Malaria Cases - Liberia Peacekeepers

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Sep 8th, 2003, 10:43 AM
  #1
PCHsmiles
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Malaria Cases - Liberia Peacekeepers

The fact that 12 Marines now have confirmed cases of malaria contracted in Liberia (after taking the meds), and another 21 Marines are showing symptoms, suggest to me travellers to Africa need to know what drugs the DOD gave the Marines, and what does that say, if anything, about the precautions civilian travellers need to be taking.

If the Marines had not been medicated, I could understand. But DOD is usually very careful. And 12 cases and possibly 21 more suggest whatever meds they took or the malarial situation need re-examining.
 
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Sep 8th, 2003, 10:56 AM
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Malaria meds do not eliminate 100% one getting malaria. Taken properly, being covered from dusk to dawn, and with deet repellent applied to exposed skin, still only lessens the possibility.

The only thing the meds are suppose to do, is reduce the intensity of the desease if you contract malaria.

Unfortunately the meds are considered propholactic (sp) they are NOT an innoculation/vaccine against the desease. There is no vaccine against Malaria, though scientists have been working on one for well over 10 years. Rumor has it that Cuba might possibily have a vaccine ready for testing??? It's only rumor.
 
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Sep 8th, 2003, 11:21 AM
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True. My major concern was the relatively large percentage who came down with malaria. I'm wondering what DOD gives the troops.
 
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Sep 8th, 2003, 11:42 AM
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Last time around they were handing out Lariam which the DOD (and family) were attempting to blame for all the "murders" at Camp (don't remember which in No.Carolina or ?). Soldiers returning and all these wives being killed.

Lariam has been known for strange reactions for some people, but blaming the drug for lots of murders and only at one military base??? Have a problem with that, but back to what the Marines got this time around!

Now with the Malerone available (about 3-years in the States), this should be what the DOD was handing out. Again, who knows.

Listen, there are some environments that are just plain toxic for our military - either the steel or the mosquitos seem to be getting them.
 
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Sep 8th, 2003, 12:00 PM
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All true. My HMO is still prescribing Lariam, and I've used it several times. so far so good. I recall the NC family cases. It did seem abit of a stretch toi connetc that with Lariam. I'm not sure what we'll take next year.
 
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Sep 8th, 2003, 12:14 PM
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And then there is the story of Chris Mathews, moderator of Hardball on MSNBC - visited Southern Africa with his family about 2- or 3-yrs ago, took the maleria meds. Then sometime after went off to the Middle East (business) and took whatever innocs and meds prescribed.

Sure enough, he returns and a few weeks or a month later comes down with symptoms that no one was able to figure what was going on with him. Fortunately, a young physician chanced to ask if he had been to Africa and if he had taken any propholactics. Sure enough, blood tests showed that he indeed had maleria. However, the strain he had contracted was so powerful, the doctors couldn't even determine what or where he contracted.

He was sicker than sick - thought he was on deaths door (not a milder case as would be expected) was out of work more than a month. Told the complete story - along with his wife, also in the news business - about what happened to him.

 
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Sep 8th, 2003, 02:04 PM
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We took at trip through West Africa to Timbuktu overland a couple of years ago and 4 of the 11 people in the group contracted Malaria!

Malaria,(not cerebral malaria) isn't that threatening as long as you know the symptoms, very much like the flu, and you seek medication immediately.

The thing that was interesting is that different people on the trip were taking different medications... because some were from Europe and some from the US...the difference in medication didn't seem to make any difference in terms of contracting the illness. But the important thing was that everyone responded very quickly to the treatment and nobody ended up in hospital.

However, it was interesting that at doctor in Mali said that he thinks the dosage prescribed in Europe and the US is generally too low...

I've lived in Africa on and off since I was a child and I've never had a problem with malaria. However, I do have an American friend who hallucinated in Larium!
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Sep 9th, 2003, 04:17 AM
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The malaria meds are so toxic over the long-term that locals do not take these, rather take such precautions as covering up from dusk to dawn and applying repellent.

The Larium has always been known to cause adverse reactions, though only about 1% getting drastic psychotic reactions. Other folks, would mostly have wierd/colorful dreams, and then there is the interrupted sleep, and some have no reactions whatsoever.

Thankfully, when the Malerone came on the market, these problems seem to have disappeared.

The only people who should not take these meds, especially, Larium are people with heart problems, but either have to be carefully prescribed by a physician of tropical meds, not your general physician (they really don't know the correct questions to ask).

If someone does contract Malaria, the protocol in most situations is very high doses of the prophylactic - Lariam or Malerone - under very close supervision. As the expression goes "the hair of the dog".

From the insert for Malerone, testing was actually done of individuals - men, women & children - residing in mosquito infested areas - the dosage was determined from these tests.

Now it would be interesting to see what the DOD has to say about the situation with the military in the Liberia cases.
 
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Sep 9th, 2003, 08:48 PM
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PCH, the AP says:

"Martin said the Marines and sailors started taking the antimalarial drug mefloquine in late June or early July in a regimen that requires troops to begin dosing two weeks in advance of a deployment, then take the drug once a week thereafter for a month until they have been out of the risk area for a month.

The military also gives troops a repellent cream containing DEET and mosquito netting."

Interesting story Sandi about Chris Matthews.

I didn't realize that 3,000 African children die a day from malaria according to a UN report earlier this year.
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Sep 10th, 2003, 04:31 AM
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Clematis -

Mefloquine is the generic Lariam. Interesting that some HMOs are now recommending that one take the generic rather than the Brand Name - naturally the generic costs less.

The protocol you've mentioned is that for Lariam and if the Marines have been using the deet repellent and keeping covered dusk-to-dawn, they're doing what's called for. However, there is no guarantee.

Yes, thousands die daily in Africa and other places around the world - a vaccine is desperately needed. One problem is that there are different types of mosquitos in different areas around the world - some are not a problem, others are killers. This is probably why it's taking so long - it's been well over 10 years scientists have been working on something to help these innocents.
 
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Sep 10th, 2003, 06:15 AM
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Each year when we go to the southern Africa region, lodges will emphasize we must take the meds. My HMO prescribes Lariam, and yes, as Sandi points out, that is the regimen. To date, we've had no side effects, but there are many opinions quite negative about Lariam. There are no guarantees, but the odds are very good if you take precautions. We'll be doing the same next year when we travel again.
 
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Sep 10th, 2003, 09:03 AM
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On this subject, is it true that different malaria meds are recommended for different regions of Africa? My physician suggested this, but prescribed Larium with the stipulation that I could change it if I needed another type. With different types of mosquitoes in the world, it makes sense that each drug would help against different insects.

And if so, does anyone know the recommendation for East Africa (TZ, Kenya)?
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Sep 10th, 2003, 10:23 AM
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Hlp, I don't know. We took the newer Malerone. It's pricey but insurance covered it eventually. We had no problems from it.
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Sep 10th, 2003, 10:33 AM
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I now work in a huge hospital in Stanger in Northern Zululand and malaria is extremely rare here. The South African laugh at the travelers who take all the meds. Along the Mozambique border in Maputoland has some but that is all. Docs are notorious for not taking our own diseases seriously but I have never taken the Malarone I bought once I got here and talked to the locals. Wes Africa is a different story!
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Sep 10th, 2003, 12:02 PM
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For current information of health issues for foreign travel see:

http://www.cdc.gov

then select destination. There is listing of the various meds and innoculations required/suggested. If a particular malaria med is no longer recommended or effective in a certain area it is so stipulated.

Last year when visiting SEAsia, we learned that Lariam which we had taken previously for trips to Africa, no longer was effective and Malerone and others were.

As far as people living in certain areas, as I mentioned in an earlier post, the long time use of these prophylactics is very toxic to the system and is not recommended for longterm use for people living in these areas. So if you're working in a hospital for a long time, you don't take the pills.

Most major cities in many of these countries are free of malaria, but outlying districts and border areas might not be.

One you have the information in hand, you make the decision as in informed person - go from there. No one can make one take something they prefer not to. I've met people who had reactions to Lariam and stopped taking them after the first pill. There is a generic pill often recommended for just such cases.

Lariam in fine for East Africa, but since the new Malerone is available with little or no side effects, this is what is now most often recommended. Again, most general practicioners are not current on tropical deseases, therefore, Travel Clinics or Public Health Clinics have more current info.

Check out the site (keep it amongst your "favorites/bookmarked"). You have information there for travel around the world.

 
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Sep 10th, 2003, 12:29 PM
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Thanks Sandi. I reviewed the CDC site before visiting my HCP, and it seemed that any of the pill options would work. But I'll see if she can change my Rx to Malerone. Strangely, one of the shots recommended on the CDC site is only available for medical emergencies according to my pharmacist -- still awaiting a call back from the HCP office to find out which one!

This thread has been quite eye opening for me from the perspective of using repellent. I absolutely hate bug sprays and will go out of my way not to use them, but it sounds like this trip will be a case of better safe than sorry.
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Sep 10th, 2003, 01:01 PM
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From experience, certainly you go prepared, and plan to take the meds and shots. But listen to the lodge managers as well, especially about bugs and DEET. Follow their advice and you'll be fine. I seriously doubt the bug situation you notice will be any different than at home. Your rangers will advise you oo. Have a good trip.
 
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Sep 10th, 2003, 01:39 PM
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HlPhillips2:

Malaria medications differ depending on what countries you are going to and the precise type of malaria that their mosqitoes give. Falciparum malaria is one of the worst and it is prevalent in many African countries.

Up until last year the only successful preventive was Larium. Malarone was used for TREATMENT but not as a preventive. However, that has now changed and you can use Malarone as a preventive. However, since no medication is 100% effective, should you get malaria while on Malarone, you need to take another medication (most likely Fansidar) to cure it.

If you are going to Kenya and Tanzania shortly then your risk will probably be slim. They are still in the middle of the dry season. I have been there three times during the dry season and I think I may have seen about 5 mosquitoes on all three trips. I see more "bugs" every evening walking my dog. However, as you know, rain brings out the little buggers everywhere so it is best to be covered.

I took Malarone in January and had absolutely no side effects and will use it again when I return this month. I have used doxycycline but I did have a reaction to the sun with that one. It is much cheaper but not as effective as Malarone.

Lariam has deservedly gotten a bad reputation. I know many have taken it with no side effects. However, many have had serious side effects. If you read Philip Caputo's book "Man-Eaters of Tsavo" he talks about having been on Lariam many times with no problems, and yet once when traveling with his wife, he had terrible hallucinations and had to leave his tent for fear of killing her. Thus it is not anything you want to play around with as long as you have other and better choices.

Hope you have a wonderful trip.

Jan
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Sep 11th, 2003, 03:09 AM
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hlp -

What is the innoculation for medical emergency only?
 
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Sep 11th, 2003, 08:19 AM
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Hi Sandi,
That was the message left on my answering machine. I've spoken with the pharmacy for clarification and it turns out that rabies and Yellow Fever vaccinations are for hospital use only (must be obtained through a hospital pharmacy), and the Hep A is available only in vials of 24. I swear, I didn't have this much trouble travling to Belize and I had to get the same shots! At least it looks like I won't need the Yellow Fever shot -- looking again at the CDC site it appears unnecessary for these countries.
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