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Malaria Prevention and Control

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					Malaria Prevention and Control                                                     Doxycycline 100mg      Taken daily, start 1-2 days        Areas where
                                                                                                          prior entry to risk area,          chloroquine and
-Malaria is both an acute and chronic disease caused by protozoa of the genus                             continue daily dosing while at     mefloquine resistant
Plasmodium. There are 4 species that can cause human malaria: P. falciprum,                               area and 4 wks after leaving.      P. falciprum exists
P.vivax, P. malariae, and P. ovale. Malaria is transmitted to humans by the bite                          Daily dosing should be taken
of an infected female Anopheles mosquito. P. falciprum is the most serious and                            the same time each day.
                                                                                   Mefloquine (Lariam)    Taken weekly, start 1-2 wks        Areas where
fatal type of Malaria.
                                                                                   228 mg base (250 mg    prior entry to risk area,          chloroquine resistant
                                                                                   salt)                  continue weekly dosing while       P. falciprum exists
-The complex life cycle of Malaria is divided into 4 unique phases:
                                                                                                          at area and 4 wks after leaving
Exoerythrocytic Phase, Hypnozoite Phase, Erythrocytic Phase, and Vector            Chloroquine 300 mg     Taken weekly, start 1-2 wks        Areas where
Phase.                                                                             base (500 mg salt)     prior entry to risk area,          chloroquine resistant
                                                                                                          continue weekly dosing while       P. falciprum has NOT
                                                                                                          at area and 4 wks after leaving    been reported
                                                                                   Atovaquone+            Taken daily, start 1-2 days        Areas where
                                                                                   Proguanil (Malarone)   prior entry to risk area,          chloroquine and
                                                                                   250mg/100mg            continue daily dosing while at     mefloquine resistant
                                                                                                          area and 7 days after leaving.     P. falciprum exists



                                                                                      C. Terminal Prophylaxis – Primaquine is the only available medication
                                                                                         that can prevent the liver stages of malaria from P. vivax and P. ovale.
                                                                                         Before taking primaquine, however, it is critical to verify G-6-PD
                                                                                         deficiency. G-6-PD deficient individuals should only take primaquine
                                                                                         under the direction of an infectious diseases specialist.

                                                                                          Please note the above chart. Terminal prophylaxis with doxycycline,
                                                                                          mefloquine and chloroquine lasts for four weeks after departure from
                                                                                          the endemic area. During the final two weeks of that terminal
                                                                                          prophylaxis, a 14-day course of 30 mg daily primaquine should be taken
Preventive measures include:                                                              simultaneously to prevent the liver stage of P. vivax and P. ovale. For
   A. Personal protective measures- Application of DEET, treatment of                     individuals taking atovaquone & proguanil, the 14 day Primaquine
       clothing with Permethrin, and appropriate netting are measures that can            course should be started the first day after leaving risk area.
       effectively provide disease vector protection.
   B. Chemoprophylaxis- Refers to the administration of a medication for              D. Unit Protective Measures- Inform the command and its personnel of
       the purpose of preventing disease or infection. Prophylactic treatment            the risk of Malaria through training of the importance of personal
       should begin 2 weeks prior travel to endemic area, except doxycycline,            protective measure and chemoprophylaxis.
       which should begin 1-2 days prior exposure. Prophylaxis should be
                                                                                   Reference: Navy Environmental Health Center (Technical Manual NEHC-TM PM
       continued throughout the time of visitation and 4 weeks after leaving       6250.1(2007))
       endemic area.

				
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