Malaria

Malaria, also known as “Paludismo,” is a potentially life-threatening mosquito-borne disease caused by parasites of the genus Plasmodium. People with malaria commonly experience fever, chills, headache, fatigue and flu-like symptoms. If not diagnosed and treated promptly, malaria can lead to severe illness, organ failure, and death. According to the World Health Organization (WHO) World Malaria Report 2025, an estimated 282 million malaria cases and approximately 610,000 deaths occurred worldwide in 2024. Approximately 95% of malaria-related deaths occurred in the WHO African Region, with the greatest impact on young children

Individuals at Highest Risk

Certain groups are at increased risk of severe malaria and its complications, including:

• Children under five years of age
• Pregnant women
• Women and girls in endemic regions
• Migrants and displaced populations
• People with disabilities
• Indigenous populations
• Individuals living in remote areas with limited  access to healthcare

Pregnant women are particularly vulnerable because malaria increases the risk of maternal anemia, miscarriage, stillbirth and low birthweight infants.

About Mosquitoes and Malaria

There are approximately 3,500 mosquito species worldwide, grouped into 41 genera. Human malaria is transmitted only by female mosquitoes of the genus Anopheles.

Although there are more than 430 recognized Anopheles species, only about 30 to 40 are important malaria vectors under natural conditions. The remaining species either  bite humans infrequently or cannot effectively transmit malaria parasites.

Geographic Distribution

Anopheles mosquitoes are found worldwide except Antarctica. Different species transmit malaria in different geographic regions and environments.

Even in countries where malaria has been eliminated, malaria-transmitting mosquitoes may still be present, creating a risk of reintroduction if infected travelers or migrants introduce the parasite.

Over 95% of the global malaria burden occurs in Africa. Countries accounting for a substantial proportion of malaria cases include:

• Nigeria
• Democratic Republic of the Congo
• Uganda
• Mozambique
• Angola
• Burkina Faso

Malaria also remains endemic in parts of Asia, Oceania, Central America, South America and selected Caribbean locations.

Mode of Transmission

Most people become infected when bitten by an infected female Anopheles mosquito.

The mosquito becomes infected after feeding on a person carrying malaria parasites. Following replication within the mosquito, the parasites can then be transmitted to another person through subsequent bites.

Symptoms generally develop seven to 30 days after infection, although incubation periods may vary depending on the species involved and whether malaria prophylaxis has been taken.

In rare cases, malaria may also be transmitted through:

• Blood transfusion
• Organ transplantation
• Shared needles
• Mother-to-child transmission during pregnancy or childbirth

Symptoms

Despite the effectiveness of modern preventive measures, no intervention provides 100% protection against malaria.

Travelers who develop symptoms during travel or after returning from a malaria-endemic area should seek immediate medical attention and contact their travel assistance provider.

Early Symptoms

Initial symptoms are often non-specific and may include:

• Fever
• Chills
• Sweating
• Headache
• Fatigue
• General malaise
• Muscle and joint pain
• Rapid heart rate
• Nausea and vomiting
• Abdominal pain
• Diarrhea
• Cough

Classic Malaria Attack

Although not commonly observed today, a classical  malaria episode may involve:

Cold Stage

• Sensation of cold
• Shivering and rigors

Hot Stage

• High fever
• Headache
• Vomiting
• Seizures (particularly in children)

Sweating Stage

• Profuse sweating
• Falling temperature
• Extreme tiredness

Diagnosis requires laboratory testing of a blood sample.

Health Advice for Travelers

Risk Assessment

Malaria risk varies significantly according to:

• Destination
• Season of travel
• Duration of stay
• Accommodation type
• Planned activities
• Access to healthcare

For example, business travelers staying in air-conditioned hotels may be at lower risk than backpackers, humanitarian workers, military personnel, outdoor enthusiasts or travelers visiting friends and relatives.

Since malaria-transmitting mosquitoes are most active between dusk and dawn, risk increases when travelers spend evenings outdoors for dining, entertainment, work activities or recreation.

Mosquito Avoidance Measures

Reducing mosquito bites is one of the most effective strategies for malaria prevention.

Travelers should:

• Stay in air-conditioned or well-screened accommodation.
• Sleep under insecticide-treated mosquito nets  where appropriate.
• Use insecticide sprays or vaporizer systems in  sleeping areas.
• Wear long-sleeved shirts, long trousers, and  clothing that covers exposed skin, particularly during evening and night-time hours.

Insect Repellents

All travelers should use an effective insect repellent containing:

• DEET
• Picaridin (Icaridin)
• IR3535
• Oil of lemon eucalyptus (where recommended)

Repellent should be applied to exposed skin whenever mosquitoes are likely to be present.

If sunscreen is also used:

1. Apply sunscreen first.
2. Apply insect repellent second.

Permethrin-treated clothing and bed nets may provide additional protection.

Preventive Medication (Chemoprophylaxis)

No antimalarial medication is completely protective and must always be combined with mosquito avoidance measures.

Recommendations vary according to destination, malaria species, resistance patterns, medical history, age, pregnancy status, and personal preference.

Travelers should consult a travel medicine specialist  before departure to determine the most appropriate preventive regimen.

Commonly Used Antimalarial Medications

Atovaquone/Proguanil (Malarone).

Adult dose:  One adult tablet daily.

Advantages:

• Suitable for last-minute travel
• Started one-two days before travel
• Continued for only seven days after leaving a  malaria area
• Generally well tolerated

Limitations:

• Cannot be used during pregnancy in most circumstances
• Not suitable for breastfeeding mothers of infants weighing less than 11 pounds / 5 kilograms
• Contraindicated in severe renal impairment

Doxycycline.

Adult dose: 100 mg daily.

Advantages:

• Suitable for last-minute travelers
• Started one-two days before travel
• Cost-effective

Limitations:

• May cause sun sensitivity
• Cannot be used during pregnancy
• Not suitable for children under eight years of age

Mefloquine

Advantages:

• Weekly dosing
• Suitable for long-term travel
• May be used in some pregnant travelers following specialist assessment

Limitations:

• Not suitable for individuals with certain psychiatric conditions, seizure disorders, or specific cardiac conditions
• Must be started several weeks before travel

Tafenoquine (Arakoda)

Advantages:

• Weekly dosing after an initial loading schedule
• Effective against multiple malaria species

Limitations:

• Requires quantitative G6PD testing before use
• Not suitable during pregnancy
• Contraindicated in individuals with G6PD deficiency
• Not suitable for individuals with a history of certain psychotic disorders

Chloroquine

Advantages:

• Weekly dosing
• Useful in limited areas where malaria parasites remain chloroquine-sensitive

Limitations:

• Chloroquine resistance is widespread globally
• Only appropriate for specific destinations where susceptibility remains

Malaria Vaccines

WHO-recommended malaria vaccines are now being deployed in several African countries as part of childhood immunization programs. These vaccines have demonstrated important benefits in reducing severe malaria and child deaths in endemic regions. However, current malaria vaccines are not a replacement for mosquito precautions or antimalarial prophylaxis in international travelers.

After Travel

Travelers should seek urgent medical attention if they develop (during travel or recent return from malaria-endemic areas):

• Fever
• Chills
• Flu-like symptoms
• Unexplained illness

Malaria can occur weeks, months, and in some cases longer after exposure, depending on the malaria species involved. Healthcare providers should always be informed about recent travel history.

References

1. World Health Organization, World Malaria Report 2025
2. World Health Organization, Global Malaria Programme
3. U.S. Centers for Disease Control and Prevention (CDC), Malaria - CDC Yellow Book 2026
4. CDC, Choosing a Drug to Prevent Malaria
5. CDC, Travellers’ Health, Yellow Fever Vaccine and Malaria Prevention Information by Country
6. CDC, Travellers’ Health, Tafenoquine Approved for Malaria Prophylaxis and Treatment

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