31 January 2011

Post holiday malaria

The summer holidays may be a thing of the past, but for some the effects continue to linger – in certain cases with dangerous and even deadly consequences.


The summer holidays may be a thing of the past, but for some the effects continue to linger – in certain cases with dangerous and even deadly consequences.

According to Dr Pete Vincent of Netcare Travel Clinics there has been a considerable increase in the number of South Africans presenting to medical practitioners and even to hospitals with malaria in recent weeks.

Most of these individuals visited malaria areas where above-average rainfall has resulted in hot and humid conditions – the ideal breeding ground for the female anopheles mosquito, the carrier of malaria.

One such case is that of fifteen-year-old Lumarno van Rooyen of Johannesburg who was recently diagnosed with cerebral malaria, which if diagnosed and treated too late can prove fatal.

Lumarno contracted malaria in Mozambique where he spent the festive season with his godfather.  His mother Lindie says were it not for a quick and accurate diagnosis of his condition, he would have died.

“Lumarno started suffering headaches, fever and abdominal pains earlier this month,” notes Lindie who is a staff nurse at the Netcare Olivedale Hospital. “I didn’t think it was malaria at first, but fortunately Lumarno’s godfather did. Needless to say, once it became evident that it might be malaria we got Lumarno to hospital as soon as we possibly could.”

Lumarno was treated by Dr Athena Savvidoua Specialist Physician, practising at Netcare Olivedale Hospital.

She diagnosed him with cerebral malaria and he was immediately admitted to the high care ward at the hospital and administered quinine.

He has since made a complete recovery. “The doctor said that if we had delayed getting Lumarno to the hospital for just  another 24 hours, he would not have made it,” recalls a relieved Lindie.

Increase in malaria not unusual this time of year

Dr Vincent says that it is not unusual at this time of year to see an increase in malaria cases as many people return from their festive season holidays having caught the illness in malaria areas.  

“Families who have visited places such as the northern parts of South Africa and Mozambique should be vigilant, watching out for possible symptoms,” cautions Dr Vincent.

“Other people travel home over the festive season after having lived and worked in non-malaria areas such as Johannesburg for long periods of time. They lose their passive immunity to the illness and end up contracting it. Sometimes malaria-carrying mosquitoes are even transported into non-malaria areas after having ‘hitched’ a ride in a vehicle.”

Passive immunity

Dr Vincent explains that people who were bought up in a malaria area acquire a passive immunity to the illness that is developed by being exposed to it.

Passive immunity can offer some protection, but this is lost fairly quickly when one moves from the malaria area. Those who intend heading home to a malaria area after such an extended stay should therefore visit their travel clinic to see whether they should take prophylaxis prior to travelling.

Dr Vincent says that countries such as Mozambique, Malawi, the DRC, Sudan and Uganda have particularly high rates of malaria, and citizens from these countries should be especially careful.

Malaria is also found in parts of Zimbabwe, Botswana, Angola and Namibia. Malaria areas in South Africa are in the northern parts of Mpumalanga and Limpopo as well as Maputaland in KwaZulu Natal.

According to the January 2011 Communicable Diseases Communique of the National Institute of Communicable Diseases (NICD) and the National Health Laboratory Service, 3 470 cases have been reported in South Africa so far this malaria season.

Most of these (61%) were reported from the Limpopo Province, 27% from Mpumalanga with the balance from KwaZulu-Natal. Some 6 600 cases were reported in the 2009/2010 season although many cases are not reported amongst returning travelers.

Stay vigilant

Keep an eye out for the symptoms of malaria even if you think you were not bitten by any mosquitoes on your trip and have religiously taken your prophylaxis, advises Dr Vincent.

Although malaria usually presents with flu-like symptoms it can also initially express itself in many different ways in different people. So report any health problems to your doctor.  The first symptoms in adults may include the following: 

  • Feelings of weakness, lethargy and dizziness
  • Fever and sweats
  • Muscular and/or abdominal pains
  • Vomiting, diarrhoea

The symptoms of the disease can appear from a week to two weeks after you are first bitten. Very occasionally it may even take a few months before the illness starts to express itself.

Dr Vincent therefore advises those who have been in malaria areas to remain vigilant for some months after they return. “Regard any fever as malaria until it is proven otherwise,” he continues, “and be sure to follow up on the results of the blood test.”

How to protect yourself

Just how does one protect oneself against the disease? Dr Vincent says that preventative medications, or prophylaxis, play a very significant role in the fight against malaria, but do not necessarily afford complete protection on their own.

A multiple approach to the prevention of the disease is therefore necessary. “Do everything possible to avoid getting bitten by mosquitoes while also taking your prophylaxis as prescribed by your doctor or travel clinic,” he advises. “Using repellents, insecticide fabric sprays and mosquito nets treated with such sprays can also help a great deal.”

Dr Vincent says that while prophylaxis does not provide complete protection against malaria it does at least provide a good measure of protection. Travellers to malaria areas should therefore be sure to take prophylaxis if they have been prescribed them by their doctor or travel clinic.

“There are a number of myths that have developed around malaria prophylaxis,” notes Dr Vincent. “For instance it has been suggested that they do not provide protection against the development of cerebral malaria. This is not true. Malaria prophylaxis that has been used properly and as prescribed invariably greatly reduces the severity of malaria and saves many lives.”

Individuals wishing to travel to a malaria area should visit their doctor or travel clinic in order to find out which malaria medications or combination of medications they should be taking.

(Netcare, Press Release, January 2011)

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