No one’s safe from malaria, but help is on the way
By Dan Oko
So there you are in your five-star Costa Rican treetop resort penthouse, enjoying a rum and something as the sun sets, when an itchy welt on your forearm alerts you that a mosquito has been sucking your blood. You scratch a bit and forget it. A week later, as the fever, headache, chills, and vomiting set in, you realize you’ve probably been infected with one of the most deadly—and democratic—diseases on earth:malaria.
In the United States, malaria was virtually wiped out some 50 years ago, but the global burden remains massive. Malaria is endemic to more than 100 countries, and everyone is subject to the bug. It doesn’t matter whether you’re sleeping under a tarp in the rainforest or paying a grand per night for an air-conditioned suite: One bite and you could be part of a worldwide epidemic. Without treatment, malaria is often fatal. Tropical regions from Southeast Asia to the Caribbean are prime breeding grounds,while sub-Saharan Africa, where the disease claims the lives of about 3,000 children daily, is the world’s hardest-hit area.
One of the difficulties in battling the disease has been the frightening increase in drug-resistant strains of malaria. Chloroquine, once the standard for malaria prevention, is now useless in many parts of the world. Because emerging strains can’t be treated with more conventional medicines, safe travel in certain malarial zones now requires taking the controversial prophylactic Lariam. Lariam can have severe side effects like hallucinations and other psychological dysfunction, and—as with all antimalarial drugs—it isn’t effective against every strain of the disease.
A guide to picking
the right antimalarial prophylactic
The
rules for avoiding malaria are deceptively simple: Prevent mosquito
bites, and avoid the disease. So it’s best to stay in
air-conditioned hotels to lower the chance of being bitten at night,
and wear long sleeves and pants to cover your skin. In the tropics,
that’s ...
It’s not all bad news, though. Public awareness is on the rise, and according to the New York–based non-profit Malaria No More, funding for prevention, education, and medicines has increased 300 percent in the past three years,with total global spending now approaching $2 billion a year (more than half from the Bill & Melinda Gates Foundation). Mosquito-net initiatives like the Nothing But Nets campaign, led by the NBA, and various government-sponsored efforts have driven developments. In January, Dr. Arata Kochi, director of the global malaria program at the World Health Organization, announced that the distribution of more than 20million insecticide-treated bed nets and a new wormwood-based Chinese medicine called artemisinin has sharply reduced malaria fatalities in trial areas. In Rwanda, deaths dropped by 60 percent in just two months.“If this is done everywhere,” Dr. Kochi told The New York Times, “we can reduce the disease burden 80 to 85 percent inmost African countries within five years.”
There’s also development on the vaccine front, led by pharmaceuticals giant Glaxo Smith Kline. In data released last fall, the company’s experimental drug was shown to be 65 percent effective in protecting infants in Mozambique. And Sanaria, a new company headed by former Navy captain Dr. Stephen Hoffman, is poised to start its own vaccine trials. All of this has given malaria specialists, such as Dr. Christian Loucq, director of the PATH Malaria Vaccine Initiative, plenty of hope. “We have never been so close to getting a vaccine,” he says. If research-and-development funds remain steady, Dr. Loucq says, a vaccine could be available as early as 2013. And while local populations would see the most immediate benefit, such vaccines could do more than simply control regional cases. “Although we don’t have a timeline,” says Dr. Loucq, “travelers could see a huge benefit.”
Travelers from North America, where malaria was eradicated some 50 years ago, lack natural defenses against the disease. In the last 20 years,more than 70 Americans have died from malaria after trips out of the U.S. And doctors diagnose some 1,500 cases annually. “People should educate themselves about the disease before they go,” says CDC malaria expert Dr. Larry Stutsker. Presenting a traveler’s guide to malaria hot spots around the globe.
Americas
Global cases: 3 percent/less than 1 percent of deaths Dominant strains: P. vivax, P. falciparum, P.malariae Threat: Rates have stabilized or diminished in the Americas (in Mexico, for example, reported cases have fallen by 97 percent in the last 20 years). But there are still risk zones, like Brazil and Haiti.
Africa
Global cases: 59 percent/89 percent of deaths Dominant strain: P. falciparum Threat:More than one million people die from malaria each year,with falciparum—the disease’s deadliest form—killing one child every 30 seconds. In Tanzania, which tallies the most deaths in Africa, the risk is year-round.
Asia
Global cases: 38 percent/10 percent of deaths Dominant strains: P. vivax, P. falciparum Threat: Take special care on trips to rural areas—both jungle safaris and trips to rice-paddy villages. But in India,where 95 percent of the population lives in risk zones, you can even contract malaria in big cities like New Delhi and Bombay.
So there you are in your five-star Costa Rican treetop resort penthouse, enjoying a rum and something as the sun sets, when an itchy welt on your forearm alerts you that a mosquito has been sucking your blood. You scratch a bit and forget it. A week later, as the fever, headache, chills, and vomiting set in, you realize you’ve probably been infected with one of the most deadly—and democratic—diseases on earth:malaria.
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