Malaria prevention

These are guidelines are intended for UK-based visitors to malaria endemic areas. They therefore apply to detainees who have been resident in the UK for some time because they lose their immunity. These guidelines are available on the Health Protection Agency website www.hpa.org.uk and can be checked for updates.

This is a basic guide to the appropriateness of various malaria prophylaxes, including contra-indications and cautions.

Name of Drug & adult dosage How to take Contra-indications Cautions
MALARONE
(250 mgs atovoquone + 100mgs Proguanil)
One tablet daily, starting 24-48 hours before arrival in risk area, daily whilst there and for 7 days after leaving risk area

Pregnancy

Children less than 11 kg weight

For children weighing between 11- 40 kg

Paediatric Malarone (i.e. lower dose tablets) should be prescribed according to exact weight. See BNF for guidance

 

MEFLOQUINE
(LARIAM)
(250 mgs  tablets)

 

One tablet weekly, starting 2.5 - 3 weeks before travel, once weekly whilst there and for 4 weeks after leaving risk area. (Start 3 weeks before departure  if taking for first time.)

If Mefloquine previously taken with- out side effects, 2 doses 1 week apart prior to departure is adequate

 
During first 3 months of pregnancy ( unless expert opinion says otherwise)
Any history of Neuro-psychiatric disorder  (including depression) or convulsions.
Family history of epilepsy
Breast feeding
Children less than 6 kg 
75% of adverse reactions to this drug are apparent by 3 rd dose, so therefore should start taking 3 weeks before departure, especially on first occasion, to establish tolerance and allow time to change to another option before leaving UK, in event of encountering adverse reactions  
 DOXYCYCLINE
(100 mgs capsules)
One tablet daily starting 48-72 hrs before departure, daily whilst away and for 4 weeks after leaving risk area    

Pregnancy

Children under 12 years

Breast feeding

May cause photo-sensitivity (3% of people)

Acid reflux problems

Interaction with combined oral contraceptive pill

 

The Health Protection Agency states that ‘Pregnant women are advised to avoid travel to malarious areas . ….Pregnant women have an increased risk of developing severe malaria and a higher risk of fatality compared to non pregnant women.’ The Immigration Directorate Instructions say that pregnant women and very young children should be provided with anti malarial prophylaxis.

If a pregnant woman is due to removal to a high risk area for malaria, there are particular concerns because Malarone and Doxycycline are contraindicated for pregnancy. Mefloquine is the only effective drug for prophylaxis for pregnant women in a chloroquine resistant area, though it should normally be avoided in the first 3 months of pregnancy according to the manufacturers. However, Mefloquine is contraindicated  in people with a history of psychiatric disorders including depression. Pregnant women with a history of psychological disorders cannot therefore be safely removed to countries that are resistant to chloroquine.

UKBA and the IRC healthcare provider have in the past frequently breached their own policies and guidelines on the provision of appropriate anti-malarials.  In these cases, Medical Justice is often able to help detainees get a Judicial Review lodged and they have mostly been successful and the removals halted.  If you have a case of a pregnant woman and/or small child, please ensure this is flagged up to the casework team.