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Recommendations for Prevention of Malaria. Mosquito Avoidance Measures. remain in well-screened areas Use of mosquito nets (preferably insecticide-treated nets) Using a pyrethroid -containing flying-insect spray in living and sleeping areas during evening and nighttime hours

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recommendations for prevention of malaria

Recommendations for Prevention of Malaria

http://wwwnc.cdc.gov/travel/yellowbook/2010/chapter-2/malaria.aspx

mosquito avoidance measures
Mosquito Avoidance Measures
  • remain in well-screened areas
  • Use of mosquito nets (preferably insecticide-treated nets)
  • Using a pyrethroid-containing flying-insect spray in living and sleeping areas during evening and nighttime hours
  • Wearing clothes that cover most of the body
  • Use of effective mosquito repellent

http://wwwnc.cdc.gov/travel/yellowbook/2010/chapter-2/malaria.aspx

deet n n diethylmetatoluamide
DEET (N,N-diethylmetatoluamide)
  • The most effective repellent against a wide range of vectors
  • DEET formulations
    • 50% are recommended for both adults and children older than 2 months of age
    • should be applied to the exposed parts of the skin
  • Permethrin-containing product may be applied to bed nets and clothing for additional protection.

http://wwwnc.cdc.gov/travel/yellowbook/2010/chapter-2/malaria.aspx

chemoprophylaxis
Chemoprophylaxis
  • Primary chemoprophylaxis regimens
    • taking medicine before travel, during travel, and for a period of time after leaving the malaria endemic area.
    • Beginning the drug before travel allows the antimalarial agent to be in the blood before the traveler is exposed to malaria parasites.
  • Presumptive antirelapse therapy (terminal prophylaxis)
    • medication taken towards the end of the exposure period
    • generally indicated only for prolonged exposure in malaria-endemic areas
    • most malarious areas of the world (except the Caribbean) have at least one species of relapsing malaria
    • Prevent relapses or delayed-onset clinical presentations of malaria caused by hypnozoites (dormant liver stages)
      • P. vivax or P. ovale.

http://wwwnc.cdc.gov/travel/yellowbook/2010/chapter-2/malaria.aspx

slide5

Choosing the appropriate chemoprophylactic agent

    • Country of travel
    • Significant reports of antimalarial drug resistance in that location
    • medical conditions, medications being taken, cost of the medicines, potential side effects

http://wwwnc.cdc.gov/travel/yellowbook/2010/chapter-2/malaria.aspx

medications used for chemoprophylaxis
Medications Used for Chemoprophylaxis
  • Atovaquone/Proguanil (Malarone)
  • Chloroquine (Aralen) and Hydroxychloroquine (Plaquenil)
  • Doxycycline (Many Brand Names and Generic)
  • Mefloquine
  • Primaquine

http://wwwnc.cdc.gov/travel/yellowbook/2010/chapter-2/malaria.aspx

drugs used for prophylaxis
Drugs used for Prophylaxis

http://wwwnc.cdc.gov/travel/yellowbook/2010/chapter-2/malaria.aspx

drugs used for prophylaxis1
Drugs used for Prophylaxis

http://wwwnc.cdc.gov/travel/yellowbook/2010/chapter-2/malaria.aspx

drugs used for prophylaxis2
Drugs used for Prophylaxis

http://wwwnc.cdc.gov/travel/yellowbook/2010/chapter-2/malaria.aspx

travel to areas with limited malaria transmission
Travel to Areas with Limited Malaria Transmission
  • mosquito avoidance measures only, and no chemoprophylaxis should be prescribed

http://wwwnc.cdc.gov/travel/yellowbook/2010/chapter-2/malaria.aspx

travel to areas with mainly p vivax malaria
Travel to Areas with Mainly P. vivaxMalaria
  • mosquito avoidance measures
  • primaquine - primary prophylaxis for travelers who are not G6PD-deficient

http://wwwnc.cdc.gov/travel/yellowbook/2010/chapter-2/malaria.aspx

travel to areas with chloroquine sensitive malaria
Travel to Areas with Chloroquine-Sensitive Malaria
  • mosquito avoidance measures
  • chemoprophylaxis alternatives:
    • chloroquine, atovaquone/proguanil, doxycycline, mefloquine,
    • primaquinefor travelers who are not G6PD-deficient
  • Longer-term travelers - weekly chloroquine
  • shorter-term travelers - atovaquone/proguanilor primaquine.

http://wwwnc.cdc.gov/travel/yellowbook/2010/chapter-2/malaria.aspx

travel to areas with chloroquine resistant malaria
Travel to Areas with Chloroquine-Resistant Malaria
  • to mosquito avoidance measures
  • chemoprophylaxis limited to atovaquone/proguanil, doxycycline, and mefloquine.

http://wwwnc.cdc.gov/travel/yellowbook/2010/chapter-2/malaria.aspx

travel to areas with mefloquine resistant malaria
Travel to Areas with Mefloquine-Resistant Malaria
  • mosquito avoidance measures
  • chemoprophylaxis options are reduced to either atovaquone/proguanil or doxycycline

http://wwwnc.cdc.gov/travel/yellowbook/2010/chapter-2/malaria.aspx

chemoprophylaxis for infants children and adolescents
Chemoprophylaxis for Infants, Children, and Adolescents
  • All children traveling to malaria-risk areas should take an antimalarial drug.
  • Pediatric dosages should be calculated according to body weight but should never exceed adult dosage.
  • Chloroquine and mefloquine
  • Primaquinecan be used for children who are not G6PD-deficient traveling to areas with principally P. vivax.
  • Doxycycline may be used for children who are at least 8 years of age.
  • Atovaquone/proguanil may be used for prophylaxis for infants and children weighing at least 5 kg (11 lbs).

http://wwwnc.cdc.gov/travel/yellowbook/2010/chapter-2/malaria.aspx

chemoprophylaxis during pregnancy and breastfeeding
Chemoprophylaxis during Pregnancy and Breastfeeding
  • Malaria can increase the risk for adverse pregnancy outcomes, including prematurity, abortion, and stillbirth.
  • Women who are pregnant or likely to become pregnant should be advised to avoid travel to areas with malaria transmission if possible.
  • If travel to a malarious area cannot be deferred, use of an effective chemoprophylaxis regimen is essential.
  • Chloroquine
    • to areas where chloroquine-resistant P. falciparum has not been reported
    • has not been found to have any harmful effects on the fetus
    • pregnancy is not a contraindication for malaria prophylaxis
  • If Chloroquine resistance is present:
    • mefloquineis currently the only medication recommended for malaria chemoprophylaxis during pregnancy.

http://wwwnc.cdc.gov/travel/yellowbook/2010/chapter-2/malaria.aspx