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Malaria kann unbehandelt tödlich enden, einen Impfstoff gibt es nicht. ##Foto: pixabay
Foto: ... Malaria-Schutz auf Reisen Wann muss ich Tabletten nehmen? Was verbindet eine Safari in Afrika, Insel-Hopping in Asien und eine Rundreise durch Südamerika? Der Reisende kann sich eine gefährliche Malaria-Erkrankung einfangen. Doch das Risiko ist nicht überall gleich.
Wie schütze ich mich vor Malaria? Malaria tropica, die besonders gefährliche Form der Krankheit, wird von Mücken übertragen. Der beste Schutz ist also die konsequente Abwehr von Mücken – mit langer Kleidung, Moskitonetz für die Nacht und einem mückenabweisenden Mittel mit dem Wirkstoff DEET oder Icaridin. »Die Mücken sind vor allem während der Dämmerung und nachts aktiv«, sagt Prof. Jürgen May vom Bernhard-Nocht-Institut für Tropenmedizin in Hamburg. Diese Maßnahmen sind allerdings kein endgültiger Schutz – eine Mücke kommt vielleicht doch durch. An dieser Stelle setzt die sogenannte Chemoprophylaxe an: Sie verhindert nicht die Infektion mit dem Erreger, aber den Ausbruch der Krankheit, wie Prof. Tomas Jelinek erklärt. Er ist wissenschaftlicher Leiter des Centrums für Reise- und Tropenmedizin (CRM) in Düsseldorf. Urlauber müssen bereits vor Beginn der Reise und regelmäßig währenddessen ein Medikament einnehmen.
Welche Tabletten sind auf dem Markt?
Die Wirkstoffe sind Mefloquin (Handelsname Lariam), Doxycyclin und Atovaquon-Proguanil (Malarone). »Lariam wird nicht mehr produziert, aber noch abverkauft, es kann also noch verschrieben werden«, sagt Sebastian Graefe, Facharzt für Mikrobiologie, Virologie und Infektionsepidemiologie in Hamburg. Doch schwere psychische Nebenwirkungen sind möglich. Doxycyclin ist ein altbekanntes Antibiotikum, das in Deutschland aus formalen Gründen nicht für eine Malaria-Prophylaxe zugelassen ist. Trotzdem wird das Medikament von der Weltgesundheitsorganisation WHO empfohlen.
Bleiben Malarone und die entsprechenden Nachahmer-Präparate mit dem gleichen Wirkstoff. »Sie sind sehr teuer, haben aber ein ganz gutes Nebenwirkungsprofil und sind auch als Notfalltherapie geeignet«, erklärt Graefe. Erwachsene nehmen täglich eine Tablette ein. Man beginnt etwa einen Tag vor Abreise und setzt die Einnahme bis sieben Tage nach Rückkehr aus dem Verbreitungsgebiet fort. Zwölf Pillen kosten mindestens 50 Euro, oft sind also zwei Packungen nötig.
Welche Nebenwirkungen haben Malarone und Co.?
Zu den üblichen Reaktionen gehören Übelkeit, Kopfweh und Schwindel. Der eine spürt sie stärker, der andere gar nicht.
In welchen Ländern muss ich besonders vorsichtig sein?
Malaria ist eine Tropenkrankheit. Die Experten empfehlen eine Chemoprophylaxe aber nur in sogenannten Hochrisikogebieten. Dazu zählen die afrikanischen Länder südlich der Sahara bis hinunter nach Mosambik – und in der Regenzeit auch der Nordosten Südafrikas samt Krüger-Nationalpark – sowie die Inseln Südostasiens östlich von Lombok bis einschließlich Papua-Neuguinea. Doch auch in anderen Malaria-Verbreitungsgebieten sollten sich Touristen vor Mücken schützen, weil dort eine Infektion möglich ist. Insgesamt kommen Malaria-Mücken in rund 90 Ländern vor, auch in Südamerika. Die WHO informiert auf ihrer Website über die genauen Risikogebiete.
Was tun in Malaria-Gebieten mit geringen oder mittlerem Risiko?
Die Experten raten, in solche Regionen ein Präparat zur Notfall-Therapie mitzuführen – vor allem, wenn es dort keine medizinische Versorgung gibt. »Damit kann man sich selbst behandeln, wenn man Fieber bekommt oder die Krankheit ausbricht« sagt Graefe. Die wichtigste Vorsorge sei aber guter Mückenschutz.
Wer zahlt für die Malaria-Tabletten?
In der Regel muss der Reisende selbst die Kosten für die Tabletten übernehmen, sagen die Mediziner. Es gibt aber einige Krankenkassen, die die Prophylaxe-Pillen zahlen.
Wann zeigen sich die Symptome von Malaria?
»Es dauert mindestens eine Woche, bis Symptome auftreten, oft auch zehn Tage oder zwei Wochen«, sagt May. Die Infektion äußert sich dann wie eine echte Grippe: mit Wechselfieber, Schüttelfrost, ausgeprägter Müdigkeit und Unwohlsein, Durchfall, Kopf- und Gliederschmerzen.
Wie gefährlich kann Malaria werden?
»Wenn man die Malaria rechtzeitig behandelt, ist das keine aufregende Sache«, sagt Jelinek. Wer nach der Rückkehr aus einem Malaria-Gebiet mögliche Symptome hat, sollte dringend einen Facharzt aufsuchen.
(03.11.2017, dpa)
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