Intended for healthcare professionals


Prophylaxis against malaria

BMJ 1999; 318 doi: (Published 24 April 1999) Cite this as: BMJ 1999;318:1139

Preventing mosquito bites is also effective

  1. David N Durrheim,, Consultant in communicable disease control.,
  2. Peter A Leggat, Associate professor.
  1. Mpumalanga Department of Health, Private Bag X11285, Nelspruit 1200, South Africa
  2. School of Public Health and Tropical Medicine, James Cook University, Townsville, Queensland 4811, Austr
  3. PO Box 2631, Knysna 6570, South Africa
  4. Headquarters Defence Secondary Care Agency, Ministry of Defence, London WC2H 8LD
  5. Institute of Occupational Health, University of Birmingham, Birmingham B15 2TT

    EDITOR—Berger's list of measures for protecting travellers against malaria is extremely useful.1 The particular emphasis on compliance with drug regimens should not, however, detract from the importance of strict adherence to effective measures for preventing contact with mosquitoes and bites. No drug is totally effective, and in areas of low transmission the risk of adverse events attributed to chemoprophylaxis may well exceed the benefit of avoided infections.2

    Although the World Health Organisation advocates protection against mosquito bites as the first line of defence against malaria, the basis for this recommendation has until recently been questionable.3 Evidence for a protective effect of insect repellants applied to the skin, air conditioners, fans, coils, vaporising mats, and long sleeved clothing has been largely speculative; use of these measures has been shown to result in decreased feeding by mosquito vectors, but direct evidence of a protective effect against malaria infection has not been gathered. Use of personal protection measures may have been compromised by widely publicised reports of encephalopathic reactions in children associated with the most widely used insect repellant, diethyltoluamide (DEET), and the nonchalance of many travellers.

    This is exemplified by the results of a postal survey of visitors to the Kruger National Park, South Africa, during the seasonal high risk …

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