malaria prophylaxis

Last edited 12/2019 and last reviewed 06/2023

Malaria prophylaxis does not afford full protection against infection. Contact advice centres for information about changing patterns of resistance and spread of malaria.

Certain individuals are at higher risk of severe malaria and need to be forewarned - these include people who are immunocompromised and pregnant women.

Malarial chemoprophylaxis can be directed against various stages of the life cycle of the malaria parasite

• causal prophylaxis
• directed against the liver stage (liver-stage schizonts of all 5 species)
• NOT effective against P. vivax and P. ovale hypnozoite stage
• ACMP recommends continuing the drug for 7 days after leaving a malarious area
  
  
• suppressive prophylaxis
• directed against the red blood cell stages
• should be taken for 4 weeks after leaving a malarious area
  
  
• prophylaxis against hypnozoites
• primaquine is active against hypnozoites (present only in P. vivax and P. ovale)
  • also has causal prophylactic activity against the liver stage schizonts of all malaria parasites of humans
  • primaquine is occasionally used for terminal prophylaxis, also known as presumptive anti-relapse therapy (PART), to eradicate hypnozoites of P. vivax and P. ovale
    • however, the routine use of primaquine for prophylaxis or terminal prophylaxis is not recommended (1)
    • primaquine is not licensed in the UK and practitioners considering the use of primaquine as a prophylactic agent should consult an expert centre (1,2)
    • primaquine is an oxidant drug and can lead to significant haemolysis in G6PD-deficient individuals.

In addition to the use of an appropriate chemoprophylaxis, probably the best advice is to avoid being bitten. This involves the use of mosquito repellants - either applied to the skin or used in a particular room, the wearing of long sleeved shirts and trousers from dusk onwards, and sleeping under a mosquito net (1,2)
Notes:

• Advisory Committee on Malaria Prevention (ACMP) in UK does not recommend purchasing antimalarial drugs over the internet or from the tropics. Travellers should purchase antimalarial chemoprophylaxis from a reputable source in the UK before departure (1,2)

Reference:

• (1) Public Health England. Guidelines for malaria prevention in travellers from the UK 2019
• (2) Health protection agency 2007. Guidelines for malaria prevention in travelers from the United Kingdom