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At Nakon Sawan (Thailand) in 1990 I received 184 mosquito bites one night; in Malaysia saw some interesting multi coloured mosquitoes which turned out to be dengue (better learn about those before you go) and was bitten by a dog in Lahore. If you are going to stick to the tourist routes you should be right but if you want to visit the high ways and by ways I wouldn't take the risk. Surely there is some palatable malaria pills out by now?
Larium is the recommended preventative for malaria but lots of people react very badly to it. I took it while travelling in India for a month and had absolutely no problems at all - basically take a big pill once a week.
Apparently some people have incredibly harsh reactions, including psychotic episodes and nightmares, and a lot of doctors have stopped recommending Larium.
Some travel experts recommend that it is wiser to concentrate on preventions such as bug spray, mosquito netting, etc.
If you stay in places where there are a lot of pigs, for a period of 1 month or more, I'd say go ahead and get the Jap E shots. As for Malaria, you can get by with Doxycycline, it's a low-grade anti-biotic. It's a (small) pill per day and cheaper than Mefloquine (Lariam). As well, realize the malaria carriers are only the female bugs and only bite at sundown. You can make the best bug repellent in the world by mixing 3 part baby oil (cheap Johnson & Johnson stuff) and 1 part Dettol (old hospital disinfectant). Both are for sale in 3rd world countries. Mix the 3 and 1 part and shake well for a minute or two. The solution turns white. it's oily, but doesn't stick. You won't see a bug in miles and it doesn't smell bad. Positive side effect is that you disinfect your hands continuosly when you touch your skin. Keeps you from getting sick.
Re the Japanese Encephalitis, we're leaving in 2 weeks to go from B'desh to the UK and were advised that JE is seasonal, starting basically with the monsoon in June (there are some good websites offering advice - just do a search). Fortunately we will avoid the risk and the cost of vaccinations (AUS$250!). My friend had the vaccine in Australia and reacted extremely violently to it, having to be flown to hospital where he fell into a coma...fortunately he made a full recovery. As for the rabies, there doesn't seem to be any harm in being vaccinated so why risk getting a horrible illness? They are pretty painless too if you get them in your own country whereas if you wait till you're bitten, some countries still use the old painful injections in the stomach. Everyone will offer different advice re malaria, but it seems that if you're going to be going to a number of different areas, it's very difficult to choose a single drug that the mozzies haven't become resistant to somewhere on your route. The advice about prevention makes the best sense. Good luck!
My travel doc prescribed Hydroxychloroquine for areas north of the Panama Canal because it works, few people have side affects and it's relatively cheap. But, south of the Canal he recommends Lariam (aka Mefloquine) because the bugs are resistant to the cheap stuff. Lariam costs about $10 a weekly pill. Does anyone know if it's generally available in South America and, if so, how prices there compare?
Having toured through Bangladesh, I was advised to go to a Travellers Clinic (Australia) before going, anyway this organisation is throughout Australia and deal specifically for "adventure" travellers, anyway getting to the point I was advised/counselled by the Doctor on what to have as precautions. So armed with my "Needle" book I was given: Jap A, Rabies, Polio. I declined any Malaria precautions, having had it (7 times) from Papua New Guinea, there is a school of thought that dont take any precautions for Malaria as the drugs (Doxy) can mask Malaria and your getting a "hit" from Malaria but don't know it. I personally seen some one expouse the virtues of taking precautions only to get malaria (?).
There are Two types of malaria: one is in your liver called Vivax (garden-type variety malaria) the other the "killer" is Falciprum (sp?) and believe me that one is the nasty one.
Anyway, enough of the depressing stuff, have a true adventure.
I have travelled with a friend who had a reaction to Larium. She had dizzy spells which lasted for about a month after she stopped taking the tablets.
They still recommended for high risk areas but did speak to a missionary in Kenya who contrated malaria even though he was taking larium.
I have found Palludrin makes me very ill, have found Nivaquine ok but it needs to be taken in conjunction with an additional tablet, I had no reactions taking this combination in Africa. I will try to find out what the additional tablets were called.
Following is some useful info I picked up from Health Canada's website, which deals with the mefloquine (Lariam) debate.
" For travellers to high risk areas, the risk of acquiring malaria and dying is significantly greater than the risk of experiencing a serious side-effect from
mefloquine. Over 11 million travellers have used mefloquine prophylaxis and severe reactions (seizure, psychosis) to this drug are rare (reported in 1 in 10,000 to 1 in 13,000 users). The great majority of mefloquine users (95-98%) have either no side effects or only mild or temporary ones. Occasionally a traveller will develop a less severe but still troublesome neuropsychological reaction (e.g., anxiety, mood change) to mefloquine (1 in 250 to 500 users) requiring a change to an alternate drug. These reactions are almost always reversible. However, death from malaria is not.
At the present time, for high risk regions of the world, mefloquine is the most effective drug to prevent malaria. Alternatives typically offered to travellers to Africa to prevent malaria are significantly less effective and often more toxic than mefloquine, i.e., chloroquine, proguanil (Paludrine), amodiaquine, pyrimethamine plus sulfadoxine (Fansidar), pyrimethamine plus dapsone (Maloprim). Doxycycline is an effective alternative but may occasionally have troublesome side effects and must be taken each and every day in order to prevent malaria."
Public Health Information Statement
Endorsed by the Canadian Infectious Diseases Society, Canadian Society for International Health, and the Canadian Public Health Association
They don't say, but I do remember, that if you are going to have a reaction to Larium you will have it within the first two weeks, which should be before you enter the affected area, and will give you enough time to change prophylaxis if need be.
And, as many have noted on this thread, prevention is absolutely required, from mosquito repellent to long sleeves and pants after sunset.
Since most of our travellers are not staying in 'resort hotels', we all need to be concerned with this topic.
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I read in the paper the other day that taking Vitamin B1 or Thiamin helps keep mosquitos at bay. Apparently the skin secretes some compound or other that is odourless to humans but repellant to insects. I'm not suggesting to use it instead of anti-malaria drugs, but anything to stop the buggers biting can only help. Anyone else heard of this?
By coincidence I have just be been given two newspaper articles on Rabies and Malaria.
For rabies they are recommending the jab as apparently there is a world shortage of the blood product used to treat rabies. I can pass the articles on (scans if anyone interested - don't think I can post them here ?).
On Malaria. The article quotes 1 in 140 suffer side effects with Larium (enough to cause temp' problems carrying out of day to day duties). Goes on to state the alts of chloroquine and paladrine are not too effective and only 30% use in many regions.
You need advice to get the right medication for the region. Malaria is on the up though in travellers returning home!
Personally I've had the rabies jab - and never had a dog go near me (except europe) - I assume its not personal.
And I've always taken the chloroquine and paladrine for India / Nepal, though again I think its as much peace of mind as anything.
But space and storage is an issue on overland trips.
Its down to the individuals I guess.
Articles where from Telegraph (maybe under travel.telegraph.co.uk - don't know). Can scan and forward if anyone greatly concerned / interested.
[This message has been edited by Fritz (edited 04 May 2001).]
I found one of Fritz's articles from the Telegraph. The very good news from the article is that there is a new alternative to mefloquine for chloroquine-resistant malaria:
"Glaxo's Malarone is a highly effective prophylactic for chloroquine-resistant malaria and ideal for most people for whom mefloquine is inappropriate. Currently it is licensed for treatment only in Britain, but is expected to get its licence for malaria prevention next month."
The other very interesting comment, which may explain the 1 in 140 with side effects from Lariam, was: "In a double-blind study of the new anti-malarial Malarone, where the control group was taking Lariam, some people suffered crippling Lariam-like side effects - just from the belief that they were in the Lariam group." In other words, FEAR of Lariam created the exact side effects that Lariam has been tarred with! Kind of the reverse effect of my faith in Vitamin C for warding off colds.
Good news - From the Fleet Street Travel Medical Clinic, London:
" Malarone approved in the USA: FDA drug regulators in the United States have just given their approval to the new anti-malarial drug, Malarone, for use in travellers; the drug will now become available in the US from late August. As reported previously in the Daily Telegraph, traditional treatment with chloroquine and Paludrine offers decreasing protection from malaria, while more effective drugs -- Lariam and to a lesser degree, doxycycline -- have been associated with unpleasant side effects; extensive trials have shown Malarone to be a well-tolerated and highly effective alternative.
Prior to this announcement, the only other country to license Malarone for prevention had been Denmark, where Malarone has now been in use since 1997. The US move comes as a particular surprise, since the FDA has previously had a reputation for acting more slowly and cautiously than its counterparts in Europe. Approval in the US now means that licensing in the rest of the world is almost inevitable, and just a matter of time.
In the UK, Malarone (a British drug) continues to be available only on an unlicensed basis at specialist centres, with formal licensing not expected until the second quarter of next year. "
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