Long time Malaria protection
 

Malarone suggested for a maximum of 28 days.
Lariam suggested for a maximum of 3 months.
I don't know the maximum period suggested for Doxycycline, but I know that it isn't so effective and I 'll travel to high risk areas. Also I have heard that sometimes it has serious side effects.

I am planning a trip from Greece to India for something more than 6 months. I 'll start travelling at April. Of course, I 'll protect myself from get bitten and I 'll have Malarone as treatment, but what about prevention for so long time?

Hi there,
The whole problem is getting a correct balance of risk against reward. A case of malaria is nasty, but almost always cureable. The medicines that are most effective in any given area are often not so effective outside that area. They are also usually freely available in the area and difficult to get hold of outside. Especially in Europe where many are not licensed. Artemisin based drugs are little short of phenomenal in Africa.
From my experience any of the medications you use as a prophylaxis are bad for you to a degree in the long term.
I spend a large amount of time in Sub saharan africa and no longer use any. They are either of limited effectiveness (Doxy) or too expensive (Malarone) or just plain nasty (Lariam).
Obviously every person reacts differently. Most common side effects of Doxy are nausea after taking it and extreme photosensitivity(1 in 10 people). It is a strong broad spectrum antibiotic as well with all that entails.
I have known people use malarone for 18 months without a problem (but the company was paying!)
Lariam sent me barking mad after just one tablet.
In the end it will be a personal choice. I have ended up with Malaria more than 10 times. As long as you are aware of it then you should be OK which ever route you choose and whether you choose to treat or block it.
Finally, as you pointed out, the only sure way is not to get bitten. Cover up and spray well in evenings and early mornings if warm. Beware shady areas during the day also.

Cheers and have a good trip.

George

Be aware
 

Hi Furious,

I've been living in West Africa for the last 10 months. The thing with taking preventative drugs is that its not 100% fool proof, and if you do get malaria its harder to detect as the drugs suppress the symptoms. I'd say your best bet is not to take any preventative drugs, but to make yourself aware of what the exact symptoms are. Carry a self test kit or take drugs when you feel the symptoms coming on. It wont cause any damage.

all the best,

Camps

I think this is the best solution. Are there several self kits? Do you have to suggest anyone?

Coartem / U-test
 

Coartem made by Novartis is the best to use as treatment. U-test makes a self test product, it's called "U-test Malaria", i'm not sure if this is a international product of if its only made in South Africa.

Safe travels,

Camps.

Malaria prophylaxis
 

dear furious,
you might find the link below useful. take a look at, the "yellow book" also. many other useful recommendations are included.

http://www.cdc.gov/travel/regionalma...htm#prevention

This quote is from a medical paper on the very subject : "..Backpackers and other travelers who move from one malarious area to another are not usually familiar with local medical facilities, and they are unable to estimate the laboratory quality of malaria testing. Continuous chemoprophylaxis should therefore be encouraged when indicated. Priority should be given to drugs that may be used or both chemoprophylaxis and standby, such as mefloquine and atovaquone-proguanil
(Malarone-NB) rather than mefloquine (Lariam-NB)." ( Long-Term Malaria Prophylaxis for Travelers; Jürgen Knobloch; Travel Med 11(6):374-378, 2004. © 2004 International Society of Travel Medicine)
NB-Nota Bene (my note)
by the way, what made you think there is a malaria outbreak in India -f I didn't get it wrong? But there IS A DENGUE threat in that region; but both malaria and dengue are transported by the mosquitos anyway. so, taking every measure for "not to be beaten" by the mosquitos would help.

wish you a happy and healthy travel.

endurin.

Yes, I know about Yellow Book and I 've read it. Thank you. India is a malaria high-risk region and I don't know yet how to protect myself. That's why I am a little nervous. I'm afraid that it's not enough just avoid get bitten. Of course there are another threats too but I already have the best protection I can for them.

Also I have three less serious questions :
1) Can we find inspect repellents with DEET on the road (Tyrkey, Iran, Pakistan, India)?

2) Why Lonely Planet and others suggest DEET for our skin and permethrin for our clothes? Can't we use DEET for our clothes too?

3) Do you carry the suggested mesh? How you put it over the bed at hotels?

3) I intend to use the inner part of my tent for this purpose. Has the added advantage of being free standing, if I use the poles. Don't know how well this will work.

On my previous trip we ended up buying a mossie net in India because they were so bad.

DEET in high concentrations i.e. over 80% (and maybe at less strength too) rots fabric. That's why you can't use it on clothes.

Q

Thank you for your replies. I am starting to understand the thing.

Do you mean to put my tent over the hotel's bed??? Will not damage this my tent because the poles will be out of the bed, at the air?

Where did you catch the mossie net in India?

DEET not only rots cloths, it melts plastic! Keep well away from your high-tech fibres, tents, glasses.....

You can treat cotton with DEET as it takes a long time to rot....

In most Malarious Countries you can pick up mozzie nets in loads of shops, supermarkets, on street-corners...both in Cities and up-country. For best results, make sure that the net is tucked under the matras and treated with bug killer (sold in the same places...one treatment lasts for about a month)

In terms of avoidance, wear long cotton clothes (treated), and socks! Make sure there is no standing water (birdbaths, puddles, swamps...) were you camp/stay! This reduces the need for insect repellent dramatically!

Jens

DEET is a repellent, and can be used with no problem against the skin. But what DEET really does is make the mosquitoes "dizzy" so that they forget to bite you. Well if you're lucky. I got mosquito bites wearing 100% DEET Jungle formula AND fully covered by thick fabric. Some mosquitoes really get hungry!

Permethrin is not an insect repellent. "It works as a contact insecticide, stunning or killing insects that come in contact with it". I would not fancy that on my skin, and would not repel.
Check this website out on DEET and Permethrin for more info:

http://www.travmed.com/trip_prep/ins...rmethrin.htm#3

cheers,

Also would like to add this bit (from website mentioned above):

"Can I use DEET and permethrin together, or is the combination unnecessary?
When maximum protection against insect bites is needed or desired, the ideal solution is to use a combination of DEET on exposed skin, and wear permethrin-treated clothing. An extended-duration DEET insect repellent (Ultrathon®) and permethrin-treated clothing is the standard personal protection system used by the U.S. military deployed in areas of the world where insect-borne disease is a real threat. One field study showed that the use of both of these products provided 99.9% protection against mosquito bites, in an environment where unprotected persons received an average of 1,188 bites per hour! "

As I wrote, I haven't tried it yet, but I think the tent floor is sufficiently strong to support the two poles. It doesn't have to withstand any storm, after all, unless I turn the ceiling fan on max.

Can't remember where we bought the net, some bazar somewhere.

Thank you very much! This site

http://www.travmed.com

that maria41 mentioned is veeeery useful.

I understood that the best chemoprophylaxis for a motorcyclist in that area for so long time is the doxycycline. I thought that it isn't so effective but I read in this site that it's more than 90% effective against chloroquine-resistant falciparum malaria!

I only have the question if we can find DEET and permethrin on the road (Tyrkey, Iran, Pakistan, India).

Beware,
Doxy can be 90% effective but the malaria parasite is very adaptable and there will be regions of the world where it has gained some resistance. Test it before you go. I have seen 2nd degree sunburn from some people who reacted to it.
Insect repellents are certainly available in Turkey, and India and definately in the major cities of Iran and Pakistan.
Mossie nets are fairly simple to attach. Always travel with a double size, some very light poly string and duct tape. A couple of small nails can usually be placed into cracks in walls, doors, windows etc. You should be able to fix it with a combo of these.
Re: Coartem suggested above. It works well for some rpeople and not so well for others