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Two strategies should be combined to prevent malaria – mosquito avoidance and antimalarial medications. Most people who catch malaria are taking inadequate or no antimalarial medication.

Travellers are advised to prevent mosquito bites by taking these steps:

use a DEET-containing insect repellent on exposed skin (20% to 30% is ideal), washing it off at night (as long as you are sleeping under a mosquito net); natural repellents such as citronella can be effective, but must be applied more frequently than products containing DEET

sleep under a mosquito net, ideally impregnated with Permethrin

choose accommodation with screens and fans (if not air-conditioned)

impregnate clothing with Permethrin in high-risk areas

wear long sleeves and trousers in light colours

use mosquito coils

spray your room with insect repellent before going out for your evening meal

There are a variety of medications available:

Artesunate Derivatives of Artesunate are not suitable as a preventive medication. They are useful treatments under medical supervision.

Chloroquine & Paludrine The effectiveness of this combination is now limited in Thailand. It is not recommended.

Doxycycline This daily tablet is a broad-spectrum antibiotic that has the added benefit of helping to prevent a variety of tropical diseases, including leptospirosis, tick-borne disease, typhus and meliodosis. The potential side effects include photosensitivity (a tendency to sunburn), thrush in women, indigestion, heartburn, nausea and interference with the contraceptive pill. More serious side effects include ulceration of the oesophagus – you can help prevent this by taking your tablet with a meal and a large glass of water, and never lying down within half an hour of taking it. Must be taken for four weeks after leaving the risk area.

Lariam (Mefloquine) Lariam has received much bad press; some of it justified, some not. This weekly tablet suits many people. Serious side effects are rare but include depression, anxiety, psychosis and having fits. Anyone with a history of depression, anxiety, other psychological disorders or epilepsy should not take Lariam. It is considered safe in the second and third trimesters of pregnancy. There is however significant resistance in parts of northern Thailand. Tablets must be taken for four weeks after leaving the risk area.

Malarone This drug is a combination of Atovaquone and Proguanil. Side effects are uncommon and mild, most commonly nausea and headache. It is an excellent tablet, however it is expensive, which can limit its use long term. It must be taken for one week after leaving the risk area.

A final option is to take no preventive medication but to have a supply of emergency medication should you develop the symptoms of malaria. This is less than ideal, and you’ll need to get to a good medical facility within 24 hours of developing a fever. If you choose this option the most effective and safest treatment is Malarone (four tablets once daily for three days). Riamet is another good option but is not available in some countries. Other options such as Mefloquine and Quinine are less desirable due to side effects. Fansidar is no longer recommended.

Measles

This highly contagious viral infection is spread through coughing and sneezing. Most people born before 1966 are immune as they had the disease in childhood. Measles starts with a high fever and rash and can be complicated by pneumonia and brain disease. There is no specific treatment. Ensure you are fully vaccinated.

Meliodosis

This infection is contracted by skin contact with soil. It is rare in travellers, but in some parts of northeast Thailand up to 30% of the local population are infected. The symptoms are very similar to those experienced by tuberculosis (TB) sufferers. There is no vaccine but it can be treated with medications.

Rabies

This uniformly fatal disease is spread by the bite or lick of an infected animal – most commonly a dog or monkey. You should seek medical advice immediately after any animal bite and commence post-exposure treatment. Having