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Japanese Encephalites - Rabies - Malaria
greetings travellers,
I will be travelling across SE ASIA and India and Jap E vacinne is recommended however as it is still quite rare I was wondering if it was worth taking these - It is also quite expensive. As for rabies, I really doubt that I will be bitten so have chosen to ignore this. After ruining a 4 week backpacking trip with malaria pills, I have decided to take a miss on that as well. Any recomendations or advice - As much as it tempts me to see how much of my $16 Million emergency medical insurance I can use up, I do not want to return in a body bag cheers Ceasar |
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?
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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. ------------------ Bruce Clarke brclarke@islandnet.com www.islandnet.com/~brclarke |
No nasty side effects were apparent when I took Larium. Whatever you use you should still take every precaution against getting bitten in the first place.
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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.
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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!
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Re Malaria drugs, a traveller recently had a bad reaction to chloroquine, paranoia and bad depression etc, switched to Lariam and he's fine.
It's very much dependent on the person, so if you've used one and had a problem, try the other. And ALWAYS use all the preventatives possible, don't just trust to the drugs. ------------------ Grant Johnson Share the Dream! at: www.HorizonsUnlimited.com [This message has been edited by Susan (edited 28 August 2002).] |
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?
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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. PS excuse the spelling Julio |
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. ------------------ Susan Johnson Share the Dream at <A HREF="http://www.HorizonsUnlimited.com " TARGET=_blank>www.HorizonsUnlimited.com </A> |
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?
------------------ Sean |
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. Link is below for the full article, which came out 1 May/01. http://www.telegraph.co.uk/et?ac=004926792754031&rtmo=pslpBBBe&atmo=rr rrrrrq&pg=/et/01/5/1/thpill01.html ------------------ Susan Johnson Share the Dream at <A HREF="http://www.HorizonsUnlimited.com " TARGET=_blank>www.HorizonsUnlimited.com </A> [This message has been edited by Susan (edited 04 May 2001).] |
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. " Dr Richard Dawood is the medical director of the Fleet Street Travel Clinic, London. http://www.whitbyonline.com/fleetstreet/news.html#6 ------------------ Susan Johnson Share the Dream at <A HREF="http://www.HorizonsUnlimited.com/index.shtml" TARGET=_blank>www.HorizonsUnlimited.com </A> |
Regarding malaria, prophylaxis and treatment:
Susan has mentioned Malarone (atovakvon/proguanil) from the pharma-company GlaxoSmithKline. This one is more effective against so-called uncomplicated falciparum malaria, which (despite the ”uncomplicated” designation) is the most aggressive one of the four malaria types that attacks humans. Malarone is for both prophylaxis and treatment after being infected with malaria. Malarone can be used in chloroquine-resistant areas, and is as such an alternative to Lariam with reportedly fewer and milder sideeffects. Drawbacks are the relatively high cost per daily pill, and the fact that Malarone is recommended to be used in a maximum of only 28 days. For longer stays in areas with chloroquine-resistant parasites (for instance Africa south of Sahara), Lariam is still the medicine of choice. The Swiss company Novartis has introduced a medicine called Riamet (artemeter/lumefantrine), or Coartem in some countries. This one is also against falciparum malaria, but as treatment only – not prophylaxis, and is supposed to be more effective against the multiresistant parasites, especially in South East Asia. Both can be used by self medication. Also, be aware of the self testing kits that are available. These might be nice to have if you`re passing through infected areas. If you experience fever, it may have other reasons than malaria, but before starting using antimalaria-medicine, one might want to test if one actually has contracted malaria. Using the kits correctly, however, needs some training. Source: Prof. Bjørn Myrvang, department of infectious diseases, Ullevål hospital, Norway (of all places...) Safe journey, and best regards from Indu |
Malaria - The most important thing is to avoid being bitten - the problem with any of the drugs available is that so many people persist in taking the drugs and not taking any steps to prevent themselves getting bitten, the disease mutates and adapts to the drugs which in turn become less effective.
We have found mixing Dettol (1/3) and Baby Oil (2/3) works well as do garlic tablets and Vitamin B1. You could go and see a homeopath before you leave - there are alternatives to the traditional drugs. We're taking China daily and Malaria Officianalis weekly as well as the above preventative methods. Early days yet but so far so good - we'll let you know....... Lisa www.chasingthesun.org [This message has been edited by Lisa (edited 18 January 2002).] |
I'll go with the garlic tablet theory as that is all I take these days. An ex British Army mate of mine says it was what they used to do. I tried it out on different people in different locations and can say that when I used serious strong DEET I stil lhave the odd bite.. when I took garlic tablets I didn't. Worked on my freinds too. You don;t seem to smell it either.. or so people tell me! http://www.horizonsunlimited.com/ubb/smile.gif
I think it would be a good compliment to any anti malarial. Incidentally, went to Zambia last year with a group of friends. Most of us took doxycycline which seemed to have no ill effects at all. One guy did take Larium, I wish he hadn't as he was one of those to experience the psychotic effect that some people have mentioned. I guess it depends on the person. |
I've just started with the six month's vacination-program. I already feel like a walking bio-hazard. http://www.horizonsunlimited.com/ubb/smile.gif
Tonight I'll take my first (of two) Larium pill to test my reaction to it. During travel I'll also use the dettol-option and the galick-pils. Also a impregnated-muskito net for the night. Better safe then sorry. Maarten |
An excellent source of information about various vaccinations, prophylaxis, etc. is the US Government's Center for Disease Control. They have a wealth of information about travel to all parts of the world, and different alternatives for maintaining your health once you get there.
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Just to add to PanEuropean's info above, there is already a good overview of vaccination info on this site in the Trip Planning section:
http://www.horizonsunlimited.com/tri...inations.shtml This info comes from Health Canada, and we have also put links to other publications on their site. We will add in the links to the CDC as well. Thanks, Michael. ------------------ Good luck and safe travels! Susan Johnson Share the Dream at <A HREF="http://www.HorizonsUnlimited.com " TARGET=_blank>www.HorizonsUnlimited.com </A> |
Just a postscript about malaria medication: Mefloquine (brand name Lariam®) has been known to cause unwanted side effects, in particular vertigo (loss of balance + dizziness). For this reason, airline pilots are forbidden to take this medication as a malaria prophylaxis. I think vertigo would be just as great a hazard to safely operating a motorcycle as it would be to safely operating a plane.
There are a number of other preventative drug programs available that do not include mefloquine. When discussing your plans with your doctor, be sure that he or she knows you will be riding a motorcycle many hours a day. |
I copied the following excerpt from the Canadian Investigative TV program the Fifth Estate. I also watched the program that was just aired last night.
From all reports taking Mefloquine is like putting a gun to your head and playing Russian roulette. There is no doctors or pharmacists in north america who can or will answer your questions giving you a definitive answer to any dangers of it’s side effects. There is a big push to get this drug taken off the market at least in Canada. From the horrific stories related on the Fifth Estate program about normal people killing themselves or other people after taking this drug. Along with the astonishing report coming first hand from Canadian soldiers regarding the Somalian affair. This was the report where the killing of Somalian citizens was directly linked to the troops being administered Mefloquine. This alone gives creedence to the fact you will never get a true answer from at least any Canadian government agencies medical or otherwize in regards to this drug. In short ... don’t take it and I don’t care who tells you it’s safe to do so. As one molicular scientist on the program stated ... the drug is so complex they cannot test it properly and they have NO idea what all the side effects may or may not be. The Nightmare Drug For many years both soldiers and civilians have wondered whether the rumours about the anti-malaria drug Mefloquine were true. The word in the military in particular was that it triggered psychotic episodes, sometimes ending in suicide or murder. As evidence mounts that the drug may have serious side effects on more that "one in ten thousand" the fifth estate brings to light some shocking new cases of tourists and troops who were never the same after they took the Nightmare Drug. Travelling to a Malaria-risk Zone? Mefloquin is highly effective and convenient, and many doctors continue to prescribe it. If you are concerned, and have questionsabout possible side effects, the place to start is with your doctor or pharmacist. There are other anti-malarial drugs available in Canada: *Doxycycline, taken daily, was used by Australian troops in Afghanistan. *Malarone is taken daily. *Chloroquine is used in some cases, but there are some chloroquine-resistant areas. A combination of chloroquine and a medication called proguanil was used by British troops in Afghanistan, and the U.S. Army, in co-operation with the Australia military, is working to develop a new anti-malaria drug called tafenoquine. Phase three of the clinical trials is due to take place in 2003. ------------------ Murphy [This message has been edited by Windwalker (edited 18 July 2003).] |
When it comes to vaccines, take all you can find. I realize they seem expensive, but compare that to the cost of your motorcycle, gear, fuel etc one the road. Checked on hospital bills lately. In the third world you may not have the luxery of a doctor, ambulance etc. If you do it is probably not up to the standards you are used to. Some of these countries just don't have the money. On the subject of the malaria pills, remember the media is selling a story. I'm not saying people have not had problems, but the media tends to blow things well out of proportions. Millions of people have taken the malaria pills with no problems. Also realize some of the people that have taken the pills and had problems blame the pills with the help of a lawyer. Rember drug manufactures have deep pockets.
------------------ John |
Well I'm not going to beat this subject to death other then to say, the CBC program The Fifth Estate wasn't and isn't selling anything. There was no mention of any law suits within the program concerning the side effects of Mefloquine. Watching the program from what I consider to be a rationale point of view. I was personally horrified listening to the terrible accounts people had experienced from the side effects of this drug.
The point to all this is and was, to try and determine weather the drug Mefloquine has dangerous side effects. There is no doubt in my mind that the program proved this beyond a shadow of doubt. I also think it is safe to say the producers of this program have far more resources then you or I to investigate and report on this subject. The bottom line that the Fifth Estate program informed the viewers was. Yes the use of Mefloquine is highly effective in the prevention of malaria and it causes horrific lasting side effects to some people. The really important issue that they tried to find out was. If a person was going to take Mefloquine was there any information or test a person could take to see if they would have any of these negative side effects. The answer that they found was an unequivocal NO. Now one has or should ask ones self if I choose to take this or any other drug. How is it going to effect me. If you can’t determine this .. why would any rational human being want to take it in the first place, especially in this case where there is other alternative malaria drugs. I for one certainly do not agree that you should be vaccinated just for the sake of getting vaccinated. Never the less, I’m not telling anyone to do anything. You all have the right to make your own choices. I just hope they are the correct ones so you or your family and friends don’t end up in a situation like the people on that program. For those of you who are interested you can get a full transcript of the Fifth Estate program on Mefloquine by going to http://www.cbc.ca/fifth/ and look under the list of past programs. Be safe, Be happy http://www.horizonsunlimited.com/ubb/smile.gif ------------------ Murphy |
I guess I wasn't clear on my last post. If a disease is possable in the area take a vaccine if available. On a motorcycle you are subject to the enviroment more than if you are on a bus or car. Also going overland you tend to get off the beaten track a bit, therefore some of the areas may be moore disease than in tourist areas. Also in any country an outbreak of disease can occure at any time. Many countries don't have the recources to recognize them in time, or to treat them effectivly one they are found. In short, get the vaccine.
As for the media they are famious for blowing up a problem, causing attention, law suits start, then they report on the legal problems. It sells! I am not saying there are not problems with some medications, but malaria is a horrable and deadly disease in many parts of the world. If you want to be trecking through the bush miles from medical care and have an onset of malaria, it is your choice.(It happens FAST) Take the alturnitive meds if recommended. They have side effects as well. Some of the new meds may have side effects that have not been recognized. Take your pick. BTW I worked in the medical field for nine years before changing carrears. I don't claim to be an expert, but I am well informed. In short the risk from the vaccine is far less than the risk from the disease. If you have questions get expert medical advice. Most family doctors are not the ones. In california go to the county health department. They are very helpful and knowledgable. You can also get vaccines for less there than a doctors office. Or do as I did and join the Army. You get all kinds of fun shots for exotic diseases. Yes I had the Japanese Enceflitis series and I did not get sick. Rabis- its alive and well here in the US. Skunks and bats are big carriers of it. Dont forget tetnis. I have seen people die of it here in the US. Rare, but it happens even today. Enjoy the ride! ------------------ John |
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