Malaria Prevention

[Pete Trucker]

Travelling to Morocco, RIM, and Mali.

Anyone know the best anti maralial tablets for these three countries as my local nurse says I need different tablets for each country, is this true and I am now totally confused?

[Wheelie]

Malarone is a new wonder drug. We didn't have to start taking it until the day befor leaving for South Africa and only had to take it for one week after we came home. I experienced no side effects.

Remember it only takes one bite from one infected mosquito. Use insect reppellant, mosquito nets, smoke coils, etc.

[gourgas]

Our GP has just prescribed Savarine for Mali and pointed out that tourists taking anti-Malarials that are too strong for the area in question makes the mozzies resistant and thereby exaserbates the problem for those that live there. We tried for Malarone and he refused for this reason, also said no Larium. These two are only for the "drastic" zones.

[DougieB]

try Nomad in London. The doctor/nurse has actually travelled outside Europe.

You don't need different pills. Reportedly the bugs in east Africa are level 4, and larium is only level 3. I dunno, I'm no doctor.

I got bored of taking those horse pills, and took nothing through Mauri, Senegal, Mali, etc. though plenty of musti cologne (spray)...

[JADE]

i was recently in east africa (kenya, uganda and tanzania), i went 2 nomad in london, who were very helpful. they put me on droxycycline and i used heaps of deet repelent. but no matter how har i tried the little bugger still got me. at first i thought i was just tired and had a bit of a tummy bug. i was jst going 2 put up with it, but in the end my muscles were soooo sore i couldn't walk. so went to a hospital and they did a quick blood test taking 15mins and costing only $5US and then $8US for antibiotic and i was good as new in 2 weeks! cheaper than the expensive tablet inthe first place. stay away from larium make some ppl go really wacky, droxy not 2 bad jst wierd dreams. good luck

[Robbert]

Hey,

Lariam is not always bad, and not everyone can afford to be on malarone all the time. Some people experience all sorts of nasty things though, and you might be along some people, but there's a good chance you're not.

Did 9 months Lariam with no probs, came across people who got malaria although they where on lariam though.

Just did 4 weeks and picked up Savarine at a french pharmasist (it's actually a prescription drug, but I stood there with my pack on my back and he gave it anyway). No problems with Savarine, and pretty cheap too.

I always carry a package with Malarone tablets, because they say it's very good to treat malaria.

[Nigelrojo]

I spend about half my time working in Equatorial Guinea (West Africa), and have been doing so now for 6 years. For the whole time I have been on various types of Malaria medication.

I started on Chloroquine, which gave me mouth ulcers (and was allegedly not much use anyway, because the malaria parasite had already acquired a resistance to it). I had to change to something else. The other options at the time were Mefloquine (Lariam) or Doxycycline. My GP did not want to put me on Lariam because I am diabetic, so I went onto Doxy, which gave me no side effects at all. I know several people who were taking Lariam, and maybe 25% of them experienced hallucinations or other weird “mental” moments as a result. The one advantage Lariam has over all other malaria drugs is, you take it weekly instead of daily. I have never come across Savarine.

Doxycycline is a good drug, but it is basically a powerful antibiotic, not a purpose-designed anti-malaria drug. No doubt because of this, there are theories and rumours around such that Doxy can degrade your immune system if you take it for too long. I took Doxy for one year, then on the advice of our paramedic in Equatorial Guinea, I switched to Malarone. I have been taking it for 4 years now and have never had any problems (no malaria, no side effects). The only problem with Malarone is, it is very expensive. It can be used as a prophylaxis (ie, prevention), or as a treatment if you should get malaria. Malarone is effective against all types of malaria. You have to remember to keep taking it for a week after leaving the malaria zone (this applies to all anti-malaria drugs).

I should explain something about the different types of Malaria. There are 4 main types: Falciparum, Vivax, Ovale and Malariae. The ones to worry about in Africa are Falciparum and Vivax. Vivax is the less serious variant, although it can “hide” in your liver and recur sometimes years after you first get it. Falciparum on the other hand is often fatal if untreated, and it can kill you very quickly. It is unfortunately the prevalent type in West and Central Africa.

As far as specific risk is concerned, this is what my employer’s risk matrix says:

· Morocco: very limited Vivax risk in Khourigba province. Some Falciparum risk along the border between Western Sahara and Mauretania.
· Mauretania: Falciparum risk in the whole country except the provinces of Dakhlet Nouadhibou and Tiris Zemmour.
· Mali: Falciparum risk everywhere including main cities.

The malaria risk in the Sahara is seasonal (ie worse during the northern hemisphere summer), while in sub-Saharan Africa it exists all year round. Personally I would not take any preventative malaria medication in Morocco or Western Sahara, and I would only take it in Mali between May and November. For a short trip I might take Doxy instead of Malarone. I would however always have Malarone on hand for treatment if required.

Last point: there is another reportedly good malaria treatment drug available now, called RIARMET or COARTEM. I have no idea how much it costs or how easy it is to find.

Of course, the best thing is not to get bitten: use mozzie nets, DEET repellent, wear light coloured clothes with long sleeves at night (the falciparum-carrying mozzies are most active at night) and try not to camp near standing water.

Nigel