According to the Centers for Disease Control and Prevention (CDC), 1,700 cases of malaria (five of them fatal) occur each year among travelers who return to the United States after visiting areas where malaria is a problem. Divers Alert Network® (DAN®) encourages all divers to review the CDC’s guide to malaria information by country and follow the ABCDs of malaria prevention to reduce the chance of becoming infected with this deadly disease.
The ABCDs of Malaria Prevention
Malaria occurs in more than 100 countries and territories worldwide, including many of the top scuba diving destinations in Southern Africa, Central and South America, Southeast Asia, the Middle East and many parts of Oceania.
None of the antimalarial drugs offer 100 percent protection against malaria.
This means the use of drugs to prevent disease. Talk to your doctor about the most appropriate drug based on your destination and personal medical history, and follow the recommended dosage exactly. Many antimalarial medications must be taken before travel, during the trip and after returning home to protect the body against infection.
Symptoms of malaria include fever, flu-like illness, chills, muscle aches, headache, nausea, vomiting and/or diarrhea. Malaria symptoms typically don’t appear until at least seven days after infection and may take up to a year to manifest.
How to Assess Your Risk
The risk for malaria in some countries can vary seasonally or be distributed unevenly. Refer to the CDC’s malaria information by country table, and contact a local dive center for advice. If in doubt, opt for the extra protection of chemoprophylaxis.
Choosing an Antimalarial Drug
Speak with a physician about your travel plans as soon as possible to determine which antimalarial is the best choice for you. Always acquire antimalarials in your home country before traveling overseas. Antimalarials purchased overseas may not be effective and can be difficult to obtain.
Some antimalarial drugs must be started a week or more prior to departure. In the case of mefloquine, a doctor may recommend trying the drug several weeks prior to travel to assess potential side effects.
Anti-Malaria Medication and Diving
No clinical data exists on scuba diving while taking antimalarial drugs. The side effects of mefloquine (sold under the brand name Lariam) may mimic symptoms of decompression illness and may cause an adverse reaction in people with certain psychiatric conditions. Consult with your doctor and dive operator regarding the use of mefloquine/Lariam.
Bite Prevention is Critical, Even When Taking Antimalarials
To prevent mosquito bites:
- Stay indoors or in well-screened areas.
- Avoid going outside during dusk and dawn when mosquitoes are most active.
- When outdoors, wear clothes that cover most of the body, and use insect repellent containing 30-35 percent DEET.
When using DEET, be careful not to spray the product into wounds or on broken skin. Use the DEET only when outdoors, and wash the product off your skin when you return to a mosquito-free area. Do not inhale or swallow DEET or allow it to get into your eyes. Finally, take care what you touch immediately following application as DEET can melt plastic and synthetic fibers.Travelers who may be exposed to mosquitoes while sleeping should use a pyrethroid-containing flying-insect spray in living and sleeping areas during evening and nighttime hours and sleep under mosquito netting treated with Permethrin in over-the-counter strengths of 1-5 percent. Use sprays with care, and follow manufacturer instructions.
Malaria is a serious health risk in some of the world’s best diving destinations. DAN urges all divers to assess their risk and take appropriate preventative measures. Tourists traveling to places where malaria is endemic without taking antimalarials have died of the disease.