GERM
00:00:09.040 – 00:00:11.840
Jambo Rafiki, Karibu! My name is Germ.

WORM
00:00:11.920 – 00:00:12.800
I’m Worm.

GERM
00:00:12.800 – 00:00:28.960
Welcome to episode 101 of the germ & worm travel health podcast: MAY-laria 2026. All malaria for the month of May. It’s a big planet. See it in good health. I’m Dr. Paul Pottinger, also called Germ. I’m a professor of infectious diseases at the University of Washington in Seattle.

WORM
00:00:29.390 – 00:00:37.230
I’m Dr. Chris Sanford, also known as Worm, associate professor in the departments of Family medicine and Global Health, also at the University of Washington.

GERM
00:00:37.390 – 00:01:40.230
Chris, let’s talk about malaria. We try to save up all of or most of our malaria questions for the month of May each year. This year is no different.

Some of the questions we’ll answer today include, are there areas with malaria that are fixed? Or do the boundaries of malaria change? If they do change, why, with so many smart scientists working on malaria, why is it still such a big issue?

What is the United States government doing with its funding that is making things so much worse? And is there a vaccine for malaria? If so, can I get it?

A reminder to our listeners, Please contact us with your questions on travel, health, your stories, and your tips for success, or if you have a request for clarification for something you’ve heard on a previous episode, we would love to hear from you. Just Visit our website germandworm.com or drop us an email germandworm@gmail.com before we jump in our medical disclaimer.

This podcast is designed to inform, inspire, and entertain, but you should not use this podcast as clinical care. Before you travel, please see a qualified healthcare professional for recommendations specific to you and to your itinerary.

Well, Chris, right now I’m in Seattle. Where are you coming to us from, please?

WORM
00:01:40.310 – 00:01:47.350
You know, I am on the island of Sicily, my first visit here, and I’m getting fat, frankly, on gelato and pasta.

GERM
00:01:47.510 – 00:02:05.410
I think gelato and pasta in the bloodstream, that’s what attracts the anophelene mosquito. So be careful for malaria. I think they’re. They’re brought in by that. We’ve talked about this before.

There actually are certain things in the diet that might pull in the mosquito. I don’t know that pasta and gelato is one of them, but let’s find out with an n of 1. That’s the kind of clinical trial I can get behind.

Chris, you let us know how, how it goes.

WORM
00:02:05.490 – 00:02:09.250
I might have to eat even more gelato to really make it a robust study.

GERM
00:02:09.650 – 00:02:11.530
From your lips to your stomach. Perfect.

WORM
00:02:11.530 – 00:02:26.290
All right, Paul, first question for you and before we get into the juicy recent issues of Malaria, I was thinking maybe you could give us a bit of an overview. Just what causes malaria? What are the symptoms? What’s going on with the disease burden on the planet?

GERM
00:02:26.450 – 00:06:47.490
Malaria is a parasitic infection. It’s an infection by a single celled or protozoan animal.

Microscopically small germ that comes to us when we are bitten by the female mosquito of the genus Anopheles, especially Anopheles, Steven’s eye. But there are other species of mosquito that can do this.

When we are bitten by the mosquito, a little bit of those parasites come out from the mosquito into our bloodstream.

They go to the liver, they multiply furiously, then they spill out into the blood and they enter our red blood cells, feasting on the hemoglobin that’s inside our red blood cells. That’s a huge problem because we need hemoglobin to carry carbon dioxide and oxyge around the body.

When they eat our hemoglobin, they destroy our red cells. That gives us something called anemia, and it can make us very sick and ill indeed. High fever, anemia, those are the classics.

But it’s worse than that. There are also complications of malaria. If you happen to be pregnant when you’re infected, the pregnancy will indeed be threatened.

It can go to the brain and cause cerebral malaria. It may go to the spleen, it may go to the kidneys. There’s all kinds of bad effects that can happen with malaria.

Now, most people who get this will have what’s sort of an influenza like illness with fever and fatigue and anemia, and eventually their immune system will knock it out. But a small percentage of people actually will not survive malaria, especially their first episode.

The deaths that typically happen are usually in young children in sub Saharan Africa. But Chris, unfortunately, tragically, each year we also have travelers from the United States, from Europe, who go to these interesting places.

They may not take their preventative medications and other steps as necessary. And some of them, unfortunately, will get malaria. A few of them will even lose their life.

Globally speaking, this is a problem not only for travelers, but of course, for people who live in these areas.

Based on the best estimates that we have from World health organization in 2023, there’s an estimated 263 million cases per year and unfortunately, almost 600,000 deaths worldwide.

Now, there’s a number of species of malaria that infect people, but the one that is most deadly and therefore most problematic is called Plasmodium falciparum. Plasmodium falciparum is what accounts for more than, well, the great majority of deaths worldwide.

And that’s the one that we focus on when we meet with our patients in pre travel counseling.

The problem here is that we actually have, we’ve made progress with respect to the global burden of malaria, but that global burden unfortunately continues to rise. Why is that? Why is things getting worse? Well, first of all, there’s more people. There’s just more people in the world.

That includes sub Saharan Africa. The population of sub Saharan Africa has grown from less than a billion to 1.7 billion just over the last 20 years.

So there’s absolute numbers of people that is rising. That means the absolute numbers of malaria is going up as well. That’s a huge issue.

Now we, we do have vaccines that can be used for many of the people living in these areas. We’ll talk about vaccines soon. But the point is the, we can do better.

And unfortunately, one of the global leaders in the prevention of malaria has been, has been defunded. That’s the U.S. agency for International Development, USAID.

I’m a huge fan of USAID and I’m hopping mad that it has been basically destroyed by the current federal administration. It’s very clear that slashes and elimination of USAID has dramatically worsened the situation for malaria for people living in these areas.

Recent report on April 23rd, 2026 published in CIDRAP has outlined this that the dismantling of the U.S. agency for International Development has forced health ministries in countries that are highly endemic, like Zambia, to dramatically cut back on their malaria prevention and case finding and treatment. This is a problem for the people who live there because they’re more likely to get sick and die.

And it’s a problem for American citizens who are eager to visit these interesting places because we too when we travel are therefore more likely to become infected. So it’s a terrible mist cutting off funding to USAID for many reasons.

Here’s yet another example of why that is shortsighted, ethically wrong and just plain dumb. Chris, what are the bottom lines in your opinion for people who may be considering traveling to a place where there could be malaria?

WORM
00:06:47.970 – 00:07:51.080
Paul and I could talk for hours on malaria and we will go into details in just a moment. But I can also summarize the take home message for the traveler, really in a sentence or two.

When you go to an area with malaria, you want to take a medication to prevent it and you want to use what we call BAM bug avoidance measures, also called ppms, personal protection measures. And that consists of and You’ve heard this from me before. Something to your skin like DEET or Picaritin, something to your clothing like permethrin.

And sleeping under a bed net if your sleeping quarters are not air conditioned. If you do that, you’re very unlikely to get malaria.

Which when they do studies on people who get malaria and come back to the US the great majority were either taking no medication or the wrong medication and didn’t use bug repellent. So if you do bug repellent and take a medication, you don’t tend to get it. If you don’t, you may and it’ll make you really miserable.

And Paul, I have a question for you. Now, the regions with malaria, are the boundaries fixed or do they change over time?

GERM
00:07:51.560 – 00:10:05.940
Yeah, I mean, things change, right? And not in a good way. What we think is happening, of course, is that the climate is changing.

We’re getting hotter and more violent in our changes of weather. And of course that’s due in very large part to what we’re doing to our own environment.

By increasing carbon dioxide and other pollution into the atmosphere, the weather gets more violent. And that means mosquitoes love that. They love the chaos, they love the heat.

In fact, there’s an estimate that perhaps between 17 and 20% increase globally.

Speaking of land that is now suitable as a home for the vector of malaria, I’ll say it again, the female anophelene mosquito has more places to live, and that’s because of what we’re doing to our environment. So this is one of a bajillion examples of why we should stop trashing our house, basically.

And that’s true in sub Saharan Africa, that’s true in Horn of Africa. That’s true in temperate parts of South Asia and East Asia as well. If you’re planning to travel to the Ethiopian highlands. And by the way, please do.

It’s super interesting and beautiful if you can do it in a way that is safe. But it’s getting hotter there. It’s been a point two degrees centigrade increase per decade over the last few decades in Ethiopia.

The hotter it gets gets there, the higher those mosquitoes can go and the more people at risk of acquiring the infection. That’s true in South America, that’s true in Asia as well. And it’s also true here, isn’t it, Chris? In good old US of A.

As of 2023, and that year, we had 10 cases of malaria acquired locally. Now many more cases, of course, for people traveling from the US catching malaria for a variety of reasons, we’ll talk about and then coming home.

I’m talking about folks going in their backyard or just going on a local trip and catching infection. In 2023, we had cases in Florida, Texas, Maryland, and Arkansas. These are not travelers. These are folks getting sick in those areas.

That’s the first time we had had locally acquired infection in more than 20 years, and the most cases nationally we’d had in 35 years total. So this is a huge problem.

And I think it’s one of the reasons why we should be thoughtful about what we do with our personal responsibility, protecting ourselves. It’s also what we should do as a society to try to take better care of our habitat and our planet. To make it harder to catch malaria and not easier.

WORM
00:10:06.180 – 00:10:34.990
Yes. Specifically, some of the things that are happening there are altitude shifts.

So usually previously mosquitoes couldn’t go above, say, 5,500ft or 6,000ft, but now they’re going higher. So in places like Papua New guinea, in the African highlands, where previously it was too cold for mosquitoes, now there’s mosquitoes.

So malaria is spreading there. Also, there’s latitude shifts. So basically, mosquitoes are going north and south, further from the tropics as the planet warms up.

GERM
00:10:35.310 – 00:10:45.390
Okay, Chris, look, science has been working on this for a long time. A lot of smart people trying to fix the malaria problem. Why is it still such a big scientific issue?

WORM
00:10:45.550 – 00:12:11.340
Well, a lot of bright people are working on this. I’ve worked with some of the scientists who’ve dedicated their whole careers to this, and these are really smart researchers and doctors.

But it’s stupendously complex. You have this interaction of the malaria parasite and mosquitoes and people. You have different species of malaria. Each has a different distribution.

They cause different symptoms. You have different types of mosquitoes that have different feeding patterns. You have different populations of people with different susceptibility.

There’s actually entire fat textbooks on malaria. And there’s docs, as I say, who spent their entire career on that.

And the more I read about it, the more I appreciate the complexity, the mathematics of it. When you look at things like the intrinsic incubation period, the extrinsic incubation period, it looks like calculus.

So you can predict over time, putting in all the variables. But it takes rain and elevation and temperature and standing water and the density of people all figure into these complex things.

Plus, Darwin lives by which I mean, as soon as we come up with a cure or an intervention, then there’s a genetic shift and resistance occurs. So the more I learn about it, the more I realize how phenomenally complex it is.

The only way we’re going to make inroads is by a sustained global effort. Which is why, like Paul, I’m somewhat appalled at recent cuts to usaid.

GERM
00:12:12.700 – 00:14:01.290
I can tell you there are some scientific problems that are hard, and there are some that are really hard. Malaria is really hard.

You may remember, Chris, I came to uw you for training in id, in large part for the opportunity to work with a wonderful mentor called Wes Van Voorhis.

Wes is still my mentor and friend, and I came here to work with him on the topic of trying to build new medications for the prevention and treatment of malaria and focusing on the phosphodiesterase genes in Plasmodium falciparum.

So that basically that means that I spent some years in the lab feeding the parasites, getting to know them, feeding the blood, often my own blood, and, you know, trying to do genetic engineering within Plasmodium to understand how these genes work. It is crazy. Their genomics are madness. They have the weirdest DNA structure of any organism I’ve ever come across. So many AT repeats.

It just makes every single aspect of this parasite is difficult to work on scientifically. I’ll just leave it there. I could talk about it all day.

Bottom line, I gave up that work, basically got frustrated and also really seduced by the concept of seeing more patients, doing more teaching and this field that I focused on for these last 20 years, antimicrobial stewardship. But the bottom line is I have tried this. I can tell you from personal experience, these parasites are tough mothers. They don’t make it easy on us.

It’s not that scientists are lazy. It’s just that they are doggone difficult to work with. Now, Chris, speaking of which, there’s a lot of misinformation among travelers out there.

Why does that happen? Why are people seeing so much false news when it comes to malaria and its prevention?

WORM
00:14:01.610 – 00:15:02.830
Well, first, let me just acknowledge that I think you’re 100% correct. I think there’s no area of travel medicine, or maybe even of all medicine in which I found so much misinformation.

So I, as a doc, I prescribe birth control pills and antibiotics and pain pills and blood pressure pills. But I’ve never heard so much bogus information spoken as if it was gospel truth as I have on malaria medications. I’m not sure why.

I’m curious to hear your theory. I have a theory. And go ahead and poke holes in this. My theory is that travelers need a travel story.

And 100 years ago, there was some actual danger, maybe your boat would sink, or 150 years ago you get eaten by lions somewhere. Given that travel is generally very safe now, people still have a need for danger, for a story, for a narrative, for a threat. And so they’ve.

With the sunken boats and the eating lions have been replaced by side effects of malaria drama drugs. So that’s my theory. What do you think, Paul?

GERM
00:15:03.390 – 00:15:46.150
Yeah, I think it’s one of these perfect storms of an infection that is, in the US Context, very rare and yet also very great threat. And so if people would just see this more often, I think they might take it more seriously.

Thank you to our listeners for being loyal listeners of German Worm and for listening to what we say. You know, you don’t want to catch malaria. And so let’s talk about that.

If you ever have a doubt about whether this is something that is real or important, it is not fake news. It is important.

And so thank you very much for meeting with your travel health professional specialist before you travel and doing what they tell you to avoid catching malaria. Yeah.

WORM
00:15:46.150 – 00:16:10.950
And just a couple myths very quickly. The medications are not poison. Some of the older ones were higher side effects, but we have drugs now to prevent malaria.

Most people don’t even know they’re on them. And also the drugs are not worse than the disease.

Also, I still hear repeatedly that, ooh, once you get malaria, it’s not curable, it can flare up for the rest of your life. And no, if we can diagnose it, we can cure it. So those are just a few of the many myths that I hear myth.

GERM
00:16:10.950 – 00:16:14.070
Mythbusting here at Germ and Worm. We’re happy to do that with you all day long.

WORM
00:16:19.060 – 00:16:24.660
Paul, question for you. Ooh, this is good. Tell us a little bit. Is there a vaccine for malaria?

GERM
00:16:25.620 – 00:19:44.680
In fact, there are two vaccines to prevent malaria that are approved and recommended by World Health Organization. Neither one of them is FDA approved for use in travelers.

Neither one of them is available for people, let’s say, for example, living in the United States, who are going to travel to a malarious area. That could change. But.

But this is still very exciting because for the people who live in these endemic areas, we have, yes, two vaccines which are not perfect, but very good. And that can help to reduce the global burden of malaria if we would only deploy these vaccines broadly, very briefly. We have two of them.

One is called rtssaso1 or moskiriks, and the other is called R21 Matrix M. And these are designed on what’s called the circumsporozoite protein. That’s part of the protein that we see initially when we are bitten by the mosquito and we have early infection with the parasite.

Like I talked about, it has to reproduce in the liver before it gets to the red blood cell. That’s the timeframe, that’s the opportunity for us to mount a good immunologic response.

And that’s the phase of the parasite life cycle that both of these vaccines focus on.

That’s super duper exciting because for children living in these areas, based on very high quality placebo controlled trials, we have efficacy more than 56% for mosky ricks and efficacy basically at 70 to 75% for the matrix M, dramatically reducing the severe episodes of malaria in young children in Sub Saharan Africa. So again, I’ll say it again, this is for kids who are living there. It’s not for adults, it’s not for Americans.

And if you travel to these areas, you will not be eligible to receive them either. So that’s different from the dengue vaccine, right, Chris?

A little bit of a different story, but I just want to put it out there that if we can reduce malaria burden even by half in young kids, that’s a huge number of potential illnesses and deaths that can be averted. By itself, it’s not enough. There are other things we have to do, like bug avoidance measures and chemoprophylaxis and case finding. It’s possible.

Part of that overlapping crazy quilt of prevention for malaria in sub Saharan Africa. It’s very exciting. This deserves all kinds of Nobel prizes and fanfare for sure. And it’s the kind of thing that the United States should fund.

And of course we’re not, we are making this worse. We have cut funds to the Challenge for Malaria Vaccines initiative.

The United States has reduced its investment in these important areas and that is making things harder, harder for people to make new vaccines, harder for people to do clinical trials proving that they work and to expand the use of these life saving and by the way, very safe and non toxic vaccines.

So once again, the United States, which should be at the tip of the spear and the cutting edge of vaccine development to make the world a better place, including for Americans, including to enhance American biosecurity. No, we’re doing, doing the exact opposite. We’re making the world less safe, less secure, less healthy. And it’s a cry and shame.

Chris, a question to you. This comes to us from Edith of Cornwall in the uk.

Edith asks what happens if I tell my doctor that I don’t want to take a medicine to prevent malaria.

WORM
00:19:45.480 – 00:20:43.400
Well, thank you, Edith, for the question. As doctors, we give advice. We don’t give orders. So were I to see you before a trip we abroad, I would encourage you to take a medication for malaria.

If you were going to an endemic area, I would tell you the advantages and the side effects and overall say that I recommend that you do it. But people don’t take our advice all the time, and that’s okay. I’m presuming, Edith, that you’re an adult and it’s your call. You’re the boss.

So I would give advice. You can take it or not take it. If you said no, I would still respect you. I would still care for you.

I would say, say it’s all the more important that you do bug repellent, because that will significantly bring your risk down. Not as much as taking a drug, but significantly. But in answer to your question, just tell the doc, and ultimately, you’re the boss.

And if you don’t want to take it, don’t be bullied into taking it. It’s your body. You’re going to be the one who gets side effects, if any.

And I fully respect people who listen to my advice and say, thank you, but I’m going to do something else.

GERM
00:20:44.360 – 00:22:12.550
I’d love to speak with Edith. And we do this right, Chris, in our clinical practice. And if it is a partnership, it requires that clear communication.

If a patient says that they are hesitant, reluctant to use a medication, you know, let’s talk about it. What is it that somebody is worried about?

It may be some of that fake news that we talked about before, Chris, Somebody’s worried about side effects or toxicity or cost.

All of those, in my experience, they’re all very manageable, and they’re all minimal and certainly, certainly much less of an issue than catching malaria itself. It’s not just the risk of dying. I mean, dying is bad. I’m against dying.

I also would just ask this person, do you have time for malaria when you come back from this vacation?

Do you really want to go to my hospital and spend a few days in hospital receiving tests, treatments, sitting in a hospital bed, or even just to be treated at home and be so sick that you cannot work because you’re so anemic? I mean, I personally, I don’t have time for malaria. That’s just that I don’t want to catch it because I don’t look bad in front of my patients.

You caught malaria. What are you doing? You hypocrite. No, it’s also. I just, I’m too damn busy. I think most of our patients are as well.

And if we frame it that way and offer a number of opportunities for different choices of preventative medications. Yeah, in my experience, Edith, I think you would come to that decision and I certainly hope that you will. If you have chosen this.

Hey, drop us a line germanwormmail.com Let us know your decision, the place where you went, and hopefully that you had a good and safe experience regardless of whether you took that medicine.

WORM
00:22:13.430 – 00:22:17.430
And Edith, if you don’t take the medication, we still like you. And again, thank you for the question.

GERM
00:22:18.230 – 00:22:18.950
That’s right.

WORM
00:22:25.990 – 00:22:31.910
Paul, question for you. Speaking of bug avoidance measures, what’s new for bug avoidance measures?

GERM
00:22:32.950 – 00:25:12.190
So, bug avoidance, you know, usually we talk about the things that are still our core, which is personal use of insect repellent and pre treating our clothing with a knockdown such as permethrin. So permethrin on the clothes, Picaridin or DEET to your body. But now there’s, there’s more. There’s much more. There’s lasers. There’s frickin lasers.

Isn’t that what Dr. Evil said he wanted? Some frickin lasers on the heads of sharks. There’s lasers for mosquitoes.

And we’ve known about this idea and concept for a long time that if you have a, you have a little laser gun that sits there and is robotically controlled using lidar to, to track the mosquitoes, that you can triangulate their position and cook them with a little burst of laser energy. It sounds like science fiction.

There are a number of products that are out there today, some of which you can purchase on the commercial market for less than a couple hundred bucks. I think ebay will send you one of these. Look, they’re not approved by the fda.

I’m not aware of high quality testing that has showed them to reduce malaria in a given area. But it’s super exciting if it’s real. I’m almost, it almost seems too good to be true.

But the concept is that you find a place where you’re going to stay, a village, a household, and you put one of these things down, give it an electrical supply and let it do its thing.

And supposedly it won’t blind you, it won’t kill your pet cat, it somehow knows what it’s shooting at and you can dramatically knock down these, you know, these bugs within a range of say 6 to 10 meters, something like this. They’re meant to be harmless to Everybody else but killer to the mosquitoes. If that’s true, I gotta tell you, I love the idea.

I would not suggest you go out for a handheld laser. How are you gonna aim the damn thing? The mosquitoes are too fast. This has to be an automated process.

If this turns out to be real, in other words, truly effective, I think it’ll be very exciting and I’m eager to learn more about this. If you see something on your social media feed about buying a laser station, number one, I would say, in my opinion, I think it’s too early.

I would probably save my money. Number two, if you go against my advice, send us a line so we know whether it’s working in your own hands.

We need a lot more information about these to make sure that they’re working. Theoretically, it makes good sense. And by the way, you should do this and not feel guilty.

I mean, are you going to kill off the local bird or frog population by killing these mosquitoes? Look, they are a meal to other species that are out there. They’re part of the ecosystem. I don’t care.

When it comes to human misery, suffering and death. If there is something that can do this without toxifying the environment and such, I would actually be very supportive.

But for the moment, color me laser skeptical.

WORM
00:25:13.150 – 00:25:29.460
Yeah, I have to agree. Even though this would make Dr. Evil really happy. What I want to see and I haven’t seen is a study is a research article.

What I’ve seen is advertising from companies that, that make a profit, which always makes me a little suspicious. So, yeah, I’m skeptical but interested and paying attention.

GERM
00:25:29.940 – 00:25:40.660
Chris, question to you from Tina of Halifax. How can I correctly diagnose myself when I get malaria?

WORM
00:25:41.060 – 00:26:54.540
Oh, thank you, Tina, for the question. You can’t accurately without laboratory confirmation.

So there’s characteristic symptoms you tend to get when you get malaria, including a high fever and sweats and chills and general misery and headache. However, they’re not specific for malaria.

And even Paul and I, specialists in the field, cannot diagnose someone with malaria based on history and physical exam without specific specialized laboratory testing involving microscopes and chemical tests. So suppose you’re somewhere where there’s malaria and you start to get fever and chills and sweats. Do you have malaria? Well, maybe.

Do you have dengue fever? Maybe. Do you have typhoid fever? Chikungunya, Something else or a pouche maybe.

There are blood tests that laboratories run, little card tests where you drop on some blood and some reagents. And you get a positive or negative. Kind of like a home pregnancy test, but much more complicated.

But they’re not approved in the US outside of laboratory use. So long way of saying how do you correctly diagnose yourself? It’s tough.

And what you should do if you get symptoms that are possibly malaria is go see a medical person who can do proper testing.

GERM
00:26:55.500 – 00:27:19.140
Yeah. There’s still some role for us as medical doctors. You need to see a doctor and that’s because maybe you’re right, it is malaria.

You’ll need treatment, maybe you’re wrong, you’ll need something else. So please do not hesitate to get with your doctor. Don’t feel guilty if you missed your dose of medication or you didn’t use your deet.

We will still take care of you. We will not cast aspersions upon you. We’re going to take good care of you. Please come see us and do it right away.

WORM
00:27:20.260 – 00:27:33.540
Yeah. Malaria can go from minor to life threatening to you being dead in 24 hours for the falciparum variety. And that’s really too good of a travel story.

You want to be the one to tell your travel story, not your next of kin.

GERM
00:27:34.340 – 00:27:35.140
Agree? Agree.

WORM
00:27:39.630 – 00:27:50.990
Paul, next question for you. Someone writes in, I’m not good at taking daily medications. Is there another weekly option other than Mefloquin that will not make me crazy?

That works.

GERM
00:27:51.470 – 00:30:38.900
Yeah. Thanks for that. So Mefloquin is an old time malaria preventative. It works well, but for some people it does cause vivid dreams.

Some people find arousing or alluring, other people find terrifying. And it also has a bad rap for potentially causing serious psychiatric issues, which is rare but apparently real. And so I appreciate this question.

The nice thing about Mefloquin was once a week, but it had these potential for side effects. Is there anything else people can use?

And the answer to this question is yes, there’s a medicine called Tafenaquine which is a relatively newer option. It is also taken once a week instead of once a day. Most of our patients do very well indeed taking Etovacrone, Proguanil or Malarone.

That’s what I usually use when I travel. And Chris, I think you’re the same. Yep, ditto. Yeah. So for people who do not have an issue taking daily medications, we usually start with Malarone.

But if you prefer a weekly option, yes, Tafenaquine is a good one. And when it’s compared with mallourone or doxycycline or Mefloquin, it works very well indeed. It is not inferior to those other time tested options.

And in fact, Tofenaquin now has this as an indication for its use. It does have one issue to Fennaquin. It’s not gonna cause vivid dreams that I know of. It’s not known to do that, although I suppose it’s possible.

No, the issue that we have, it’s something that we worry about as your medical doctor and that is this uncommon but very common real issue for people who have deficiency of an enzyme called G6PD. Glucose 6 phosphate dehydrogenase is an enzyme that we all have and need in our bodies and it helps us process energy.

It’s an important thing to keep us Alive. And about 1% of people alive today have lower levels than others. They’re healthy and normal. They would not realize that they have low G6PD.

But with tafenaquine and other related medications, that can precipitate a crisis if someone actually has low G6PD to start with. And that can make people very sick indeed, causing hemolysis, triggering a case of hemolytic anemia, which by the way, is what malaria itself causes.

So that’s a real kick in the shins if that happens.

The point is, if you’re thinking about taking a weekly dose of Tafenaquin to prevent malaria, you should have a blood test first to make sure that you have normal G6PD activity again. Globally it’s about 1% of people, but there are certain populations where it may be a higher risk.

I would not prescribe to Fennequin to someone without a G6PD test in advance. That’s not an expensive test. It does take a day or two to come back and so it’s an extra step in the Travel Health process.

But it’s something that I would be happy to do. Chris, I suspect you would be happy to do the same as well.

WORM
00:30:39.550 – 00:30:50.430
Yeah, you bet. You bet. Also, listeners, if you’ve taken to Finiquin, I’m doing an informal collection of anecdotes. Drop us a line. Did you have side effects?

Did you not have side effects? Let us know.

GERM
00:31:06.920 – 00:31:45.160
Everyone. Thank you so much for joining us here on episode 101 of Germ and Worm. As always, we welcome your questions on Travel Health.

Please send them along or with tips for travel success. Suggested corrections we would love to hear from you, germandworm@gmail.com or visit our website germandworm.com if you have enjoyed what you’ve heard here on Germ and Worm, please subscribe. Rate us favorably on your device and spread the Word with friends, family and on the socials. Those are free ways to support us on this podcast.

Please join us next week for episode 102, tick tock 2026. Your questions asked and answered about tick related infections. Until then, I’m Germ, I’m Worm.

WORM
00:31:45.160 – 00:31:47.080
It’s a big planet seed and good health.

GERM
00:31:47.720 – 00:32:09.680
We’ll see you next time.

This podcast is designed to inform, inspire and entertain, but it does not establish doctor patient relationship and so this podcast should not replace your conversation with a qualified healthcare professional. Please see one before your next adventure.

The opinions in this podcast are Dr. Sanford’s and Dr. Pottinger’s alone and do not necessarily represent the opinions of the University of Washington or UW Medicine.