Malaria is a life-threatening disease caused by the bite of a female Anopheles mosquito, infected with a parasite. The disease is very common in tropical regions, including large areas of Africa and Asia, Central and South America, and some Pacific islands. Malaria cannot be spread directly from person to person.
Malaria can range from a very mild illness to severe disease and even death. Starting treatment as soon as possible is imperative.
Malaria symptoms can be difficult to spot as they are similar to other fevers. They may include high temperature, sweats and chills.
Malaria can be a deadly disease if not diagnosed and treated quickly. Untreated, malaria can cause severe illness or death within 24 hours. Infants, children under 5 years, pregnant women and girls, travellers (who have no immunity), and people with HIV or AIDS are at higher risk of severe infection. Malaria infection during pregnancy can also cause premature delivery or delivery of a baby with low birth weight. Malaria can sometimes return and require further treatment.
Severe symptoms are:
Malaria is caused by a parasite transmitted through the bites of infected female Anopheles mosquitoes. When an Anopheles mosquito bites a person with malaria, the mosquito becomes infectious. When this mosquito bites another person, it transmits the virus. Malaria is not spread from person to person like a cold or the flu, nor is it sexually transmitted.
Malaria can also be transmitted through blood transfusions and contaminated needles. The first symptoms of malaria may be mild and difficult to recognise, similar to many other febrile illnesses. P. falciparum is the deadliest malaria parasite, and is most prevalent in Africa. P. vivax is the dominant malaria parasite outside of sub-Saharan Africa.
Malaria is considered an emergency and needs to be treated quickly with antimalarial medicines. Artemisinin-based combination therapy medicines are the most effective treatment for P. falciparum malaria. Chloroquine is recommended for treatment of infection with the P. vivax parasite only in places where it is still sensitive to this medicine. Antimalarial drug resistance is a growing problem and the World Health Organization urges regular monitoring of drug efficacy.
Travellers to areas where the disease is endemic should take antimalarial medicine, starting a few days or weeks before you travel and continuing it when you return. However, the medication will not prevent all cases and avoiding getting bitten is important. Insect repellent should be used, and you should sleep under insecticide-treated mosquito nets. Wearing long-sleeved clothing and trousers in the evening, when mosquitoes are most active, can also help to prevent bites.
For people living in endemic regions, game changing vaccines are now being rolled out in routine childhood immunisation programmes across Africa – two different vaccines have now been shown to be effective.
Other prevention strategies for people living in malaria endemic countries include the use of insecticide treated bed nets, spraying inside homes and the use of chemoprophylaxis – where vulnerable populations are given antimalarial medication during times of the greatest malarial risk.
Malaria is one of the oldest diseases known to humanity, with some historians even arguing that it played a part in the fall of the Roman empire. Malaria flourished throughout the world, including in Britain where it was commonplace around the Thames marshes and was known as either marsh fever or ague.
There was huge progress against the disease in the 20th century and it was eradicated in Europe and the United States. In 2019 China was also officially declared free of the disease – a remarkable achievement for a country 90 per cent of whose population lived in malaria endemic areas in the 1940s.
Africa and south east Asia have also seen huge declines in the number of cases since the beginning of millennium thanks to renewed efforts to eradicate the disease. However, that progress has stalled in recent years: according to WHO’s World Malaria Report 2024 there were about 11 million more cases of the disease in 2023 than in 2022.
There is concern that malaria could easily come surging back due to a number of factors: drug resistance; the spread of a “super mosquito” from Asia to Africa; climate change leading to an explosion in mosquito numbers; and a drop in funding for control efforts. However, the roll out of two vaccines in recent years has provided a glimmer of hope.
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