Q: My wife will be travelling to Mumbai, Surat and Hyderbad next month from Durban, South Africa. What prophylactic antimalarial does she need and what other medication should she carry? She has no illnesses currently.

A:Malaria does occur in most parts of India (including large cities). According to the World Health Organization, every year in India an estimated 2 million cases of malaria occur with 1,000 deaths; and 95% of the population live in malaria-risk areas. Seasons with more rainfall and higher temperatures will have more malaria transmission than colder, drier seasons. However, in most tropical and semi-tropical countries, transmission may occur even during cooler months or periods of less rainfall. Because the mosquito that transmits malaria bites at night, travellers who are frequently out of doors between dusk and dawn will be at greater risk for malaria. People who were born in India are not protected against malaria. People born in and residing in a malaria risk area of India, after suffering repeated attacks of malaria, may develop some immunity to the disease. However, any such immunity disappears once they move to a place where they are no longer exposed. Such people, returning from residence in a malaria free area, may become severely ill. Since malaria can cause a severe, even deadly illness, all travelers to India should take appropriate measures to protect themselves and their traveling family members against malaria. Key Steps to Protect Yourself

1. Visit your doctor 4-6 weeks before travelling. If your personal healthcare provider is not familiar with travel medicine, you may need to visit a travel clinic or a city or county public health department. Such a visit will allow you to get necessary travel information, vaccinations, and antimalarial drug prescriptions (there is no vaccine against malaria).
2. Purchase your antimalarial drug before travelling. Drugs purchased overseas may not be completely effective due to quality issues. They may also contain the wrong drug, an incorrect amount of active drug, or be contaminated, which could be dangerous.
3. Take all of your drug as prescribed, before your trip, while you are travelling, and after you return to your home country. If you fail to take the entire prescription, you will not get complete protection.
4. Prevent mosquito bites. Malaria is transmitted by the bite of an infected Anopheles mosquito; these mosquitoes usually bite between dusk and dawn.
   • If possible, remain indoors in a screened or air-conditioned area during the peak biting period.
   • If no screening or air conditioning is available: use a pyrethroid-containing spray in living and sleeping areas during evening and night-time hours; sleep under bed nets, preferably insecticide-treated ones.
   • Wear long-sleeved shirts, long pants, and hats, when you go outdoors.
   • Use insect repellent when you go outdoors. Apply insect repellent to skin not covered by clothing. Use insect repellents that contain DEET (diethylmethyltoluamide) for the best protection.
5. However, despite all precautions, you may still get malaria.
   • Know the signs and symptoms of a possible malaria infection. Malaria symptoms are usually similar to the flu and can include fever, chills, headache, muscle aches, fatigue, nausea, vomiting, and diarrhoea. Symptoms may be mild, especially if you have had previous attacks of malaria. However, you should not ignore any symptom, even if mild.
   • If you or another traveller become ill, either while you are travelling or after your return (for up to 1 year), you should seek immediate medical attention. Malaria may quickly become a serious and difficult-to-treat illness, requiring hospitalisation, and can be fatal. If not promptly treated, malaria may cause coma, kidney failure, and death. Tell the healthcare provider that you have been in a malaria-risk area.