Pop quiz: if you're planning a vacation to a Caribbean hotspot this winter -- say, some place like Jamaica -- do you need to worry about malaria? How about if you're going to the Bahamas? The Dominican Republic?
The fact is if you're going to parts of any of those countries, malaria could be a threat. Yet few Canadian travellers think about the potentially fatal infection when planning getaways, and that can be a dangerous oversight, say doctors.
A recent poll conducted by Leger Marketing found that less than a third of Canadians planning vacations said it was a top priority for them to talk with a doctor about travel-related illnesses. Most were more likely to be concerned with planning sightseeing, accommodations and worrying about currency.
Even when asked about the travel health treats they worried about, most replied that malaria was well down the list:
- Traveller's Diarrhea (56 per cent)
- Sunburns (46 per cent)
- Accidents (44 per cent)
- Hepatitis A and B (38 per cent)
- Malaria (16 per cent)
Toronto-based travel medicine expert Dr. Jay Keystone thinks Canadians need to give more thought to the threat of malaria. He notes that while many Canadians travel to the Dominican Republic, many are unaware that malaria is endemic almost everywhere there. (By endemic, he means that the disease is always present.)
It's also endemic in small parts of the Bahamas and Jamaica, and huge swaths of southern Asia, South America, India, and Africa.
Many take wrong antimalaria meds
One way to avoid malaria is to avoid mosquitoes, since they are what carry the malaria parasite. But the most effective protection is through antimalarial medications, which can kill the parasite once it has entered the body.
Yet, judging by the numbers, many Canadians don't take the pills. The Public Health Agency of Canada says there are at least 400 cases of malaria in Canada every year and a few of those were fatal.
Every one of those deaths occurred in Canadians who picked it up while travelling. And every one was preventable, Keystone says.
"Those deaths happen for two reasons," Keystone says. "Either travellers don't take their antimalarial medications because they think it's no big deal; or they are given the wrong drug."
Most parts of the world are now resistant to what was once the most commonly prescribed antimalarial medication, cloroquine. So while the drug might still work in Mexico, for example, it won't work for those travelling to Africa and most of Asia.
Keystone says family doctors in Canada, who usually have little experience with malaria or tropical diseases, are often unaware of which drug to use.
"Which is why travel medicine clinics are so important," he says. "They have the expertise to know where malaria is and also to know which drug to use."
As diseases go in Canada, malaria is relatively rare. "But the bottom line is Canadians are at risk when they travel to malaria areas," Keystone says.
"Malaria can kill. And it kills quickly -- in about three days if you pick up the killer strain, P. falciparum. If you haven't treated it properly, you can be gone in three days," he emphasizes.
Infections often misdiagnosed
One of the tricky aspects of malaria is that testing for it is notoriously inaccurate. Labs in Africa have reported false positive rates of close to 50 per cent, Keystone says. Even here in Canada, it's easy for a lab technician to miss it.
"Labs in Canada don't have a lot of experience with malaria," Keystone explains. "They will often miss a light infection."
What's more, many doctors don't realize that even if a patient has malaria symptoms (which include fever, headache, fatigue) and they test negative, they need to be tested twice more before malaria can be ruled out.
Keystone knows of a case a couple of years ago in which a 26-year-old returned to Canada after spending two years in Malawi. He developed symptoms, went to an ER saying he thought he might have malaria, but was sent home when the first test came back negative. Within three days, he was dead.
"If [the hospital doctors] had said ‘Come back tomorrow, we'll check you again,' that 26-year-old would still be alive," Keystone says.
To make malaria diagnosis even more complicated, infections with the most severe strain can take up to two months to produce symptoms. That's why it's so important for travellers to malaria areas to watch for flu-like symptoms even two months after they come home – and to tell their doctors where they've travelled.
New Canadians too, need to be reminded that even if they grew up in malaria-endemic areas, they will lose their immunity while in Canada and could become infected it they return to their homelands for a visit.
"In fact," Keystone says, "almost half the cases of malaria in Canada are new Canadians who go home to visit friends and relatives."
"And 20 per cent of the deaths in Canada are in those who came from malaria-endemic countries and lost their immunity – which is an amazing figure."
Finally, Keystone would like to remind Canadians to buy their antimalarial medications before they leave. That's in part because some medications – though not all – need to be started before travel. But it's also to avoid fake pills.
"Counterfeit medication makes up 50 to 80 per cent of antimalarial pills in some parts of the world," Keystone says. "Which is why we say: buy them here. Do no go and say ‘I'll get them cheaper over there.'"
