Malaria is a serious tropical disease spread by mosquitoes. If malaria is not diagnosed and treated promptly, it can be fatal.

A single mosquito bite is all it takes for someone to become infected.

Symptoms of malaria

It is important to be aware of the symptoms of malaria if you are travelling to areas where there is a high malaria risk (see below). Symptoms include:

• a high temperature (fever) of 38°C (100.4°F) or above
• vomiting 
• sweats and chills
• muscle pains
• headaches 
• diarrhoea

Symptoms can develop as quickly as seven days after being bitten, although they usually appear between 10-15 days afterwards.

In some cases, the symptoms may not appear for up to a year or, occasionally, even longer.

When to seek medical attention

You should see a doctor if you develop the symptoms of malaria, even if it's several months after your trip.

If you are abroad and start to experience malaria-like symptoms, go to the nearest medical centre or hospital. A blood sample will be taken to test for malaria.

Read more about diagnosing malaria.

Malaria risk areas

Malaria is found in more than 100 countries, mainly in tropical regions of the world including:

• large areas of Africa and Asia
• Central and South America
• Haiti and the Dominican Republic
• parts of the Middle East
• some Pacific islands, such as Papua New Guinea

Malaria is not a problem in the UK. More information about the risk of malaria in specific countries can be found on the Fit for Travel website.

What causes malaria?

Malaria is caused by a type of parasite known as Plasmodium. There are many different types of Plasmodia parasites, but only five cause malaria in humans.

The Plasmodium parasite is mainly spread by female Anopheles mosquitoes, which are night-biting mosquitos. When an infected mosquito bites, it injects the parasites into your body.

Read more about the causes of malaria and how it is spread.

Treating malaria

If malaria is diagnosed and treated promptly, virtually everyone will make a full recovery. Treatment should be started as soon as the diagnosis has been confirmed.

Anti-malarial medication is used both to treat and prevent malaria. Which drug used and the length of treatment will depend on:

• the type of malaria
• the severity of your symptoms
• where you caught malaria
• whether you have taken an anti-malarial to prevent malaria 
• whether you are pregnant

Read more about treating malaria.

Complications of malaria

Malaria is a serious illness and can be fatal. It can also cause serious complications including:

• severe anaemia - where red blood cells are unable to carry enough oxygen around the body, leading to drowsiness and weakness
• cerebral malaria - in rare cases, the small blood vessels leading to the brain can become blocked, causing seizures, brain damage and coma 

Read more about the complications of malaria.

Preventing malaria

In 2010, over 1,700 travellers were diagnosed with malaria after returning to the UK. Seven of these people died.

Many cases of malaria can be avoided. An easy way to remember is the ABCD approach to prevention:

• Awareness of risk - find out whether you are at risk of getting malaria before travelling.
• Bite prevention - avoid mosquito bites by using insect repellent, covering your arms and legs and using an insecticide- treated mosquito net.
• Check whether you need to take malaria prevention tablets - if you do, ensure you take the right antimalarial tablets, at the right dose and that you finish the course.
• Diagnosis - seek immediate medical advice if you develop malaria-like symptoms, including up to a year after you return from travelling.

Speak to your GP if you are planning to visit an area where there is a malaria risk. It may be recommended that you take antimalarial tablets to prevent infection.

Read more about preventing malaria.

Symptoms of malaria can develop as quickly as seven days after you are bitten by an infected mosquito.

Typically, the incubation period (the time between being infected and when symptoms start) is 10-15 days. However, in some cases, it can take up to a year for symptoms to develop.

The initial symptoms of malaria are flu-like and include a fever, headache, sweats, chills and vomiting. This is often mild and can sometimes be difficult to identify as malaria.

Other symptoms of malaria include: 

• muscle pains
• generally feeling unwell  
• diarrhoea 

With some types of malaria, the fever occurs in 4-8 hour cycles. You feel cold at first with shivering that lasts for up to an hour. You then develop a fever that lasts for 2-6 hours, accompanied by severe sweating.

Seek medical advice immediately if you develop the symptoms of malaria, even if it is several weeks, months or a year after you return from travelling.

Plasmodium falciparum malaria

The most serious type of malaria is caused by the Plasmodium falciparum parasite. It can develop very quickly into a severe, life-threatening illness.

If it is not treated promptly, it can lead to life-threatening complications, such as:

• breathing problems
• seizures (fits)
• organ failure
• severe anaemia - a lack of oxygen in your blood (although this is very rare)

The most serious complication of falciparum malaria is a blockage in the blood vessels that supply the brain.

Read more about the complications of malaria.

Malaria is caused by the Plasmodium parasite.  The parasite can be spread to humans through the bites of infected mosquitoes.

There are many different types of Plasmodium parasite, but only five types cause malaria in humans. These are listed below.

• Plasmodium falciparum - mainly found in Africa and responsible for most malaria deaths worldwide.
• Plasmodium vivax - mainly found in Asia and Latin America. This parasite produces less severe symptoms than Plasmodium falciparum, but it can stay in the liver for up to three years which can result in relapses.
• Plasmodium ovale - fairly uncommon and usually found in West Africa. It can remain in your liver for several years without producing symptoms.
• Plasmodium malariae - is quite rare and usually only found in Africa.
• Plasmodium knowlesi - is very rare and found in parts of Southeast Asia.

How malaria is spread

The Plasmodium parasite is spread by female Anopheles mosquitoes, known as night-biting mosquitoes, because they usually bite between dusk and dawn.

If a mosquito bites a person infected with malaria, it can also become infected and spread the parasite on to others.

The parasite enters the bloodstream and travels to the liver. The infection develops in the liver before re-entering the bloodstream and invading the red blood cells.

The parasites grow and multiply in the red blood cells. At regular intervals, the infected blood cells burst, releasing more parasites into the blood.

Infected blood cells usually burst every 48-72 hours. Each time they burst, you will have a bout of fever, chills and sweating.

Pregnancy and malaria

The World Health Organization (WHO) recommends that pregnant women should avoid travelling to areas where there is a risk of malaria.

If you get malaria while pregnant, you and your baby have an increased risk of developing complications.

There is also a higher risk of premature birth, stillbirth and miscarriage (loss of the pregnancy during the first 23 weeks).

You should visit your GP if you are pregnant and travelling to a high risk area. They may recommend that you take anti-malaria medicine.

Read more about taking antimalarials while you are pregnant.

Visit your nearest surgery or hospital if you are abroad and have malaria-like symptoms. A blood sample will be needed to check for parasites.

The symptoms of malaria can take up to a year to develop, so you should still let your GP know if you experience flu-like symptoms a while after your travels.

You should tell them about any areas you have been to where there is a risk of malaria, including brief stopovers.

If malaria is suspected, a blood test will usually be carried out at your local hospital rather than at your GP surgery.

The test will confirm whether or not you have malaria parasites in your blood and, if you do, the type of parasite that is causing your symptoms.

You should receive the results of your blood test on the same day. If you have malaria, treatment will be started straight away.

Read more about treating malaria.

Antimalarial medication is used both to prevent and treat malaria.

If you have taken an antimalarial as a preventative measure, the same type of antimalarial should not be used to treat malaria. It is therefore important to tell the doctor treating you which antimalarial you have previously taken.

Preventative antimalarials

It is usually recommended you take antimalarial tablets if you are visiting an area where there is a malaria risk.

You should visit a specialist travel health clinic or your GP surgery to discuss your options.

The type of antimalarial tablets prescribed will be based on the following:

• where you are going
• any relevant family medical history
• your medical history, including any allergies to medication that you have
• any medication that you are currently taking
• any problems that you have had with antimalarial medicines in the past
• your age
• whether you are pregnant

You may need to take a short trial course of antimalarial tablets before travelling. This is to check that you do not experience an adverse reaction or side effects. If you do, alternative antimalarials can be prescribed before you leave.

Antimalarial treatment

If malaria is diagnosed and treated promptly, a full recovery can be expected. Treatment should be started as soon as your blood test confirms malaria.

The same antimalarial medicines used to prevent malaria can also be used to treat malaria. However, if you have taken an antimalarial as prevention, you should not take the same one to treat malaria. Tell the doctor treating you the name of the tablets that you took to prevent malaria.

The type of antimalarial medicine and how long you need to take it will depend on:

• the type of malaria you have
• where you caught malaria 
• the severity of your symptoms
• whether you took preventative antimalarial tablets
• your age 
• whether you are pregnant

Your doctor may recommend using a combination of different antimalarials to overcome strains of malaria that have become resistant to single types of medication.

Antimalarial medication is usually given as tablets or capsules. If someone is very ill, it will be given intravenously (through a drip into a vein in the arm) in hospital.

Treatment for malaria can leave you feeling very tired and weak for several weeks.

Types of antimalarial medication

There are five types of antimalarials used to prevent and treat malaria. These are described below.

Atovaquone plus proguanil (also known as Malarone)

• Prevention: the adult dose is one adult-strength tablet a day. Child dosage is also once a day, but the amount depends on the child’s weight. It should be started just one or two days before your trip, taken every day that you are in a risk area and for seven days after you return.
• Recommendations: a lack of clear evidence means that this antimalarial should not be taken by pregnant or breastfeeding women. It is also not recommended for people with severe kidney problems.
• Possible side effects: intestinal upset, headaches, skin rash and mouth ulcers.
• Other factors: it is more expensive than other antimalarials so may be more suitable for use on short trips. 

Doxycycline (also known as Vibramycin-D)

• Prevention: the dose is 100mg daily as a tablet or capsule. You should start the tablets two days before you travel, take them all the time you are in a risk area and for four weeks after you return.
• Recommendations: not suitable for pregnant or breastfeeding women, children under 12 years of age (due to the risk of permanent tooth discolouration), people who are sensitive to tetracycline antibiotics or people with liver problems.
• Possible side effects: sunburn due to light sensitivity, stomach upset, heartburn and thrush. It should always be taken with food, preferably when standing or sitting. Doxycycline reduces the effectiveness of combined hormone contraceptives, such as the contraceptive pill or contraceptive patches.
• Other factors: if you take doxycycline for acne, it will also provide protection against malaria as long as you are taking an adequate dose (ask your GP). Doxycycline is relatively cheap.

Mefloquine (also known as Lariam)

• Prevention: the adult dose is one tablet weekly. Child dosage is also once a week but the amount will depend on the child’s weight. It should be started three weeks before you travel, taken all the time you are in a risk area and for four weeks after you get back.
• Recommendations: it is not recommended if you have epilepsy, seizures, depression or other mental health problems, or if a close relative has any of these conditions. It is not usually recommended for people with severe heart or liver problems.
• Possible side effects: dizziness, headache, sleep disturbances (insomnia and vivid dreams) and psychiatric reactions (anxiety, depression, panic attacks and hallucinations). It is very important to tell your doctor about any previous mental health problems, including mild depression. You should not take this medication if you have a seizure disorder.
• Other factors: if you have not taken mefloquine before, it is recommended that you do a three-week trial before you travel to see whether you develop any side effects.

Pregnancy

If you are pregnant, you should avoid travelling to areas of the world where there is a risk of malaria.

Pregnant women have an increased risk of developing severe malaria. There is also a greater risk that both the mother and their baby will experience complications if they get malaria.

If you are pregnant and unable to postpone or cancel your trip to an area where there is a malaria risk, it is very important that you take the right antimalarial medicine.

Some of the antimalarials used to prevent and treat malaria are unsuitable for pregnant women because they can cause side effects for the mother and her baby.

The list below outlines which medications are safe or unsafe to use while pregnant.

• Mefloquine (Larium) - although there is no evidence to suggest that mefloquine is harmful to an unborn baby, it is not usually prescribed during the first trimester of pregnancy (weeks 1-13), or if pregnancy is a possibility during the first three months after preventative antimalarial medication is stopped.
• Doxycycline - is never recommended for pregnant or breastfeeding women because it could harm the baby.
• Atovaquone and proguanil (Malarone) - are generally not recommended during pregnancy or breastfeeding because research into their effects is limited. However, if the risk of malaria is high, they may be recommended if there is no suitable alternative.

Malaria is a very serious illness which can be fatal if not diagnosed and treated quickly.

The falciparum parasite causes the most severe malaria symptoms and most deaths.

Anaemia

The destruction of red blood cells by the malaria parasite can cause severe anaemia.

Anaemia is a condition where the red blood cells are unable to carry enough oxygen to the body's muscles and organs, leaving you feeling drowsy, weak and faint.

Cerebral malaria

Some rare cases of malaria can affect the brain. This is known as cerebral malaria and it can cause your brain to swell, sometimes leading to permanent brain damage. It can also cause seizures (fits) or coma (a state of unconsciousness).

Other complications

Other complications that can arise due to severe malaria include:

• breathing problems, such as fluid in your lungs
• liver failure and jaundice (yellowing of the skin and whites of the eyes)
• shock (a sudden drop in blood flow)
• spontaneous bleeding
• abnormally low blood sugar
• kidney failure
• swelling and rupturing of the spleen
• dehydration (a lack of water in the body) 

As complications of severe malaria can occur within hours or days of the first symptoms, it is important to seek urgent medical help as soon as possible.

The effects of malaria are usually more severe in pregnant women, babies, young children and the elderly.

The risk of malaria for people travelling to affected areas is significant, so it is important to take precautions to prevent it.

Approximately 1,500 travellers return to the UK with malaria every year. Most of the malaria imported to the UK is caused by plasmodium falciparum and is acquired in Africa.

Many cases of malaria can be prevented by the ABCD approach:

• Awareness of risk: know your risk of malaria.
• Bite prevention: avoid bites as much as possible.
• Chemoprophylaxis: take the right antimalarial tablets.
• Diagnosis: get immediate medical help for symptoms.

Awareness of the risks

You can check whether you need to take preventative malaria treatment for the country that you are visiting by looking at the Fit for Travel or NaTHNaC websites.

Visit your GP or local travel clinic for advice on malaria and other health risks as soon as you know that you are going to be travelling.

Bite avoidance

While you will not be able to avoid bites completely, the less you and your family are bitten, the less likely you are to catch malaria. Below are a number of things you can do to help prevent being bitten by mosquitoes:

• Ideally, stay somewhere with effective air conditioning and screening on doors and windows. If this is not possible, try to stay somewhere with doors and windows that close.
• If you are not sleeping in an air-conditioned room or if the air-conditioning is not effective, you must sleep under an intact mosquito net that has been treated with insecticide.
• Use insect repellent on your skin and in sleeping environments. Remember to reapply frequently.
• The most effective repellents contain diethyltoluamide (DEET) and are available in sprays, roll-ons, sticks and creams.
• Wear light, loose-fitting trousers, rather than shorts, and shirts that have long sleeves. This is particularly important during early evening and at night, as this is the mosquito’s preferred feeding time.

Garlic, vitamin B and ultrasound devices do not prevent bites.

Chemoprophylaxis: taking appropriate antimalarial tablets

Taking medicine to prevent catching malaria is essential for all travellers who are visiting areas with malaria. However, antimalarials are not 100% effective, so avoiding bites is also important.

Taking antimalarial medicine:

• Make sure you get the right antimalarial tablets before you go.
• You will have to pay for your antimalarials, so include the cost in your trip budget.
• Follow the instructions included with your tablets carefully.
• It is important that you continue to take your tablets after you return from your trip. This is to cover the incubation period of the disease.
• Most tablets need to be taken for four weeks after you return, although atovaquone plus proguanil (Malarone) needs to be taken for only one week.

Talk to your doctor to make sure that you are prescribed a drug you can tolerate. You may be more at risk from side effects if you have:

• AIDS/HIV
• epilepsy or any type of seizure
• depression
• heart problems
• liver or kidney disease
• porphyria (an inherited condition that causes sensitivity to sunlight)
• psoriasis
• psychiatric problems

You may also be more at risk from side effects if: 

• your spleen has been removed or does not work properly
• you take medicine (such as warfarin) to prevent blood clots
• you are a woman using combined hormonal contraception, such as the pill or patches

If you have taken antimalarial medicine in the past, do not assume that it is suitable for future trips. The medicine you need to take depends on the strain of malaria carried by the mosquitoes and drug resistance in the region that you are travelling to.

In Britain, chloroquine and proguanil can be brought from local pharmacies. For all other antimalarial tablets, you need a doctor's prescription.

Diagnosis: get prompt medical advice

If you become ill when you get back from travelling, even if you took the right malaria prevention tablets, you must see your GP or a hospital doctor straight away.

Tell the doctor that you have been exposed to malaria. It is important that you tell them which countries you have travelled to in the last 12 months, including brief stopovers.

Malaria can develop very quickly, so it is important to get medical advice, diagnosis and treatment as soon as possible if you think you may have malaria.

Glossary

Disease

A disease is an illness or condition that interferes with normal body functions.

Stomach

The sac-like organ of the digestive system. It helps digest food by churning it and mixing it with acids to break it down into smaller pieces.

Nausea

Nausea is when you feel like you are going to be sick.

Diarrhoea

Diarrhoea is the passing of frequent watery stools when you go to the toilet.

Ulcers

An ulcer is a sore break in the skin or on the inside lining of the body.

Anxiety

Anxiety is an unpleasant feeling when you feel worried, uneasy or distressed about something that may or may not be about to happen.

Depression

Depression is when you have feelings of extreme sadness, despair or inadequacy that last for a long time.

Unlike many travellers, Alex Beard was careful to take precautions against getting bitten by a malaria-carrying mosquito. She went to Africa armed with insect repellent, a mosquito net and antimalarial tablets. However, after several months travelling, her precautions lapsed

“I’d been studying in Ghana for about four-and-a-half months," she says. “My best friend and I decided to travel back to England by land.

“We stopped in Burkina Faso. I’d been feeling a bit ill for a while but I just put it down to an upset stomach and feeling tired, and ignored it.

“We were in a small rural village, miles from anywhere, when I started to feel very ill. I had a stabbing pain in my side and I found it really hard to breathe. I took painkillers and didn’t tell anyone about it. I can be very stubborn. But eventually I was so weak I couldn’t even pick up a glass.”

Alex’s friend realised something was wrong. She took Alex to the village’s tiny medical centre.

“The doctor sent me off for a blood test which they did at the vet's. There I was, surrounded by pictures of sheep and goats. I thought I was losing my mind. I kept fainting.”

Back at the medical centre, the doctor told Alex she had plasmodium falciparum malaria, the most dangerous kind. But she found it very hard to understand what was being said.

“We don’t speak French so they had to tell us about seven times before we understood. Eventually they resorted to doing impressions of mosquitoes. We thought we knew the classic signs of malaria and I didn’t have them. I just couldn’t believe it.”

The doctor gave Alex a bag of pills. She had to take 15 pills every day for three days. He also gave her pills to take in case she relapsed.

As there was no hospital, all Alex could do was go back to her hostel, take the pills and hope for the best. She spent three days drifting in and out of consciousness with a high fever, unable to walk or move. Then she felt well enough to travel to the nearest city, so she could be nearer better medical facilities in case she got worse.

She rested for four days, then carried on travelling for the next three months. She suffered two relapses and took her pills, which stopped the disease again. However, when she got home, she continued to suffer.

“I was in and out of hospital having severe night sweats and speech problems. I had really bad sickness and severe stomach problems. I had to go back for regular blood tests, which didn’t show any sign of the parasites, but I was still ill. It took me about 18 months to get over it and I now have irritable bowel syndrome as a result of malaria.”

Alex says that British travellers should take malaria prevention seriously.

“When you’re somewhere for so long, malaria protection doesn’t seem too important,” she says. “I was sleeping outside my mosquito net because it was too hot and I must have missed taking some pills. I kick myself for it now.

“We are so lucky to have easy access to these antimalarials. Millions of people die from malaria in the developing world. Find out what you need and stick to your regime. It’ll only take a few seconds out of your day.”