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Julio 13 Apr 2001 18:02

Malaria prevention in Thailand
 
All

I have heared conflicting reports on whether I need to take malaria tablets in Thailand.

Am going next month, any advice apreciated.

thanks

Julio

Susan Johnson 2 May 2001 21:56

Julio

I'm sure you will continue to get conflicting reports about this topic. Rather than just put my opinion in, I've picked up some useful info from Health Canada's website, which also deals with the mefloquine (Lariam) debate.

"Malaria is a major killer worldwide and is the principal, life-threatening infectious disease that Canadian travellers face when travelling to high risk areas such as sub-Sahara Africa and New Guinea. In recent years, there has been a dramatic increase in malaria cases in Canadian travellers including several deaths.

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 neuropsycho-
logical 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



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Susan Johnson
Share the Dream at <A HREF="http://www.HorizonsUnlimited.com
" TARGET=_blank>www.HorizonsUnlimited.com
</A>

Macca 10 May 2001 09:40

Not one to wade into a rather contentious issue, ie, to take or not to take anti-malaria "pills", however, speaking as one who has had malaria (both types!), I still choose not to take anything to prevent malaria.

Now the schools of thought are: not to take propylactics (sp) and deal with malaria by not going uncovered during dusk & dawn, appropriate clothing et-al, should to have symptoms (flu-like) of malaria it can be readily treated, now this should be tempered with where you are at the time of feeling "lousy". This school of thought adopts the policy of not putting drugs into the body which CAN mask malaria (I personally have seen people who religously take propylactics still come down with malaria), and also years down the track when you are all 'adventured-out' you have "cabbages" growing on your liver from some anti-malaria drugs you took years before.

Now the other school of thought is: take the anti-malarials and believe you are immune from the roamings of a dirty probiscus of the female (always the women, isn't it, OUCH! that hurt maam) mossie.

Should you be unlucky to get malaria, get help ASAP regardless if it's Vivax (you'll live) or Falciprum (sp) (chances are you may die), then for the eradication, and yes, they now can eradicate malaria, is to go onto a course (about 2 weeks) of Primaquinne (sp), this is normally coupled with an initial injection of Fansidar. It should be noted that Primaquinne is the medical worlds last line of defence for malaria so it is a controlled drug (in Australia, anyway).

I suppose all the above hasn't really solved much, I can only go by what and how I dealt with my episodes of malaria, I'm now in Papua New Guinea (malaria central) and still choose (life is about choices) not to take anything for it, I'll take my chances and deal with them.



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Cheers & beers
Mark & Lynda
R1150GS


Susan Johnson 11 May 2001 23:14

I found a good site recently - the Fleet Street Travel Clinic, has a doctor who writes for the travel section of the Telegraph newspaper.

News item: "
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. "

Quite a good overview on this controversial topic of malaria prevention and treatment can be found on the site: http://www.whitbyonline.com/fleetstreet/news.html#2

As Mark & Lynda have said, life is about choices. Good luck with yours!


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Susan Johnson
Share the Dream at <A HREF="http://www.HorizonsUnlimited.com/index.shtml" TARGET=_blank>www.HorizonsUnlimited.com
</A>

Julio 15 May 2001 00:36

Hi Peeps

Have just returned from my trip and decided not to take any Malaria prevention.

Pauladrin last time I took it made me so ill that I would never take it again.

I made sure that I was doused in Autan and made sure that i was covered. The mozies only seemed to be around at dawn and dusk. After that they seemed to not bother with you. I did sleep in a mozi net.

They still do bit through your clothes so they only provide limited protection. I was probably only bitten 6 times, of which 4 were from the same evening as I did not make it back to the room to put on the spray as I had been diving.

There were two danish guys taking the malarone with no side effects. They had also travelled through Vietnam/cambodia/Laos and so far haven't come down with Malaria.

I will probably try this out on my Afica trip at the end of the year (still with loads of Autan and covering up as I still get bad reactions to the bites.

Julio


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