High-risk alert: vital malaria drug goes out of stock in SA
This comes as infection and mortality rates have dramatically worsened
Pregnant women and children under 11kg have no medicine available to protect them from malaria, according to the National Institute of Communicable Diseases (NICD).
There are three different drugs used to prevent malaria for travellers going into high- and moderate-risk malaria zones until the end of May.
But only one drug Mefloquine (Larium) can be used with pregnant women and infants, and it is out of stock in SA.
The shortage of the drug for pregnant women comes as the most recent figures show malaria cases and deaths increased dramatically in 2017 from the year before.
In its most recent newsletter, the “Communicable Disease Communique”, the NICD wrote: “There are currently no mefloquine-containing products available in South Africa – Lariam® has been discontinued in this country ... This means that there is currently no product that can be used for pregnant travellers or children weighing less than 11 kg.”
The latest publicly available malaria figures from the 2018 SA Health Review show that in 2017, there were about 30,000 cases of malaria, up from 6,000 in 2016.
This translated into 331 deaths in the country compared with 54 in 2016.
One reason there is no drug to prevent malaria in babies and pregnant women is that Roche sold the division that produced Larium, and the new company is not planning to sell it in SA, according to Prof Lucille Blumberg, a consultant at the NICD and malaria expert. The NICD said as toddlers, infants and pregnant women were also at the highest risk of complications from malaria, they should avoid malaria areas until the end of May.
Blumberg said even without prophylaxis for pregnant women, the NICD advice remained the same: “We have always advised pregnant women not to travel to malaria areas in the high-risk season.”
The major areas of transmission of malaria in SA are the northeastern parts of Limpopo, along the borders with Mozambique and Zimbabwe, some Lowveld areas of Mpumalanga, including the Kruger National Park, and the far northern parts of KwaZulu-Natal.
The NICD has also reclassified Musina in Limpopo, once a low-risk area for malaria, into now a moderate-risk area, and travellers going to Musina are advised to take preventative medication. The reclassification comes after NICD analysed all malaria cases from 2014 to 2018 to see if the disease-transmission area had changed. But the good news for travellers is that preventative malaria medicine no longer requires a visit to the doctor and a script. The two other malaria drugs used to prevent the disease can now be bought over the counter at pharmacies, making it easier and cheaper for consumers to protect themselves.
The change was gazetted late last year. One drug to prevent malaria, Doxycycline, is an antibiotic and is very cheap, but can lead to light sensitivity, sunburn and thrush in some users.
The other, Atovaquone & Proguanil, known as Malanil, is more expensive and has fewer side effects.
Blumberg explained that medication to prevent malaria was generally reserved for travellers.
“Part of the malaria programme strategy is ensuring that people living in malaria areas are very aware of malaria [flu-like] symptoms and the need for early diagnosis. There is lots of training of medical staff to ensure that if people in the area have a fever they must then do a malaria test.”