Malaria: The holiday bug with a lethal sting
The most deadly form of malaria is on the rise among travellers – yet all too many are failing to take the steps that could prevent it. City worker Andrew Wylde tells Rob Sharp his own cautionary tale
Tuesday 07 July 2009
Filling up your back-pack for a trip to Western Africa, you try to pack in all the precautions necessary to stave off a whole gamut of freakish events, from rock falls to asteroid strikes. Mini-first-aid-kit? Check. Imodium? Check. Factor 30 suncream? Check. Malarone? Check. So imagine your horror when you return to the UK, a month later, carrying a disease that is one of the most widespread killers on the planet. Talk about bad luck.
Malaria claims the lives of a million people worldwide every year – and many of these people have the means to prevent it. In the UK, around 2,000 people return from abroad with the disease annually; between 10 and 12 of these cases die. Often these are travellers who have not been as vigilant as they should be. According to the travel website Gapyear.com, a third of gap year travellers do not take antimalarials, and around 41 per cent do not sleep under a mosquito net, despite travelling to an area where the disease is prevalent. According to Malaria Hotspots, a travel advice website set up by pharmaceutical company GlaxoSmithKline, there has been a 190 per cent increase in travel to malarious destinations such as Africa and India over the past 10 years. In addition, the most severe form of malaria (Plasmodium falciparum) is on the increase among British travellers. At this time of year, when students are gearing up for their years abroad, parents should take note.
One man who knows just how real is the risk of malaria is Andrew Wylde, a 24-year-old investment banker working for CitiGroup in London's Canary Wharf. He contracted malaria twice when travelling in the Upper West region of Ghana, and at one point doctors told him he'd been just 12 hours away from dying. He now believes it's down to the fact that he did not take his anti-malarial, Lariam, as religiously as he should have. He suffered from a temperature of over 40 degrees and was unable to move or leave his bed for two weeks. He also lost a dangerous amount of weight.
While Wylde took Lariam, there are various anti-malarial pills which are available over the counter. Chloroquine and Paludrine are generally taken together, but are losing their efficacy in Africa. On prescription, Lariam varies in effectiveness, though might not work with children and can cause hallucinations. Doxycycline and Malarone can cause sunburn but are more effective. However, it must be stressed that these are all preventative measures rather than vaccines.
Wylde says the problems started when he took a break from his volunteer work with a British charity linked to a series of Jesuit missions that were supplying teaching work to rural schools, in Wa, in the northwest part of the country. "We played football every day at about six o'clock and that's when the mozzies would come out," he says. "And one night I stayed out there a bit later, until around seven o'clock, and didn't think anything of it. But I came back with a lot of bites."
Three or four days after this onslaught he began to get sweats, diarrhoea and aches. Ignoring it to begin with, a few days later he says he was finishing a beer when the full extent of the illness hit him like a rocket. "I just started to sweat so hard my head began pounding. I returned to the house I was staying in to discover that my temperature was soaring. I felt alright about it but my mate was freaking out because he knew how serious it could be. But I wasn't really with it, being pretty blasé. I went to the hospital and they diagnosed me pretty immediately with malaria. I remember them indicating to me that it was in the latter stages. Up until that point I thought it was something dodgy I'd eaten and the heat, I think."
He was put on a drip. "They wanted to rehydrate me as soon as possible, and filled me with drugs. I lost loads of weight. I didn't tell my parents at the time; I waited until I was better two or three weeks later and they obviously freaked out. I think everyone does."
Only one month later, he contracted the disease again. "I'm not sure how I got it that time," he says. "We had a huge mango tree outside our house so a lot of mosquitoes would go into the shade of it during the day. I used to spend time there listening to the World Service." When he got ill this time he went straight to a doctor, and it only took him a week to recover. "This time I realised something was up almost straight away and went to a medic more or less immediately. I wanted them to sort it out as soon as possible, naturally."
At this point he first noticed the disparity in the way the Westerners and the locals were treated. "I knew a couple of the kids in the school I was working in who died from malaria and that was such a tragic experience," he says. "Obviously you are going to get ill when you're poorer because you might not have the diet. I was lucky enough to have a hospital very close to where I was staying but it can take about 20 hours to get to somewhere suitable in some of the rural areas when people are travelling on foot. I mean, the second time I got malaria I went to one of the best doctors in the region. I even went to his house, where there were pictures of him shaking hands with the Pope and Bill Clinton. I doubt most people would have had that opportunity."
Sometimes malaria in Westerners is not remedied so easily. Jo Yirrell, who now works as a campaigner for malaria awareness, lost her 20-year-old son Harry to malaria in 2005. He had gone travelling in western Ghana only to contract the disease; he returned after four months and died in hospital. Yirrell retraced his steps in a BBC News documentary Our World: Malaria, broadcast last month. "Harry had not completed his full course of medication," she now says. "And didn't sleep under a mosquito net. He thought it was something that wouldn't happen to people like him."
Kate Humble, the wildlife presenter and science journalist, contracted cerebral malaria while on holiday in Zanzibar. "I am extremely lucky. I didn't take malarial pills. When I got home I started feeling really ill. I assumed I had flu. Horrible feelings. I spent a week in hospital, with two blood tests every day. I took a drug to kill the infection; it made my ears ring. The whole experience was absolutely miserable. No one likes being in hospital. Idiotically, I did it again when I went back to Ghana ... I thought I'd be fine and I got it again and I had another miserable week in hospital. I got a lot of flak from the doctors and nurses who said I should have known better. They were right. I could have died."
Despite all the scare stories, it is unlikely to stop twentysomethings from venturing into the unknown. "It won't stop me travelling," says Wylde. "I'll go anywhere and try anything. When it comes to malaria, chances are you're going to be bitten by something. Even then, you should be wary about assuming tablets are a vaccine rather than a preventative measure. If you get bitten by 10 mosquitoes in a night and one of them has malaria the drug will probably do its job. But if you get bitten by 40, and half of them are carrying it, then you might not be so lucky."
How to avoid malaria
* Don't transfer anti-malarial tablets from one country to the next because mosquitoes are becomingly increasingly resistant to prescription drugs. In West Africa chloroquine has been found to be virtually ineffective in certain areas as has Lariam in South East Asia, so it's always important to get a new prescription for each country you're travelling to.
* Make sure you follow the instructions on your anti-malarial pills because you often need to take them up to a week before you travel. You should start taking mefloquine (Lariam) two to three weeks before, doxycycline and Malarone one to two days before travel and start all other anti-malarial medicine one week before travel.
* Malaria drugs may seem expensive but they're absolutely essential to prevent catching the disease. Shop around for the best price – online pharmacists often do a good deal. You have to post your prescription first and fill out some forms, but you can make huge savings.
* Hook a mosquito net over your bed whilst you're away on your trip. They're now super-lightweight and pack down small and are essential for countries like India and Africa. Go for one with a Permethrin-impregnated mesh – which will stop even the tiniest of mosquitoes from crawling through the holes.
* Apply a mosquito repellant to any areas that your clothing doesn't cover – particularly your hands, neck and feet. Look for repellants that contain diethyltoluamide (Deet), a powerful anti-malarial chemical. Brands which contain 20 per cent Deet are safe to use for children, those which contain 50 per cent Deet are safe for adults, and 100 per cent products should only be used on clothes.
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