I never use malaria tablets when going to Thailand or Laos. Instead I rely on good mosquito repellent which I apply twice a day (morning after the shower and evening). The key is not getting stung by mosquitoes (which might carry other diseases besides malaria, for instance dengue).

If Malaria " is present in all areas of Laos except Vientienne" then clearly there is a risk. Only you can decide if it is worth taking. The fact that it is heavily visited has no bearing on the probability of contracting Malaria. As Amin says the key is not to get bitten and that is the only way to stay 100% safe. Is this realistic? Not for me as I am a mozzie magnet!

As far as Koh Lanta and Krabi are concerned, the are within the no precautions necessary area.

I assume "no precaution necessary" is referring only to anti-malarials-- IIRC there is dengue fever in the south of Thailand and you should use mosquito repellent.

Malaria prophylactics are unnecessary in these areas. The web sites you quote err in being overcautious and do not,in most cases, set out the side effects of the medication. Doctors who live and work in Lao and who are specialists in tropical medicine state that prophylactics are required only if on extended treks in the jungle. Use Deet and cover up at night.

"The web sites you quote err in being overcautious" on what facts have you based this assertion Vientienneboy?

The vast majority of research and collation of statistics is carried out outside of Asia at the Schools of Tropical Medicine in Liverpool and London, the Gates Foundation in the US, the Wellcome Foundation and the UN. Where do you think the " doctors who live in Lao get their information?" Or maybe they have there own research facilities that no one has yet heard of?

FromLA, I hope you will make this decision in consultation with a travel medicine or tropical medicine professional.

Agree with Kathie. When we were at the Anantara (Golden Triangle, Thailand), the hotel manager told us he used to manage a top hotel in Luang Prabang and the majority of the employees came down with malaria every year. That might have changed, but you you really need the opinion of a travel doc. Since you are "FromLA" - I have a recommendation in Santa Monica, if you'd like.

If you have Kaiser, they have an excellent travel, medical division which I started using in 2003. I'm from L.A.

I personally have never taken malaria medication for Thailand, but I took it (Malarone) twice for two different trips to Ghana and got it for a very reasonable price through Kaiser.

You really need to consult a travel, medical professional on this issue.

Happy Travels!

"Or maybe they have there own research facilities that no one has yet heard of?"
Well there you go Crellston; another person not living in the area posting with an air of authority. It is unfortunate for you that you have not heard of the malaria research and work done in Lao by doctors at the French Embassy Clinic and the Aust Govt clinic. perhaps if you came to Lao and visited these places your might post with more knowledge.
Going to travel clinics is pretty much a waste of time. Most of the doctors have never been to the regions for which they prescribe prophylactics, preferring to rely on conservative govt web sites. The reason these sites are conservative is that they do not want to run the risk of getting sued.
In a similar vein, both the US and Aust Govt web sites still have information on travel warnings from Vientiane to Luang Prabang due to Hmong insurgencies that happened over 10 years ago.

Care to enlighten us about the implied negative "side effects" of Malarone (the preferred anti-malarial for the area), VB?

I, for one, can't wait for this one...

VB, I was aware of the work carried out by the doctors at the French and Australian clinics if only because you continue to mention it. However, essential though there work undoubtedly is, I doubt that they are in a position to see the bigger picture and assess the overall risk with any degree of accuracy (if indeed these doctors are actually saying that there is no need for prophylactics in Lao - which I seriously doubt). According to WHO statistics, Lao PDR has made great strides in the eradication of this disease over the last decade and hopefully this will continue but the fact remains that the disease still remains in the country with thousands of reported cases each year. Indeed, one would hope that the doctors on the ground in Lao are the very people collating the statistics and passing them on to the WHO and others for risk assessment.

If people wish to accept your advice simply because you happen to live in the country in preference to organisation like the US CDC, the UK NHS and the WHO, then that is entirely there prerogative. However, I for one feel that your comments are misguided at best and at worst, potentially dangerous.

As for my speaking with an "air of knowledge", I don't think so. An air of experience, perhaps, an air of exasperation, certainly, especially when I come across the misleading information on this site all too often. I contracted Malaria many years ago probably through my own stupidity in not taking the meds correctly and it is not something I would care to repeat or for anyone else to go through - "an intelligent man learns from his own mistakes, a wise man learns from the mistakes of others".

You are correct that I do not live in Lao but even if I did, I fail to see how this would enhance my knowledge of the subject of malaria and the relevance of this point. This is about as relevant as saying "I went to Lao, didn't take the prophylactics and was ok". So what?

Your comment that the malaria websites err on the side of caution is perfectly correct. Of course they do! Otherwise, what would be the point? As for these websites mentioning the side effects, that is the job of the doctor prescribing the medication, taking into account the individual's personal medical history.

Clearly we are never going to agree on this issue so we will just have to agree to disagree. Forum members here will make up there own mind but for what it is worth, my "advice" is to consult a doctor experienced in travel medicine preferably a couple of months before travel as malaria is not the only issue one should be concerned about.

When we were planning our trip to Laos, Cambodia& Thailand, we used the travel clinical our local Kaiser, as we usually do. They were great & gave us an arsenal of drugs, including malarone. We were instructed to take the anti-malarial drugs before arriving in Cambodia but was not advised to take them for any other country. My daughter-in-law went to the University of California, Davis student health center where they advised her to take malarone before we left for her travel in Thailand. . They also told her she needed a Japanese encephalitis vaccine (2 shots). She was sick as a dog with migraines for two weeks from the vaccine. We had all already had typhoid & yellow fever vaccines when we went to Peru. At that time, the travel clinics advised us to take malarone while we were in the Amazon. Knowledgable locals told us that there had been no reported cases of malaria in Manu, Peru for several years. I was much more comfortable taking malarone, so did. My husband & daughter chose not to & were fine. Once I started taking it I slept like a baby, not only because of the drug but also because I stopped being so anxious about getting malaria.

The point of all of this is that 1) even if you think a medical professional knows what they are doing, they are not always right (being a medical professional myself, I can really say this). My daughter-in-law did not need a Japanese encephalitis shot for the length of time we were in Thailand & had she mentioned it to me, I would advised her against taking the shot. She also did not need to be taking malarone as she only went to Thailand. 2) people have different comfort levels. I feel more comfortable taking malarone than my husband. I am also a mosquito magnet & he never gets a bite.

My best advice is, both as a traveller and a health consumer, to educate yourself as much as possible and then make the most informe decision you can. There will never be one right answer for everyone.

Crellston, fair enough. Actually doctors at both of the places I mentioned do not recommend prophylactics unless, (as I have stated), you are going for an extended jungle trek.
As you are also no doubt aware, dengue is far more a source of danger. Unfortunately at this point there is nothing that can be taken for dengue, except to cover up and use deet.

As far as possible Malarone side effects are concerned:
Common Side Effects of Malarone
Malarone has been studied thoroughly in clinical trials. In these studies, one group of people received Malarone, while another group was given a placebo (a "sugar pill" with no active ingredients). As a result, it was possible to see what side effects occurred, how often they appeared, and how they compared to the placebo.

In clinical studies, the most common side effects of Malarone in adults included:


Headache -- in up to 22 percent of adults
Stomach pain -- up to 17 percent
Muscle pain -- up to 12 percent
Nausea -- up to 12 percent
Vomiting -- up to 12 percent
Weakness, or a loss of energy and strength -- up to 8 percent
Diarrhea -- up to 8 percent
Upper respiratory infection, such as the common cold -- up to 8 percent
Back pain -- up to 8 percent
Cough -- up to 6 percent
Fever -- up to 5 percent
Appetite loss -- up to 5 percent
Dizziness -- up to 5 percent
Flu-like symptoms -- up to 4 percent
Upset stomach -- up to 3 percent.


In clinical studies, the most common side effects in children included:


Stomach pain -- in up to 33 percent of children
Headache -- up to 19 percent
Vomiting -- up to 13 percent
Cough -- up to 9 percent
Flu-like symptoms -- up to 9 percent
Itching -- up to 6 percent
Fever -- up to 6 percent
Diarrhea -- up to 3 percent.
Inflammation, redness, swelling, or bleeding of the mouth, including the cheeks, tongue, gums, and lips
A skin rash that is red, blistering, or peeling
Red spots on your skin
Signs of anemia or other blood cell problems, including:

Fatigue or extreme weakness or tiredness
Unusual bruising or bleeding
High fever, aches, and pains, which may be signs of an infection



Signs of liver problems or liver failure, including:

Dark urine
Loss of appetite
Pain in the upper part of the stomach
Yellowing of the whites of the eyes or skin (jaundice)
General feelings of discomfort



Signs of an allergic reaction, such as:

An unexplained rash
Hives
Itching
Swelling of the mouth or throat
Wheezing
Difficulty breathing.

Thrush is another problem and this is common.

Let me reinforce what cjon says. Make sure you know what is recommended for your destinations. I always suggest that people in the US print out the cdc recommendations to take with them to their appointment. The standard of practice for travel medicine in the US is to follow the cdc recommendations. If the health care professional recommends something other than what the cdc recommends question them about it carefully. As cjon says, her daughter-in-law did not need the JE vaccine nor did she need malarone for Thailand.

There are individual circumstances to be taken into consideration in travel medicine including the traveler's own health status, where they will be staying and what activities they will be engaged in. Thus, there is no one-size-fits-all answer. But if you get a recommendation substantially different from what the cdc or NHS recommends, ask.

The above stats from VB was copied from this site: http://malaria.emedtv.com/malarone/malarone-side-effects.html

Advise anyone to read and here are some comments that VB failed to copy:

Just like any medicine, Malarone® (atovaquone/proguanil) can cause side effects. However, not everyone who takes the medication will have problems. In fact, most people tolerate it quite well. If side effects do occur, in many cases, they are minor and either require no treatment or are treated easily by you or your healthcare provider.

Also, the article is copyright by Clinaero, Inc.

Wow. Look at those numbers! 3%!! 8%!!!

Sounds like you're more likely to encounter negative side effects from the aspirin you took.

I've never -- nor has anyone I've known who has traveled to the area -- had ill side effects from Malarone. That's not to say it can't happen, but to make such an misguided and uninformed statement as you have above requires a bit of a big, hard slap back into reality.

You're not a doctor, so please I urge people reading this thread not to get medical advice from VB.

As Kathie has noted many times previously, please consult your doctor for the most sound medical advice, not a travel board...or an expat.

VB strikes again..

33% 19% 13%
You are not a mathematician are you filmwill? Perhaps you are a md? No, then again perhaps not.

So you teach math?

33% for stomach pain...that's your biggest risk?

Sounds like a supremely dangerous medicine indeed.

Go crawl back under your bridge now, little troll.

I have to chuckle over the cut and paste of possible side effects. Are you aware VB, that in listing side effects, the pharmas are required to list every complaint a subject had, even if there is no link between the complaint and the medication? Thus, the listing "Upper respiratory infection, such as the common cold -- up to 8 percent" Obviously, malarone does not cause the common cold.

I never understand these controversies (also people's strong opinions about flu shots). An individual decision, which should be discussed with a qualified physician. VB, why do you care so much about what others choose to do?

I will always err on the side of caution because I have a friend who came down with malaria in SE Asia or India, after traveling in "low-risk" areas. He has had recurrences and ongoing health problems. How he wishes he had taken Malarone, a wonder drug with very rare and minimal side effects compared to previous alternatives.

I always look forward to taking malarone as I sleep like a log & have incredible dreams. I am allergic to many, many drugs & tolerate malarone just fine. Kathie, I think taking the CDC info to an appointment is the way to go. There is a lot of rigidity of opinion on this forum that is not helpful when answering a posting. There is also a lot of nit picking that is really unpleasant and unnecessary. Sometimes I hesitate to post a question or a opinion because I feel like someone's going to jump on it and pick it apart.

"Go crawl back under your bridge now, little troll."
I generally find that those posters of extremely limited intelligence refer to others as trolls when they themselves are incapable of making another response.