There has been an addendum to the South African Guidelines for the Prevention of Malaria updated 2018, reflecting the current scarcity of mefloquine-containing products.
Although mefloquine given as an option for chemoprophylaxis, there are currently no mefloquine-containing products available in South Africa. Lariam has been discontinued in this country and there are manufacturing issues regarding Mefliam that will take a while to be resolved.
This means that there is currently no product that can be used for pregnant travellers or children weighing less than 11kg. As these are also the travellers at highest risk of complicated malaria, they should be strongly advised not to go to malaria risk areas. If they have no option but to go, they should use all methods available to prevent getting bitten by the mosquitoes and should seek immediate medical attention should they have any signs of illness.
IMPORTANT CHANGES TO THE GUIDELINES
Both doxycycline and atovaquone proguanil are now S2 and are available from pharmacies without a prescription. The South African Malaria Risk Map has been updated, and some areas that were previously low risk areas are now classified as moderate risk. The changes have been made based on notifications of confirmed cases of locally acquired malaria infections over the past five malaria seasons (2014-2018).
Importantly, IV artesunate is now registered and does not have to be procured under section 21. There is therefore no excuse for not having IV artesunate available as the first-line treatment option for severe malaria where needed.
MALARIA BY NUMBERS
For the three malaria-endemic provinces (Limpopo, Mpumalanga and KwaZuluNatal), 1 761 cases were detected in January 2019, compared with 429 in December 2018. In the whole of 2018, there were 17 539 cases and 114 deaths. That was down on the number in 2017: 30 437 cases and 331 deaths. That was the worst year since 2000 (64 622 cases, 459 deaths).