Compare the guidelines for malaria prevention for travellers

from Indonesia & Australia going to malaria prone areas.

Rebhung, Yudith M.; Bani, Vebry O. M.; Suriasa, Deodatus Th

Background of Malaria:
Malaria is an entirely preventable and treatable mosquito-borne illness. In
2014, 97 countries and territories had ongoing malaria transmission.(1) Malaria
remains an important cause of illness and death in children and adults in countries in
which it is endemic. Malaria control requires an intergrated approach, including
prevention (primary vector control) and prompt treatment with effective antimalarial
agents.(2)
Malaria is a serious febrile illness due to infection of red blood cells with a
parasite called Plasmodium. It is transmitted by mosquitoes. Five species of
Plasmodium that can infect humans are Plasmodium falciparum, Plasmodium vivax,
Plasmodium ovale, Plasmodium malariae, and Plasmodium knowlesi.(3)
Figure 1. Proportion of cases due to P. Falciparum and P. Vivax.

An estimated 3.3 billion people are at risk of malaria, of whom 1.2 billion are
at high risk. In high-risk areas, more than one malaria case occurs per 1000
population. There were an estimated 198 million cases of malaria worldwide (range
124283 million) in 2013, and an estimated 584 000 deaths (range 367 000755 000).
90% of all malaria deaths occur in Africa.
Malaria is spread by the bite of female Anopheles mosquito. Thedisease can
cause fever, chills, andflu-like illness. If it is not treated, itmay cause severe
complicationsand death.(4) The incidence of malaria in the Indonesian population in

2013 was 1.9 % decreased compared to 2007 (2.9%), but in West Papua show a sharp
increase in the number of malaria patients (Figure 2).
Figure 2. Case of malaria, depends on province in Indonesia at 2007 and 2013

The prevalence of malaria in 2013 was 6.0 percent. Five provinces with the
highest incidence and prevalence are Papua (9.8% and 28.6%), East Nusa Tenggara
(6.8% and 23.3%), West Papua (6.7% and 19.4%), Central Sulawesi (5.1% and
12.5%) and Maluku (3.8% and 10.7%) (Table 1). From 33 provinces in Indonesia, 15
provinces have malaria prevalence above the national average, mostly in eastern
Indonesia. Provinces in Java-Bali is an area with malaria prevalence is lower than
other provinces.
Table 1. Incidents and Prevention of Malaria Depends on Province of
Indonesia in 2013

Methods:

Health databases such as PubMed and government guidelines and information

on current practices from both Australia and Indonesia were searched. Information
found was reviewed and comparisons were made between the two countries. Research
was also obtained from book, databases, journal articles and online resources.
Outcomes:
There are 2 way for prevention. Non-Pharmaco prevention and Chemoprevention.
Non-pharmaco prevention should be done to prevent human from mosquitos bite:
1. Sleep under mosquito net; better using impregnated one (soaked in mild
pestiside solutions, pemethrin or deltamethrin).
2. apply mosquito repellents: aplly on to skin surface, spray, smoke or electric.
3. Avoid out door activities where we are exposed to mosquitoes, or protect
ourself from mosquitoes using special sweeter which cover all hands and
stocking from mosquitoes during outdoor activities. Mosquitoes are active
between 18:00 and 06:00 in spaces under 2000 meters above sea level.
4. Protect rooms using mosquito mesh of certain sizes.(5)
Chemoprevention is the use of antimalarial medicines for prophylaxis and for
preventive treatment.(2)Chemoprophylaxis is addressed to people who travel to
malaria-endemic areas in the short time, such as tourists, researchers, forestry officials
and others.(6)
Malaria may be prevented by taking drugs that inhibit liver-stage (preerythrotic) development (causal prophylaxis) or drugs that kill asexual blood stages
(supresive prophylaxis).Keep in mind to consider the sensitivity of plasmodium when
using chemophylaxis. Plasmodium falciparum virulence species is high then
chemoprophylaxis is primarily aimed at this spesie infection. In connection with
reports of high plasmodium resistance to chloroquine, it is no longer used chloroquine
as chemoprophylaxis, therefore doxycycline be an option for chemoprophylaxis.
Doxycycline taken one day before departure at a dose of 2 mg / kg per day
for no more than 12 weeks. Doxycycline should not be given to children aged <8
years and pregnant women.(6) Because, it has teratogenic effect for pregnant women
and has the side effect like,growth retardation ofbone in the fetus, cause discoloration
and dysplasia in teeth.(7)If the trip cant beavoid , its important to doprevention in
pregnant women.
All pregnant women who will travel to the endemic area should be given
education how toprotect herself from mosquito bites (Non-Pharmaco prevention).
Besides, Chemoprevention is important although it can not beprovide absolute
protection. Chemoprophylaxis is important for pregnant women because it may
decreaseparasitaemia , prevent complications of severe malaria and increase weightof
the baby's. We can use antimalarial drugs for pregnant women such as :
1. Chloroquine
can be used in all periode of pregnancy. The use of drugs started 1week before
traveling, during inendemic area , up to 4 weeksafter go out from the endemic
area. The side effect of this drug ismild vertigo , gastrointestinal
disorders,itching , blurred vision , andurticaria . However , These drugs are
notrecommended as chemoprophylaxisprimary because some andemic
arearesistant to chloroquine .
2. Mefloquine

Mefloquine is a recommended drug in the second trimesterand the third

trimester that can be used when the endemic area has beenresistantto
chloroquine. some research said that the usemefloquine onfirst trimesternot
cause abortion andmalformations in the fetus. The use of drugs started1-2
weeks before departure,during in endemic areas, continueduntil 4 weeks after
returning fromtraveling. Minor side effects andof this drug is
headaches,syncope, and gastrointestinal disorders.
3. Atavaquone and Proguanil ( Malarone )
Some research said that the use of MalaroneIn all trimesters of pregnancy is
notshow teratogenic effects.This medicine is used toareas that are resistant
toMefloquine such as Southeast Asia andAfrica. The advantages of using this
drugsis the time required moreeasy which we consume 1-2 days
beforedeparture and continued until 7days after traveling.The negatif effect of
this drug is the drugs are expensiveand contraindicated for patientswith renal
impairment .
Besides, some research said that we cant give doksisiklin for children aged <8 years
old who want travel to endemic area, because doksisklin can make decolorization of
teeth. But some research said that the decolorization of teeth can dissapear with
clearance abrasive and brush your teeth regularly.(8)

Conclusions:

References:

1.

Fact Sheet on The World Malaria Report 2014 [Internet]. WHO. 2015.
Available from:
http//:www.who.int/malaria/media/world_malaria_report_2014/en/

2.

World Health Organization. GUIDELINES FOR THE TREATMENT OF

MALARIA [Internet]. 3rd ed. Guidelines For The Treatment of Malaria.
Avenue Appia: World Health Organization; 2015. 71-88 p. Available from:
http://apps.who.int/iris/bitstream/10665/162441/1/9789241549127_eng.pdf

3.

Guidelines for Malaria prevention in travellers from the UK. England: Public
Health England; 2015.

4.

CDC and Malaria [Internet]. Atlanta; 2014. Available from:

http://www.cdc.gov/malaria/resources/pdf/fsp/cdc_malaria_program.pdf

5.

Sudoyo AW, Setyohadi B, Alwi I, Setiati S. Buku Ajar Ilmu Penyakit Dalam.
Jakarta: EGC; 2009.

6.

Pedoman Penatalaksanaan Kasus Malaria di Indonesia [Internet]. Jakarta:

Kementerian Kesehatan Republik Indonesia; 2008. p. 137. Available from:
http://www.pppl.depkes.go.id/_asset/_download/Pedoman_Penatalaksana_Kas
us_Malaria_di_Indonesia.pdf

7.

Sugita KSL, Wande IN. Peranan Kedokteran Wisata Dalam Upaya Pencegahan
dan Penatalaksanaan Malaria Pada Kehamilan. 2013;102.

8.

Wangi YS, Sumardika IW. Doksisiklin Sebagai Kemoprofilaksis Malaria Untuk

Wisatawan. CDK-229. 2015;42:465.