Symptoms Fever shivering joint pain vomiting aneamia symptoms haemoglobinuria tingling preventative measures dependant upon control and elimination of the insect vector There is currently no artificial means of prevention Methods used to prevent the spread of disease or to protect individuals in areas where malaria is endemic include prophylactic drugs mosquito eradication and the prevention of mosquito bites There is currently no vaccine that will prevent malaria but this is an active field of research Some drugs that can be used for treatment of malaria can also be used for its preventative qualities however they need to be taken daily or weekly These are seldom used by those living in a malaria abundant enivornment and are commonyl found amongst travellers visitng regions of hight malaria activity Quinine was used starting in the seventeenth century as a prophylactic against malaria The development of more effective alternatives such as quinacrine chloroquine and primaquine in the twentieth century reduced the reliance on quinine Today quinine is still used to treat chloroquine resistant Plasmodium falciparum as well as severe and cerebral stages of malaria but is not generally for malaria prophylaxis Modern drugs used preventively include mefloquine Lariam doxycycline available generically and atovaquone proguanil hydrochloride Malarone The choice of which drug to use is usually driven by what drugs the parasites in the area are resistant to as well as side effects and other considerations The prophylactic effect does not begin immediately upon starting taking the drugs so people temporarily visiting malaria endemic areas usually begin taking the drugs one to two weeks before arriving and must continue taking them for 4 weeks after leaving atovaquone proguanil only needs be started 2 days prior and continued for 7 days afterwards Controlling the vector is the most useful way of preventing the spread of malaria Efforts to eradicate malaria by eliminating mosquitoes have been successful in some areas Malaria was once common in the United States and southern Europe but the draining of wetland breeding grounds and better sanitation in conjunction with the monitoring and treatment of infected humans eliminated it from affluent regions In 2002 there were 1 059 cases of malaria reported in the US including eight deaths In five of those cases the disease was contracted in the United States Malaria was eliminated from the northern parts of the USA in the early twentieth century and the use of the pesticide DDT eliminated it from the South by 1951 In the 1950s and 1960s there was a major public health effort to eradicate malaria worldwide by selectively targeting mosquitoes in areas where malaria was rampant 12 However these efforts have so far failed to eradicate malaria in many parts of the developing world the problem is most prevalent in Africa The United States itself may face the spread of malaria in the future as climate change warming leads to an expansion of the areas in which mosquitoes are active Mosquito nets and prevention of mosquito bites Mosquito nets help keep mosquitoes away from people and thus greatly reduce the infection and transmission of malaria The nets are not a perfect barrier so they are often treated with an insecticide designed to kill the mosquito before it has time to search for a way past the net Insecticide treated nets ITN are estimated to be twice as effective as untreated nets 16 Since the Anopheles mosquitoes feed at night the preferred method is to hang a large bed net above the center of a bed such that it drapes down and covers the bed completely The distribution of mosquito nets impregnated with insecticide often permethrin has been shown to be an extremely effective method of malaria prevention and it is also one of the most cost effective methods of prevention These nets can often be obtained for around US 2 50 3 50 2 3 euros from the United Nations the World Health Organization and others For maximum effectiveness the nets should be re impregnated with insecticide every six months This process poses a significant logistical problem in rural areas A new type of impregnated net called Olyset releases insecticide for approximately 5 years 17 and costs about US 5 50 ITN s have the advantage of protecting people sleeping under the net and simultaneously killing mosquitoes that contact the net This has the effect of killing the most dangerous mosquitoes Some protection is also provided to others including people sleeping in the same room but not under the net Unfortunately the cost of treating malaria is high relative to income and the illness results in lost wages C