Malaria Prevention Flashcards

1
Q

Malaria Prevention - Risk Assessment Components (3 parts)?

A
  1. Person - VFR, extremes of age, pregnancy, immunosuppressed, co-morbidities
  2. Place - Sub-Saharan Africa, areas of deforestation, rural vs urban, accommodation type
  3. Time - longer term travellers, seasonality
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2
Q

Malaria Prevention - Insect Repellant Options?

A
  1. DEET - reapply q6-8h, 50%, >2 mo of age, ok for preg and breastfeeding
  2. Icaridin - 20%, >6 mo of age, q4-6h
  3. IR3535 - use highest strength, >2 mo of age, q6-8h, not helpful for Anopheles
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3
Q

Malaria Prevention - Chemoprophylaxis options in Chloroquine-sensitive region?

A

1st line –> Chloroquine
2nd line –> Hydroxychloroquine

Both taken once weekly starting 1 week before travel to area, during exposure, and 4 weeks after leaving malaria-endemic region.

3rd line –> Atovaquone-proguanil, doxycycline, mefloquine

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4
Q

Malaria Prevention - Chemoprophylaxis options in Chloroquine-resistant regions?

A

Drugs of choice: Atovaquone-proguanil, doxycycline or mefloquine
2nd line: primaquine daily

-If mefloquine resistance, use either of other two

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5
Q

Malaria Prevention - Chloroquine-sensitive regions?

A

Haiti, Dominican Republic, Central America north of the Panama Canal, parts of Mexico, parts of South America, north Africa, parts of Middle East, and west/central China

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6
Q

Malaria Prevention - Chloroquine-resistant regions?

A

Most of sub-Saharan Africa, South America, Oceania and Asia

-Some mefloquine resistance in border areas of Thailand, Myanmar, Laos and Cambodia, and southern Vietnam

-Now almost worldwide however

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7
Q

Malaria Prevention - Atovaquone-proguanil chemoprophylaxis dosing?

A

Malarone
-Daily
-Start 1 day before until 7d after

Considerations: DDI, renal dosing (avoid if eGFR <30), needs fatty meal (milky drink), cannot crush
Pregnancy/BF: ok in 2nd trimester, data in 1st trimester
Side effects: neuro, GI, hair loss

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8
Q

Malaria Prevention - Doxycycline chemoprophylaxis dosing?

A

-Daily
-1 day before until 4 weeks after

Considerations: DDI
Pregnancy/BF: up until 15 wks, no BF and no for children?
Side effects: gastritis, teratogen, bones/teeth, photosensitivity

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9
Q

Malaria Prevention - Mefloquine chemoprophylaxis dosing?

A

-Weekly
-3 weeks before until 4 weeks after

Considerations: DDI, psych hx (don’t give), can crush, epilepsy issues, anticoag issues
Pregnancy/BF: ok
Side effects: neuro psych (dreams, insomnia, anxiety, depression)

-Many people discontinue due to side effects, 95% of ADRs by 3rd dose

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10
Q

Malaria Prevention - Tafenoquine chemoprophylaxis dosing?

A

-Monthly for 6 months vs weekly?
-Unclear access in Canada

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11
Q

Malaria Prevention - Pregnancy Risks?

A

-Increased risk of severe malaria
-Placental sequestration (can delay diagnosis)
-Congenital malaria (rare but more common with vivax)

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12
Q

Malaria Risks - Pregnancy Prophylaxis

A

-Chloroquine/Proguanil –> ok in all trimesters, folic acid with proguanil but resistance
-Mefloquine - all trimesters
-Doxycycline - under special circumstances <15 weeks + 4 weeks on return
-Atov/Prog - data sparse, take folic acid for duration

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13
Q

Malaria Prevention - Proph for Epilepsy?

A
  • Doxy YES
  • Atov/Prog YES
  • Chloroquine NO
  • Mefloquine NO
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14
Q

Malaria Prevention - Children Chemoproph?

A

-Mefloquine easiest - >5kg, weekly
-Atov/Prog - >5kg with milk/yogurt daily
-Doxy >12 years old

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15
Q

Malaria Prevention - Chemoproph in renal disease?

A
  • Atov/Prog - avoid if eGFR <30 (can do dose reductions if needed)
  • Mefloquine - ok in severe disease
    -Doxycycline - ok in severe disease
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16
Q

Malaria Prevention - Chemoproph in liver disease?

A
  • All drugs metabolized by liver

Severe disease:
- Doxy YES
-Malarone ??
-Mefloquine NO

Mod to mild disease:
-Can use all three

17
Q

Malaria Prevention - Chemoproph in G6PD deficiency

A

All but Primaquine ok

18
Q

Artemisinin resistant areas?

A

-Rwanda
-Uganda
-Horn of Africa

19
Q

What are the approved malaria vaccines?

A
  1. RTS,S/ASO1E - Mosquirix
    -26% reduction in severe malaria
    -30.1% reduction in first malaria episode
  2. R21/Matrix M
20
Q

What are the 5 threats to vector control for malaria?

A
  1. Vector resistance to insecticides
  2. Invasive vectors (A stephensi)
  3. Climate change
  4. Funding challenges
  5. Diminished access, use and durability of insecticidal nets
21
Q

What are 4 means of vector resistance to insecticides?

A
  1. Metabolic resistance
  2. Behavioural resistance
  3. Cuticular resistance/reduced penetration (thickened cuticle)
  4. Target site modifications (Kdr, Ace1r)
22
Q

What are 2 new means of vector control?

A
  1. Dual ITNs - nets (pyrethroids + new insecticides)
  2. New IRS insecticides (new modes of action)
    -Broflaniline WP - Vectron T500 pre-qualified by WHO
23
Q

What are the two approved methods by WHO for vector control? What are the supplemental interventions suggested?

A
  1. Long-lasting insecticidal nets
  2. Indoor residual spraying

Supplemental: larviciding + house screening