Malaria Prevention

Question 1

What should be applied on the skin before outdoor activities?

Answer 1

DEET
30% - ok for children as young as 2 months and up.

Question 2

how long is 30% DEET effective for?

Answer 2

4 to 6 hrs

Question 3

how long is 15% DEET effective for?

Answer 3

5 hrs

Question 4

how long is 10% DEET effective for?

Answer 4

3 hrs

Question 5

how long is 5% DEET effective for?

Answer 5

2 hrs - safe in 6 months to 2 yrs old

Question 7

What are the risks of ingesting DEET?

Answer 7

can lead to seizure, hypotension, angioedema and death

Question 8

should DEET be applied before or after sunscreen?

Answer 8

AFTER. This would allow sunscreen to penetrate well.

Question 9

What are the pathogens in MALARIA?

Answer 9

P. falciparum
P. vivax
P. ovale

Question 10

Which antimalarial is contraindicated in seizure, psychosis, depression and anxiety?

Answer 10

mefloquine

Question 11

How is mefloquine taken?

Answer 11

Start 1-2 weeks before patient leaves, then once a week during the trip, then for 4 weeks after the trip.

Question 12

Which antimalarials are safe in pregnancy?

Answer 12

Chloroquine ( in chloroquine-sensitive areas), but in resistant areas, mefloquine is safer after the 1st trimester of pregnancy, can be used in children < 5 years old

Question 13

In mefloquine-resistant areas, what are the safe chemoprophylaxis agents in pregnant women?

Answer 13

None.
only chloroquine is safe in pregnancy.

Question 14

What side effects of mefloquine would require discontinuation?

Answer 14

Severe: seizures, psychosis (early on).

Less severe: anxiety, depression, irritability, nightmares. more common in women especially.

Question 15

What are the neurological warnings of Mefloquine?

Answer 15

dizziness, loss of balance, tinnitus (can become permanent)

Question 16

What are the side effects of Chloroquine?

Answer 16

bitter taste, omiting, headache

Less common: hair pigmentation, skin eruptions, myopathy, reversible corneal opacity, partial alopecia, blood dyscrasias, nail/mucous discoloration, photophobia, retinopathy, myopathy

Question 17

How is chloroquine and hydroxychloroquine started?

Answer 17

Start 1-2 weeks before traveling, continue until 4 weeks after leaving the country.

Question 18

What medical condition requires you to AVOID chloroquine?

Answer 18

seizure and epilepsy

Question 19

when to start primaquine?

Answer 19

prophylaxis: start 1-2 days before travel, continue daily in region, and continue for 7 days after leaving the area.

Question 20

when to start atovaquone/proguanil prophylaxis?

Answer 20

start 1-2 days before travel, continue daily while in region, and for 7 days after leaving the area.