by Buck Tilton

Malaria is the greatest health risk to US travelers to any region where the disease exists. Once thought to result from breathing "swamp gas," the moist fumes rising from wet areas, malaria literally means "bad air." But all four species of the parasite that cause the disease get into human blood only from the bite of the female Anopheles mosquito.

Every traveler's "ounce of prevention" should include common-sense practices to help avoid mosquito bites.

Some of the most practical suggestions are:

• Clothing thick enough to prevent 'skeeter nose penetration.
• Insecticide, e.g., permethrin, on clothes; repellents containing a minimum 12 percent and a maximum 35 percent N, N-diethyl-meta-toluamide (a.k.a. N, N-diethyl-3-methylbenzamide)--better knows as DEET--on exposed skin (and note: DEET should be washed off skin as soon as exposure to mosquitoes has ended).
• Netting to sleep under.
• Avoidance of Anopheles mosquito during prime time--they are primarily dusk and nocturnal feeders.
  

Practical prevention, unfortunately, seldom meets all of a traveler's prevention needs, and accidental exposure to an infected mosquito is virtually guaranteed in high risk areas.

So, to be as safe as possible, you'll have to resort to chemical prophylaxis. The drug of choice for prevention of malaria has long been chloroquine (and it still is in many regions of the world), but some parasites have developed a resistance to it.

In March, 1990, the Centers for Disease Control (CDC) made mefloquine (often sold as Lariam) the officially approved drug in chloroquine-resistant areas. The recommended dose of mefloquine is one 250 mg tablet once per week for four weeks starting one week prior to entering the malaria zone. After four weeks, one 250 mg tablet should be taken every two weeks for the duration of your visit, and for two more doses (four weeks) after returning home. Consult your physician before planning to take any drug. Although normal side-effects with short-term use of mefloquine are minimal, some people--people with high blood pressure or heart problems--should take the drug only under careful physician supervision. Controversy exists concerning the use of mefloquine by children and pregnant women, as well as long-term use of the drug. Once again, consult your physician.

© 1999 Buck Tilton; All Rights Reserved