malaria chemoprophylaxis. prevent disease, disability and premature death identify basic facts,...

Malaria Chemoprophylaxis

Prevent Disease, Disability and Premature Death

Identify basic facts, types, and the importance of malaria chemoprophylaxis.

Objectiveهدف

Prevent Disease, Disability and Premature Death

Chemoprophylaxis Types

Side Effects

Overviewمرور

Prevent Disease, Disability and Premature Death

Malaria Defined – Transmission

Mainly by certain species of female mosquitoes of the genus Anopheles

Transfusion

Needles

Congenitally

Prevent Disease, Disability and Premature Death

Malaria Defined Symptoms

Symptoms - fever and flu-like illness (chills, headache, muscle aches, and fatigue)

Symptoms may occur 7 to 9 days after being bitten by an infected mosquito

Malaria may cause anemia and jaundice

Prevent Disease, Disability and Premature Death

Protozoa of the genus Plasmodium

P. falciparum - the most deadly

P. vivax - Middle East, Asia, Oceania, and Central and South America

P. malariae - less common

P. ovale - less common

Plasmodium falciparum infections, if not promptly treated, may cause kidney failure, coma, and death

Malaria Defined Infectious Agent

Prevent Disease, Disability and Premature Death

Malaria Life Cycle

Prevent Disease, Disability and Premature Death

Prevent Disease, Disability and Premature Death

Malaria Chemoprophylaxis

Providers have the ultimate responsibility of prescribing medications for malaria

Choice of regimen is determined by two factors:

Drug resistance in specific locations.

Any allergic or other reaction to the anti-malarial drug of choice

Restriction by job

Prevent Disease, Disability and Premature Death

Malaria Chemoprophylaxis

Mefloquine(Lariam®)

250mg salt(228 mg/base)

Once/week

Chloroquine Phosphate(Aralen®)

500 mg salt(300 mg base)

Once/week

Doxycycline 100 mgOnce/day

Primaquine(terminal prophylaxis for P. Vivax

or P. ovale)

15 mg baseOnce/day for 14 days

Prevent Disease, Disability and Premature Death

Side Effects - Mefloquine

Frequently observed side effects

Vomiting, (3% incidence).Minor neurologic events.

Dizziness, vertigo, headache, decrease in sleep, visual, and auditory disturbances.

Neurologic side effects have an incidence of less than 1%.

Serious adverse events

SeizuresDisorientation, Toxic encephalopathy

Mefloquine is not authorized for prophylaxis in aviators and divers

Prevent Disease, Disability and Premature Death

Side Effects - Chloroquine

Frequently reported symptoms

Anorexia

Diarrhea

Abdominal cramps

Vomiting

Nausea

Mild symptoms reported

Headache

Deafness

Tinnitus

Blurred vision,

– Long-term or high-dosage therapy may result in irreversible retinal damage.

Prevent Disease, Disability and Premature Death

Side Effects - Doxycycline

Common side effects

Nausea

epigastric distress

Vaginitis

Sensitivity to sun exposure

Less frequent Diarrhea

Vomiting

Stomach and esophageal ulceration

– The frequency and severity of gastrointestinal side effects may be reduced by taking doxycycline with meals

– Absorption of this drug is impaired by antacids containing aluminum, calcium, magnesium, iron, or bismuth subsalicylate (Pepto)

Prevent Disease, Disability and Premature Death

Side Effects - Primaquine

The most frequently observed side effects

Abdominal discomfort

Nausea

Headache

Interference with visual accommodation

Do not use during pregnancy

Do not use with G-6-PD deficient individuals (physician determination)

Prevent Disease, Disability and Premature Death

Side Effects – Primaquine (G6PD)

Primaquine is the only currently available drug able to destroy dormant malarial pathogens in liver cells and prevent relapse of P.vivax or P.ovale malaria

Unfortunately, it is a strong oxidizing agent, and can cause severe hemolytic anemia in G-6-PD deficient personnel

Prevent Disease, Disability and Premature Death

What is G6PD deficiency?

G-6-PD deficiency a hereditary, sex-linked enzyme defect that results in the breakdown of red blood cells when the person is exposed to the stress of infection or certain drugs

SymptomsFatiguePale color Shortness of breath Rapid heart rate Yellow skin color (jaundice) Dark urine Enlarged spleen

Prevent Disease, Disability and Premature Death

G6PD deficiency

Members who test G6PD deficient must

Be informed of the deficiency, the signs and symptoms they may experience and why they may occur, and the risks of taking oxidant medications.

Be advised to consult with their unit medic if malaria medications are administered to them

Refer these individuals to the flight surgeon for evaluation

Prevent Disease, Disability and Premature Death

Questions to ask the Patient

What exact city are you going to?

Certain risk is eliminated at higher elevations

What are the dates you’ll be in the country?

Risk may only be during certain seasons

What date are you leaving

If it’s less than a week , may need to consider starting with doxycycline then switching

Prevent Disease, Disability and Premature Death

Questions to ask the Patient (cont’d)

Are you allergic to any medication?

Patient may not be able to take this medication

Have you taken this medication before?

Are you taking any meds now?

Prevent Disease, Disability and Premature Death

Summary

Chemoprophylaxis Types

Side Effects

Prevent Disease, Disability and Premature Death

Questions?

سواالت