Though malaria has long been
a consideration for divers traveling
to Pacific destinations, those
heading to Honduras and Belize
usually don’t think much about it.
That era of complacency may be at
an end. A CDC representative
recently told Undercurrent that there
have been confirmed malaria cases
among tourists whose only recent
travel had been to Roatán, and they
said that they now recommend that
travelers to the Bay Islands take
chloroquine (Aralen). Other areas
of central America are also considered
malaria risks, although the
Caribbean (except areas of Haiti
and the Dominican Republic) is
still basically malaria-free.
World Health Organization
statistics breaking down malaria
infections by country reveal some
startling trends. While divers have
long thought of destinations like
Papua New Guinea as significant
malaria risks, in WHO’s most recent
stats actual annual per capita rates of
infection in PNG (14.84 cases/1000
population) were less than half what
they were in Belize (38.33 cases/1000
population). Similarly, rates of
infection in Thailand (1.95 cases/
1000 population) and Malaysia (1.90
cases/1000 population) were a
fraction of those that occurred in
Honduras (7.44 cases/1000 population).
Of course, these Central
American rates still pale in comparison
with the malaria risk in Vanuatu
(58.3 cases/1000 population) and the
Solomon Islands (a staggering 312.19
cases/1000 population), but they’ve
nonetheless become significant.
While the bulk of Central
American malaria infections occur
in the interior, malaria is a confirmed
presence in resort areas in
Belize, Honduras, and the Bay
Islands, according to the CDC. For
divers taking side trips into the
interior or traveling through
mainland airports, malaria risk may
be significant. But in spite of the
CDC warnings, none of the travel
information that’s come our way
from Belize resorts makes any
mention of malaria risk or recommends
that guests take chloroquine.
(Note that malaria
prophylaxis must begin well in
advance of exposure to the parasite
to be effective, so divers planning
trips should see their doctors early.)
As if the increase in infections
weren’t enough, the lethal P.
falciparum species of malaria is
becoming increasingly resistant to
medications such as chloroquine. In
fact, chloroquine-resistant malarial
parasites are fast becoming the
norm. Chloroquine has been so
ineffective in Kenya that the
government recently banned use of
the drug. Chloroquine-resistant
malarial parasites are now found in tropical South America and are
spreading, with chloroquineresistant
infection currently a risk as
far north as southern Panama. If
the northward movement continues,
chloroquine-resistant malaria
may soon become a threat to divers
visiting Central America. The risk
of contracting chloroquine-resistant
malaria is still endemic in areas of
the Pacific, including Papua New
Guinea, the Solomon Islands,
Vanuatu, Indonesia, Thailand, and
other areas of southeastern Asia.
Despite its high toxicity and
unpleasant side effects, including
nausea, dizziness, and insomnia,
the CDC still generally recommends
treatment with mefloquine
(Lariam) for travelers where
chloroquine-resistant malaria is
common. But even Lariam is losing
its punch. Recent CDC reports
confirm that mefloquine-resistant
malaria has been reported in
Thailand. Our first-hand reports
from divers taking Lariam who
returned from PNG with malaria
suggests that the problem of mefloquine-resistant malaria may
be becoming more widespread.
An effective vaccine certainly
seems long overdue, but, despite
ongoing research, vaccines have
proved elusive. Some recentlydeveloped
vaccines may prove
more successful. A genetically
engineered DNA vaccine is the
most exciting prospect. One has
already passed initial human tests;
the vaccine was well-tolerated and
produced an immune response in
almost half the recipients. Plans are
underway to test a second experimental
vaccine designed to take a
new tack by targeting P. falciparum,
the deadliest malaria parasite, at
each stage of its life cycle within its
human host. Perhaps the era of
nasty antimalarials will soon be
history and we can return to
simpler drugs like coffee, kava kava,
and nitrogen on our dive trips.