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Malaria Medicines & Diving

My husband and I are planning a trip this fall to Papua New Guinea, where we expect to enjoy several days of diving and a couple days of trekking through some heavily forested areas. We've been reading about recommendations for anti-malaria medications. Are these drugs really necessary?

Malaria is indeed endemic to Papua New Guinea, and the serious health risk posed by this disease cannot be overstated. Anti-malarial drugs, as prescribed by your physician, are a vital part of an overall plan to prevent infection whenever you are traveling in a known malarial zone.

The malaria parasite, a protozoan of the genus Plasmodium, is transmitted to humans by the bite of an infected Anopheles mosquito, usually between dusk and dawn. After an incubation period of 13-17 days, symptoms develop; they are characterized by an abrupt onset of chills, shivering, sweating and high fevers. Fevers may occur daily until settling into a cyclical pattern.

Remember the ABCDs of malaria prevention:

  • Awareness (Understand the risk and severity of malaria.)
  • Bite prevention (Reduce the risk of malaria through appropriate precautions.)
  • Chemoprophylaxis (Work with your doctor to select the most appropriate drug, and
    complete the course of pills.)
  • Diagnosis (Understand the signs and symptoms of malaria; should they occur, seek
    medical help immediately.)

    Discuss your travel plans with your physician well before departure. Many anti-malarial drugs require that you begin taking them days, sometimes weeks, before departure. The drug options will vary according to the strain of malaria found in your destination. All the drugs used for malaria prophylaxis are considered safe and are generally well tolerated, but side effects and toxic reactions can occur — some of them serious. Nonetheless, the risk of malaria may warrant tolerating temporary side effects. If a diver is unable to take a preventive medication because of side effects, the trip should be canceled or the medication changed to ensure coverage; the risk of contracting malaria is simply too great.

    There have been no studies conducted on malaria medication use while diving. In the absence of scientific data, we recommend caution and stability on the drug before attempting any dive. Divers should also note that the potential side effects of the anti-malarial drug mefloquine (sometimes sold under the brand name Lariam) may mimic symptoms of decompression illness.

    While drug prophylaxis is vital, it's even more important to prevent the insect bites that transmit the disease. The use of prescribed medication without complementary bite prevention through the use of clothing and insect repellents is inadequate; it's like driving without seatbelts while thinking your airbags will suffice in the event of an auto accident.

    To avoid mosquito bites, stay in well-screened areas while indoors, and wear clothes that cover most of the body when outdoors. Use mosquito nets for sleeping, and when you go outside use insect repellent containing at least 30 percent DEET. Stronger concentrations can be used with caution. Permethrin, a synthetic chemical available in over-the-counter strengths of 1 percent and 5 percent, is also commonly used to treat clothing and mosquito nets. Use these with care and according to manufacturers' instructions.

    Even with aggressive preventive means, it is still possible to contract malaria. Symptoms may develop well after the trip is over, so follow your physician's advice, and finish the complete course of anti-malarial drugs prescribed. If flu-like symptoms (any illness with chills, fever and headache) develop during a trip within a malaria-endemic area or within several months after the last exposure, seek qualified medical attention immediately.
    Daniel A. Nord, BFA, EMT-P, CHT
    Director of DAN Medical Services