Malaria: The Signs, and When to Go In

Key takeaways

A fever after travelling to forest, upland or rural areas where malaria occurs is a reason to be seen NOW, and you must tell the doctor where you have just been. According to CDC, that window lasts for up to a year after you return.
Malaria is often missed because it looks like flu: fever, chills, headache, aching all over, nausea. Do not wait for the textbook shivering attack to arrive on a regular cycle — CDC's list of symptoms contains no cycle at all.
CDC treats suspected or confirmed malaria as a medical emergency, because the illness can deteriorate quickly and unpredictably. There is no waiting period that can be regarded as safe.
Confusion, seizures, yellow skin and eyes, difficulty breathing, very little urine, unusual bleeding: call 115 or go to emergency care.
Unlike the viral fevers, malaria CAN be cured with medicine. But a blood test has to confirm it first, and the doctor chooses the medicine — buying something to try ruins both of those things.

The most important thing first: if you have a fever and you have been to forest, upland or rural areas where malaria occurs at any point in the past year, say that sentence out loud to the doctor. Malaria gets missed mainly because nobody thinks of it — and the doctor only thinks of it once they know where you have just been.

Recognising it — and what it is very easily mistaken for

CDC lists the signs: fever and flu-like illness, chills or shivering, headache, aching all over, exhaustion, nausea, vomiting, diarrhoea. Reading that list shows the problem straight away — it overlaps almost entirely with flu and with ordinary viral fever.

Do not wait for the textbook shivering attack on a regular cycle: CDC's list of symptoms contains no cycle at all. Waiting until the fever looks like the thing you were told about is a way of losing time.
Dengue opens in exactly the same way and also occurs where there are many mosquitoes — but the two illnesses need handling differently, so do not settle the question at home.
Flu, viral fever, pneumonia and urinary infections also begin with a fever and aching all over.
Nobody tells them apart reliably by looking, not even a clinician.

The incubation period is where people lose the thread. According to CDC, most people begin to feel unwell at the earliest around a week after infection, but it can also be as late as a year or more. That means the trip from the start of the year still counts — do not dismiss it because it was “a long time ago”.

What you must say to the doctor

Where you went: which area, rural or urban, whether you went into forest or slept out at a field hut or shelter.
The dates you went and came back. According to CDC, a fever while still in an area where malaria occurs, or after returning — within up to a year — is in both cases a reason to be seen straight away and to give your travel history.
The first day of the fever, written down with the time of every temperature reading — the first question the doctor asks, and the thing most often misremembered.
Whether you took preventive medicine before the trip, and whether you kept taking it through to after you got back. Taking preventive medicine does not mean you cannot get malaria.

What to do straight away at home

Be seen so a blood test can be done — this is the main task, not something to wait on. Take the sheet with the fever dates and the trip itinerary.
Keep fluids going continuously, a little at a time: boiled and cooled water, oral rehydration solution made up exactly as printed on the sachet, thin rice water, milk.
Let the patient rest and dress lightly; for a high fever, sponge them with warm water.
Watch what you can observe, not just the thermometer: can they still drink, are they vomiting everything back, are they passing urine, are they alert or drowsy, are the skin and eyes becoming more yellow.
Put one person on watch overnight — CDC treats suspected malaria as a medical emergency because the illness can deteriorate quickly and unpredictably.

What must NOT be done

Do NOT wait to see whether it is better tomorrow — with malaria there is no waiting period that can be regarded as safe.
Do NOT buy malaria medicine yourself to try. According to CDC, which medicine is used depends on the type of parasite, where the infection was acquired, how severe it is, the patient's age and whether she is pregnant.
Do NOT use antibiotics on your own: malaria is not caused by bacteria.
Until dengue has been ruled out, avoid ibuprofen, aspirin and other non-steroidal anti-inflammatory drugs, because they raise the risk of bleeding. Paracetamol (acetaminophen) is the usual choice, but the dose is a decision for the doctor or the pharmacist.
Do NOT use coin-rubbing, skin-pricking or cupping; do NOT set up an intravenous drip at home.

When you must go to hospital

GO TO EMERGENCY CARE or call 115 (the emergency number in Vietnam) NOW if the patient has: confusion, rambling speech, unusual agitation, drowsiness that is hard to rouse, or coma; seizures; fast breathing, difficulty breathing; yellow skin, yellow eyes; very little urine, or none at all; unusual bleeding; continuous vomiting, unable to keep fluids down; collapse, unable to sit up; cold clammy pale skin. — BE SEEN THE SAME DAY, do not wait until tomorrow, if you have a fever and have been to an area where malaria occurs at any point in the past year, even if you can still eat and drink and are still alert: what needs doing today is a blood test. If the first test is negative and the fever continues, be seen again within the next one to three days. Young children, pregnant women, people who have never lived in an area where malaria occurs, and people with underlying conditions need a far lower threshold for waiting.

Malaria can be cured with medicine — but the test comes first

This is where malaria differs from the viral fevers. According to CDC, prescription medicines can treat and cure malaria; also according to CDC, only a doctor can diagnose it and a blood test is needed to confirm it. So what decides the outcome is not the medicine but being tested early. CDC also names children, pregnant women and people without immunity as the groups more likely to become severely ill.

Malaria is an illness that has to be dealt with at a medical facility: the test has to be read immediately, and treatment belongs in hospital. At home only the part before and the part after are possible. A Y Te Xanh doctor consults remotely so you can decide whether to go and so you are reminded of exactly what to say about the trip; a nurse provides recovery care at home after discharge. Not every test belongs at home — anything that must be run immediately gives more reliable results when the sample is taken at a medical facility. If any sign in the box above is present, go in first and call afterwards.

The signs, the window of up to a year after a trip, the advice to give your travel history, the need for a blood test and the fact that prescription medicines can cure malaria all follow US CDC guidance; the warning to avoid ibuprofen and aspirin until dengue has been ruled out also follows CDC. This article passes that on and does not replace being examined in person. Citing CDC here does not imply that CDC endorses Y Te Xanh or our services.

Need personalised advice for your loved one? Call our hotline 094 368 81 15 (24/7) — calling to ask a question or to book costs nothing. GreenCare has doctors who come to examine, nurses who carry out doctor's orders (injections, infusions, dressing changes), remote consultation by video call, and a review of the medicines you are taking; an in-depth remote consultation, or any one after the first, is a paid service. For children we take examination and acute care only — not long-term care at home, and not newborns or expectant mothers. We confirm we have staff in your area and provide transparent pricing before we begin.

Sources

CDC — About Malaria
CDC — About Dengue

Frequently asked questions

Does malaria spread from person to person?

Not directly, the way flu does. The illness is transmitted by mosquito bites, so being next to the patient, eating with them or caring for them will not give it to you. What is worth noting is the biting hours: according to CDC, malaria transmission occurs mainly between dusk and dawn, because the mosquitoes that carry it feed at night. That is the opposite of the mosquitoes that carry dengue, which bite during the day — so where both occur, protect against mosquitoes both day and night, and sleeping under a net is genuinely useful.

I am about to travel to an area where malaria occurs — how do I protect myself?

Ask a doctor before you go and take a detailed itinerary with you. According to CDC, there are tablets that can prevent malaria, but a doctor needs to see where you are going before deciding which one — and if you are prescribed them, they must be taken exactly as prescribed, including the period before you leave and the period after you get home. Many people stop the moment they land, which is precisely when they should not. Alongside that, CDC advises protecting against mosquitoes: use an approved insect repellent, wear long sleeves and long trousers, and sleep under an insecticide-treated net.

How long is the incubation period before symptoms appear?

According to CDC, most people begin to feel unwell at the earliest around a week after infection, but it can also be as late as a year or more. So the period to remember is not the last few days but the whole past year: if you have a fever and you went to an area where malaria occurs at any point in it, tell the doctor, even if the trip was long ago.

Does one negative test rule malaria out?

Not necessarily. If you still have a fever and no other cause has been found, go back to be seen rather than treating the first result as the final answer. Repeat your travel history at the next visit, because the person seeing you may be someone different who has not read that part.

Is there still malaria in Vietnam?

There is, but not everywhere. CDC places the malaria risk in Vietnam in rural areas, and states that there is no risk in the large cities. The groups that tend to be affected are people who go into the forest, work upland plots, sleep in the forest or in border areas, and visitors who go to those places. If you and your family only stay in the city and have not travelled, your fever is almost certainly due to something else — but you still need to be seen to find out what.

How do I tell malaria from dengue?

You cannot tell by observation, because both open with fever, headache and aching all over, and both occur where there are many mosquitoes. Only a blood test can settle it. While you wait, handle it in the way that is safe for both possibilities: avoid ibuprofen and aspirin, watch more closely once the fever breaks, and give your travel history to the doctor so that malaria is not overlooked.