1.

Myth:

Malaria is not a serious infection for healthy people.

Fact:

Malaria is a major killer worldwide and is the principal life-threatening infectious disease that Canadian travellers face when travelling to high-risk areas of the world. In recent years there has been a dramatic increase in malaria cases in Canadian travellers, including several deaths.

2.

Myth:

All travellers to the developing world need malaria prophylaxis.

Fact:

Many destinations in the developing world are either free of malaria or the risk is so low that malaria prophylaxis is not needed. Furthermore, some travellers to countries with known malaria risk may not need to take malaria prophylaxis because malaria transmission is often confined to particular areas of a country (usually rural) and may be seasonal. For example, most individuals travelling only to urban centres or resort areas in Central and South America or Southeast Asia do not require malaria prophylaxis. However, ALL travellers (adults and children) to any area with any risk of malaria should use personal protection measures, such as treated mosquito nets and insect repellents, to avoid mosquito bites.

3.

Myth:

Pregnant women, babies and children should not receive malaria prophylaxis.

Fact:

On the contrary, pregnant women, babies and small children are at particular risk for serious malaria; if they must go to high-risk areas they should take malaria prophylaxis. Several effective prophylaxis regimens are known to be safe in these groups.

4.

Myth:

Most people who take mefloquine have serious side effects.

Fact:

For travellers to high-risk areas, the risk of acquiring malaria and dying is significantly greater than the risk of experiencing a serious side effect from mefloquine. Over 11 million travellers have used mefloquine prophylaxis, and severe reactions (seizure, psychosis) to this drug are rare (reported from 1 in 10,000 to 1 in 13,000 users). The great majority of mefloquine users (95-99%) have either no side effects or only mild and temporary ones. Occasionally, a traveller will experience a less severe but still troublesome neuropsychological reaction (e.g. anxiety, mood change) to mefloquine (1 in 250 to 500 users) requiring a change to an alternative drug. These reactions are almost always reversible. Death from malaria, however, is not.

5.

Myth:

Drugs that are safer than mefloquine are available either in Canada or abroad.

Fact:

For high-risk regions of the world, mefloquine is the most effective drug to prevent malaria. Alternatives typically offered to travellers to Africa (e.g. chloroquine, proguanil [Paludrine^®], amodiaquine, pyrimethamine [Daraprim^®], pyrimethamine plus sulfadoxine [Fansidar^®], pyrimethamine plus dapsone [Maloprim^®]) are significantly less effective and often more toxic than mefloquine. Doxycycline is an effective alternative but may occasionally have troublesome side effects and must be taken each and every day in order to prevent malaria.

6.

Myth:

If I take prophylaxis, the malaria I get will be more resistant to treatment.

Fact:

The prevention of malaria in travellers using prophylactic drugs (including mefloquine) does not promote the development of resistant malaria parasites. Appropriately used prophylaxis can actually reduce resistance by lowering the burden of malaria disease.

7.

Myth:

There is only a limited period in which one can take prophylaxis safely.

Fact:

There is no absolute time limit on how long one can take any antimalarial prophylactic drug. The small number of individuals who will experience significant side effects from antimalarial drugs usually do so within the first few weeks of use. Many mild side effects decrease with continued use of prophylaxis.

8.

Myth:

Some malaria cannot be treated.

Fact:

If identified early and treated appropriately, almost all malaria can be completely cured. However, even short delays in the diagnosis of malaria can make treatment more difficult and less successful.

9.

Myth:

Once infected with malaria, you are infected for life.

Fact:

Appropriate treatment and follow-up can ensure complete cure of malaria.

10.

Myth:

Individuals born and raised in a malarial country are immune for life.

Fact:

Over time, individuals raised in areas where malaria is common either die from the disease or become partially immune to its most serious manifestations. However, this immunity is short lived once an individual leaves a malarious area. Although avoidance of mosquito bites is important for protection (e.g. appropriate clothing, screens and mosquito nets, repellents), anti-malarial prophylactic drugs are essential for optimal protection in most settings. Any individual who has travelled to malarial areas and subsequently develops fever should urgently seek medical advice (even if the fever appears many months after returning to Canada) and request blood films to rule out malaria.