Mosquitoes, a love hate relationship

They love me.  I hate them.  I seem to attract mosquitoes every time I go on a vacation to a warm place.  When I get a mosquito bite, my skin swells up like a giant tennis ball and itches like crazy for a week.  My husband never seems to get bitten. And if he does, the mosquito bites disappear after a few hours.  I don’t know why I am so unlucky.  Unfortunately, my 3 year old daughter appears to have inherited my genes in this respect.  The mosquitoes also love her.

Mosquito bites are incredibly annoying.  In many developing countries in Asia, Middle East, South America, and Africa, mosquitoes also carry deadly diseases, such as malaria, dengue fever, chikungunya, yellow fever, and Japanese encephalitis.  We are lucky not to have to worry about these diseases in the U.S.  However, I fear that travelers often forget about how common and dangerous these diseases are in other countries and don’t take the necessary precautions.

In my practice, I have many families who travel to India to visit friends or relatives and stay for many weeks at a time.  Malaria is endemic in ALL of India, rural and urban areas.  The disease is more common during the wet monsoon season, which is roughly June through September.  This coincides perfectly with our summer break, when most families take the time to take long international trips.  Parents will often tell me how they knew of someone who got malaria in India.

Getting malaria can be very scary.  Malaria usually presents as high fevers, chills, and flu-like symptoms, such as body aches and fatigue.  Malaria can also cause severe anemia, jaundice (yellowing of the skin), seizures, kidney failure, coma, mental confusion, acute respiratory distress syndrome, and death.  Children under age 5 are particularly vulnerable to these severe complications of malaria.  There are 4 different types of malaria, with Plasmodium Falciparum being the  worst type.  Infection with this species is known to cause rapid and severe illness.  In fact, infection with this type of malaria is considered a medical emergency!  Over the last 2 decades, the rates of Plasmodium falciparum infection is increasing in India with an estimated incidence of >40% of all malaria infections in that country.

The good news is that malaria is PREVENTABLE.  There is no anti-malaria vaccine yet but there are exciting new treatments in the horizon.  The Bill and Melinda Gates Foundation are developing some exciting new anti-malaria drugs. For now, the best way to prevent malaria is to take medications to prevent malaria called chemoprophylaxis and use insect repellants, such as DEET.  Most of these malaria prophylactic medications are safe, well-tolerated, and effective for people of all ages.  In addition, I recommend travelers use repellants with 20-30% DEET, even on infants as young as 2 months.  Use mosquito nets when your accommodation does not have window screens or air conditioning. Permethrin can also be applied to clothing and bed nets.  The type of mosquito that carries the malaria parasite tends to bite during the twilight hours, between dusk and dawn. Be careful when you’re visiting those night markets or having dinner at sunset.

How do you know if there is a risk for malaria at your trip destination?  Check the   CDC website.  If there is a risk, visit your doctor or a travel medicine specialist at least 2 weeks before your trip since some medications need to be started a couple weeks before you leave.  Since nausea or vomiting is the most common side effect with these prophylactic medications, take it with food and water.  You can also call your doctor and switch your medication if you get an unwanted side effect before you leave on your trip. Many parents are reluctant to give medications to their children.  I get it.  I usually don’t like giving unnecessary medications to children either.  But when I weigh the risk of my child getting a deadly disease, like malaria, with the possible side effects  of the medication, I would choose to give the prophylactic medication every time.

Malaria symptoms can develop as early as 7 days after initial exposure and as late as several months after departure.  If you have visited a malaria endemic area and come down with high fevers, don’t forget to mention your recent travel to your doctor.  Prompt diagnosis and treatment of malaria is life-saving.

Now what about the other bad diseases that mosquitoes can transmit? Like dengue fever or Japanese encephalitis?  Tune in for future posts on these mean and smart bugs!

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