The most effective and thus desirable measure to prevent malaria is a large- scale vaccination; although significant progress has been made in the research field, at present, there is not a licensed and commercially available vaccine.

Prevention is organized in the following lines of action:

I. Vector control II. Bite protection III. ABCD model for travelers

Indoor Residual Spraying (IRS): IRS  is carried out with a hand-operated compression sprayer only by well- staffed and well- equipped services. The selection of the insecticide depends on the possible resistance, the level of efficacy, the cost- effectiveness, the safety and the type of the surface that needs to be sprayed. DDT seems to have long efficacy that lasts at least 6 months; it should be mentioned that the usage of different type of insecticide every year is recommended. 

Fogging/ area spraying: is effective in reducing the density of adult mosquitoes. 
       
Larval Control: larval control methods are applied in the breeding sites of mosquitoes. i) water management: larval sites may be drained, ii) chemical larvicides: Themiphos is the most used agent and can be used in potable water collections, iii) biological larvicides: biopesticides such as Bacillus thuringiensis seem to be effective but they should re- introduced every two weeks; larvivorous fish such as Poecilia reticulata and Gambusia affinis can be used into collections of potable water in rural and peri- urban areas in order to control the mosquito population.   
     
Genetic control: the best known method is the male mosquito sterilization technique which aims to the production of sterile eggs after mating.   
    
Insecticide Treated bed- Nets (ITNs) and especially LLINs (long- lasting insecticidal nets- up to 3 years): they seem to be the most effective protection during sleeping. The mosquitoes that seek for a blood meal do not wait in the room but they are either repelled or killed after contact. The net should be checked for holes and must be tucked in under the mattress so that there is no way through for the mosquito. In conclusion, ITNs reduce the human biting rate and the mosquito daily survival rate.

Insect repellents: they are applied to exposed skin and sometimes to clothes at dusk when the anopheline mosquito becomes more active.[1, 2] Repeated applications may be required every 3–4 h, especially in hot and humid climates.[2] There are two categories, synthetic chemicals, such as DEET (N, N- diethyl- m- toluamide) and KBR305 (piperidine), and plant derived products such as eucaluptus oil.[1, 2] Aerosol sprays: they are used for quick knockdown and killing.[2] Mosquito coils: they contain pyrethrins and synthetic pyrethroids; the insecticide is released by the burning coil and can protect everyone in the room.[1] Vaporising mats/ liquid vaporizers: they function with electricity. They heat up in order to release pyrethrins and they seem to be more effective than coils.[1] Protective clothing: the material has to be thick enough so the insect can not bite through. It is very important to use clothes with long sleeves and long trousers (tucked in the socks) so that wrists and ankles are respectively protected. The clothes should be treated with insect repellent as well as the exposed skin. [1, 2] Screening doors and windows[1] Air-conditioning[1] Insecticide Treated bed- Nets (ITNs)

III. ABCD model for travelers to malaria endemic countries

The ABCD model has been configured in order to help travelers to endemic countries protect themselves from a probable infection and illness and to prevent importation of the disease when returning.

Awareness.   Without awareness of malaria risk it is unlikely that an individual will take precautions. People should be informed about the malaria transmission and prevention; they must develop a preventative behavior and learn to comply with chemoprophylaxis. However, there are some barriers, including age, sex, ethnicity, education level, personal beliefs, that obstruct the deployment of a compliant to the advices behavior.   

Bite protection.   Personal Protection Methods  (as described above)    

Chemoprophylaxis.   More and more people travel across the world either for business or for pleasure while malaria remains the most important cause of fever in returning travelers. During the transmission season in endemic countries, all travelers that are exposed to mosquito bites, are at risk of malaria. In addition to personal protection methods, prophylactic drugs should be given accompanied with accurate information and instructions. The selection of the appropriate chemoprophylaxis depends on the estimated infection risk, the drug resistance status, the possibility of side effects and the health beliefs of the traveler that may affect his compliance.  Chemoprophylactic therapy should be started one week before departure in order to (i) observe possible side effects before the journey and (ii) to achieve adequate blood levels of the drug at the time of possible infection, and should be continued for four weeks after return. Another measure is the “stand- by therapy”; in that case, travelers are prescribed and carry a course of treatment for use in case of fever or strong clinical suspicion of malaria. Thus, travelers should be fully informed on how to take the medicines, the symptoms, possible side effects and of course the possibility of therapy failure.

Diagnosis. Unfortunately, many clinicians are not familiar with the disease and diagnosis may delay having consequences such as complications of the disease or even death. Therefore, any fever combined with headaches, weakness, nausea, diarrhea in a returning traveler should be considered as malaria until proven otherwise. Travelers should be advised to immediately search for medical examination and rapid diagnosis when influenza- like symptoms occur within one year of returning from a malaria- endemic country.