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

Yes, doxy has the side effect that makes the skin more sensitive to the sun, but I have a little dark colour skin and I have never burned from the sun in my life. I have never used sun protector cream, neither sun glasses nor hats etc. Although this time I will carry a sun protector cream because I think it's essential if you use doxy.

We took free standing mossie nets to india.
They come in a bag about 300mm dia a nd have their own pop up frame work built in.A little bit bulky but they fold flat so there's no thickness to them.
Worked well.
Got them from the local outdoor shop.

Lomg term on doxy
 

Has anyone been on doxy for more than the max period of 4 months recommended? Any issues? And can Doxy be found easily in South America?

Malaria treatment
 

Doxycycline:
I have heard of people taking this long term. It has the advantage that its antibiotic so can prevent against GI infections but its used in the UK as a treatment for MRSA so in my mind i wouldn't want to risk making myself immune to it.

I used Larium for a year without any problems. If you going to react then it will usually be on taking the third tablet (week 3) so just start t in the UK before you leave to make sure

As for not taking any preventative treatment - its crazy. Malaria can/will kill you in a very unpleasant way if you are unlucky enough to contract the Falcipurum strain (found in africa), the other three strains do not kill but one of these you cannot always get rid of and will lie dormant for many years in the liver - NO THANKS!

So.... are you a doctor???
 

I guess Mr. Camps here is a doctor. Or at least he thinks he is, giving medical
advice to people about a potentially deadly decease.
I find that very very &^$%#!!!:censored:

BMW.BEC is absolutely right. Some forms of malaria can kill you before you are
even aware that you have them.
Other forms are un cureable and will course 'flame-ups' for the rest of your
natural life.

Why do we have doctors? Then listen to them!

If you decide not to take any prophylaxis that is fine. But NEVER EVER tell
others to do the same if you are not qualified.

Maarten :mchappy:

ps. Took Lariam for 40 weeks and I am not more screwed up then before that.

Firstlly, I am not condoning you risking your health by not taking antimalarial drugs. It is a personal consideration of risk, just like getting on a motorbike, going to distant countries, trusting strangers, hitch-hiking etc etc etc. Then best you can do is inform yourself from the experience of others, and make your own decision.

Going from Greece to India is not particularly malaria-prone. It is said that malaria exists in southern Iran, but I think you'd have to look pretty hard to find it. I worked in the south of India for some time, and half the people working with me (westerners) didn't bother with prophylaxis. Don't think I heard of anyone who knew of any cases of Malaria.

BUT

There is the always the risk . Personally (and embarking on the same trip), I am not taking anything. Lariam and Doxycycline are nasty , toxic chemicals, which are well described above. By taking antimalarials, you're giving your body a small, but significant dose of poison. Inherently, this too has risks, and side effects do not always manifest themselves in the short term. More practically If you're staying in hotels or hostels, you are not as exposed as when you are, say camping. You can buy cheap burning mosquito coils anywhere in India (they will always be the smell of Kerala to me), which are good. Take DEET repellant, and cover up in the evenings.

Make your own decision, it's just another risk you have to think of, like robbery, accidents, terrorism etc.

What actually are the symptons to look out for. And if they show how long has one got to get treatment?

Very good and interesting debate. My travel doc. has recommended that I take Doxy for almost my entire 15 month RTW. I get a few drug breaks in Argentina/Chile and Europe of about a month each, so I won't be on it for more than 3 or 4 months at a time. A person doing an extended trip in a malaria place could CONSIDER drugs for the max time, then take a drug break, then head back on the meds, or switch it up. Less safe than being drugged all the time (or is it???) but safer than no prophylaxis.

I don't have a mossie net, but I'll be getting one when I feel I need it in mainland Mexico.

Always wondered why I couldn't use DEET on clothes. Now I know!

Thanks,
Mitch

PS: Malaria - Wikipedia, the free encyclopedia

malaria advice
 

I totally agree with Maarten! Who is this Camps to give such risky advice! Malaria kill 2 milion people per year and not only locals !!! It is as with the Indians in South America when the Spaniards arrived 500 years ago!
They had no defence whatsoever agains flu. The same applies for us whities, no defence against malaria. Don't listen to what expats tell you who are on standby. I f you have had malaria before the risk is less because your body knows what it is. Many expats have had malaria but even then standby can be considered as risky! Chances are you think you have a mild flu in stead of Malaria! then you missed your chance of effective treatment.

I have been on Lariam for more than a year and if you are not sensitive for the mental side effects (depressions, anxiaty etc) then Lariam is a wonderfull profilax. Why is it that Lariam can be used for a year and Malarone only for 28 days or maybe 3 months by exception!!

do be stupid, take profilax

cheers,
Noel
exploreafrica.web-log.nl

Malaria Advice
 

There is an online magazine about Uganda that has a regular column written by a doctor based in Kampala.If you look in the past issues, (easily retievable from the website), there is an excellent 4 or five part series of articles dealing with Malaria.Well worth a read.
The Magazine address is www.theye.co.ug

Steve

something I posted a little while back....
 

this is a post that i sent a little while back to another thread also discussing malaria and meds....

My husband and I have both experienced malaria....whilst taking anit-malaria meds..........remember - no medication guarantees 100% effectiveness!
Malaria is a serous and is sometimes a fatal disease....and, at present, there is no vaccination against malaria.
it is true that sometimes the locals of a country may have 'some' in-built protection but there are more indigenous deaths due to malaria in Africa then of AIDS.

When travelling through Africa my husband and I took doxycycline as we required a medication for prolonged use. It was effective as we did not suffer from malaria whilst in Africa....but we were always using other precautions as well...ie spray, covering up etc.

However, whilst in South America we suffered two very bad attacks of malaria - whilst also taking doxy...(Strain- plasmodium vivax..the most common) This was however, not due to the lack of effectivenss due to the drug but to illness and vomiting which reduced the drugs ability to be effective! I was unable to reach other meds or a hospital for almost 2 weeks....during this time the situation just worsens. Once admitted I suffered temps of 42 degs....and things excreting from every orifice for 6 days...there is always a risk of coma in this scenario.

Self medication may work in very mild cases but this can be a killer and correct treatment should be sought. The parasites can remain in your liver for many months or even years before once again becoming active.....so you think your self-medication has worked.....it has usually just succeded in laying the parisites dormant for a while.

One option is to carry with you the tablets Cloroquine and Primaquine...both available abroad easily....but only via prescription in the UK. But you should always discuss proper usage of these meds with a doctor before-hand so you know how to adminster them correctly.
as mentioned above - there are side effects with taking doxycycline - but these are usually mild and in the form of sensitivity to sunlight on the skin...and often this is short term only.

We have now used doxycycline in all areas - high risk etc - for a period of 4 and half years on and off....

for more information on MALARIA PRECAUTIONS visite the site
fitfortravel home page
and for information on medications try the link for the same site.....
http://www.fitfortravel.nhs.uk/Gener...prophylax.html

I hope this helps.....
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