anyone who is concerned about taking Lariam should perhaps discuss being prescribed Malarone instead with their GP. Malaria is a serious illness and it really is important to take anti-malarial drugs rather than rely on dubious 'alternative' medicines with less proven efficacy.
Hi everyone - I am from south africa and a lot of the outlying areas which south africans go on holiday to are malaria areas. Dont kid yourself malaria is dangerous - the reason for this is when you get the symptoms which are flu like symptons with a fever - you dont think to have a malaria blood test hence the disease is prolonged in the body in south africa our doctors ask you if you have been to a malaria area if any symptons are there - the disease is curable if caught early - however depending on your immune system it can re-occur annually - normally the same time each year. if you have been out of the country and you get flu like symptons - have a malaria test - even if you dont think you have it - better to be safe than sorry. In south africa we have a tablet which is new on the market called malanil. Apparently this is the best - little side effects etc - we were in the extreme bush in July and the people who went with us were given this - the only side effect was the first day they could not sleep but thats all.
My friend nearly died from malaria even though he completed the course of tablets! I remembered this thread and wanted to share about a new product that I've used, what with all the news about malaria again here http://www.irishtimes.com/news/health/malaria-cases-up-9-per-cent-in-ireland-1.1752331 It is a spray called Incognito anti-mosquito, that is clinically proven to protect against malaria! I used it in Africa recently and didn't get a single bite, though those around me were covered in them! I bought it from a pharmacy in Dub.