Malaria in Sabi Sands?
Dec 15th, 2009, 06:42 PM
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No.
I think the risk is low though. Some people who post here go there several times a year and I'd like to know what they do about it. Obviously the residents aren't on meds.
I took malaria prevention for a short stay in June.
I think the risk is low though. Some people who post here go there several times a year and I'd like to know what they do about it. Obviously the residents aren't on meds.
I took malaria prevention for a short stay in June.
Dec 15th, 2009, 07:43 PM
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I realized I did not finish my thought. "No", I don't believe there are any malaria free areas, but to me it is not worth the risk to not take some type of malaria prevention. My apologies for the unfinished sentence.
Dec 16th, 2009, 05:53 AM
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Not in Sabi Sands, but there are some malaria free areas elsewhere in South Africa, Madikwe for one.
Major cities in SA are malaria free, but not many outlying areas or game reserves.
While those who live in these areas rarely take malaria meds long-terms, it's rare than any of them haven't come down with malaria at least once, probably more.
It's not a pleasant disease (killing millions worldwide yearly) and why bring something home to deal with rather than souvenirs.
Major cities in SA are malaria free, but not many outlying areas or game reserves.
While those who live in these areas rarely take malaria meds long-terms, it's rare than any of them haven't come down with malaria at least once, probably more.
It's not a pleasant disease (killing millions worldwide yearly) and why bring something home to deal with rather than souvenirs.
Dec 16th, 2009, 07:49 AM
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We have been to SS several times (March, May, July, October) and never took any malaria meds. Always carry a stand-by medication.
We wear long sleeves and pants all times and use "peaceful sleep" or similar for protection. And always sleep under a net.
The prob with low risk (and any other area) and malaria precaution is that you feel "safe" because of the meds - but you really aren't.
Everybody who travelled malaria areas (with or without meds) suffering from flu-like symptoms should get to a doctor tell about the whereabouts recently and order a blood check - because of the risk even when meds have been taken!
As with many issues - it's totally depending on every ones personal decision and foremost evaluation of risk.
The millions who are killed by the disease are neither killed in America nor Europe where treatment is easy and widely available. The millions who are killed live in countries with underdeveloped health system or rather none health system at all.
Happy travels
SV
We wear long sleeves and pants all times and use "peaceful sleep" or similar for protection. And always sleep under a net.
The prob with low risk (and any other area) and malaria precaution is that you feel "safe" because of the meds - but you really aren't.
Everybody who travelled malaria areas (with or without meds) suffering from flu-like symptoms should get to a doctor tell about the whereabouts recently and order a blood check - because of the risk even when meds have been taken!
As with many issues - it's totally depending on every ones personal decision and foremost evaluation of risk.
The millions who are killed by the disease are neither killed in America nor Europe where treatment is easy and widely available. The millions who are killed live in countries with underdeveloped health system or rather none health system at all.
Happy travels
SV
Dec 16th, 2009, 12:17 PM
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April is historically the month in Kruger with the highest incidence of malaria ( http://www3.interscience.wiley.com/c...44382/PDFSTART ), so in March you will be bumping up to it. Having said that the risk is pretty low (4.5 cases per 10,000 visitors during April). Based on their findings, the authors of the referenced article conclude that, although prophylaxis can be useful, emphasis should be placed on educating travelers to South African nature reserves about malaria, particularly on avoidance of mosquito bites and prompt investigation of fever. This coincides with what SV has stated. So, even if you take prophylaxis, it's important to take some additional care (long pants and sleeves at dawn and evening, along with some repellent spraying of the ankles).
Generally speaking, my own thought is that it's easier to take meds (again, combined with other precautions) than perhaps having to deal with a nasty infection and explaining to the doctor why prophylaxis was skipped.
Generally speaking, my own thought is that it's easier to take meds (again, combined with other precautions) than perhaps having to deal with a nasty infection and explaining to the doctor why prophylaxis was skipped.
Dec 17th, 2009, 06:27 AM
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The article referenced above is a good paper and does a good job of discussing the risk. Some caveats:
--the study was done in Kruger Park proper, not the outlying nature reserves. I wonder if the risk would be different (lower?) with the smaller numbers of staff present that could be infected and be bitten by camp mosquitoes;
--they don't mention the nationality of the visitors surveyed, and it's possible that some of the local visitors may have some partial immunity;
--the study was done in 1996, I'd be interested to see an update.
Personally, I saw less than 10 mosquitoes during a week-long stay in Kruger last April (late in the month). I still took prophylaxis.
--the study was done in Kruger Park proper, not the outlying nature reserves. I wonder if the risk would be different (lower?) with the smaller numbers of staff present that could be infected and be bitten by camp mosquitoes;
--they don't mention the nationality of the visitors surveyed, and it's possible that some of the local visitors may have some partial immunity;
--the study was done in 1996, I'd be interested to see an update.
Personally, I saw less than 10 mosquitoes during a week-long stay in Kruger last April (late in the month). I still took prophylaxis.
Dec 17th, 2009, 07:00 AM
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I've travelled and worked in some very high risk areas in Southern Africa most of working life (30+ years), many of those years as a safari guide. I've never taken meds, and nor does anyone else I know. A few friends have contracted malaria, but have been treated very successfully. Nobody I know personally has died of malaria nor suffered any life-threating situations.
I agree that more than a million folk die of the disease every year in Africa. But most of these folk live in areas where health care is minimal or non-existent. In most of these areas, they share homes and sleeping quarters with infected folk, so the cycle simply continues.
The most important factor in reducing risk is a physical or chemical barrier. You need three components simultaneously - an unprotected source (a person with malaria), an unprotected recipient and a female mosquito of the right species looking for a blood meal at the right time. If you remove any of those components, you don't get transmission. Simple.
In South Africa, we generally isolate malaria victims immediately (thus creating the first barrier). Then if you protect yourself with repellants, mosquito nets, long sleeves and trousers, etc. (re. spassvogel's post), you are at extremely low risk.
Almost all of the medical problems I've encountered on tour have been related to side-effects of anti-malaria tabs. Yes, I know what the "experts" say ...
IMO, there is considerably more risk of poisoning your system with unnecessary chemicals, than of contracting malaria. Most "First World" folk are very concerned about their health what they eat and put in their bodies, and yet do not hesitate to ingest chemicals they don't know to protect themselves from a risk that is negligible. I don't see the sense in that.
I've always been interested in the "partial immunity" issue - it may be possible, but seeing that I've never contracted malaria, I'm not sure how I could've built up an immunity. Just a thought ...
I don't claim to be an expert, I'm simply sharing my own experience. I think that each individual must make their own choice.
But my recommendation would be ...
Enquire locally before you buy, and then buy locally - at a fraction of the price.
I agree that more than a million folk die of the disease every year in Africa. But most of these folk live in areas where health care is minimal or non-existent. In most of these areas, they share homes and sleeping quarters with infected folk, so the cycle simply continues.
The most important factor in reducing risk is a physical or chemical barrier. You need three components simultaneously - an unprotected source (a person with malaria), an unprotected recipient and a female mosquito of the right species looking for a blood meal at the right time. If you remove any of those components, you don't get transmission. Simple.
In South Africa, we generally isolate malaria victims immediately (thus creating the first barrier). Then if you protect yourself with repellants, mosquito nets, long sleeves and trousers, etc. (re. spassvogel's post), you are at extremely low risk.
Almost all of the medical problems I've encountered on tour have been related to side-effects of anti-malaria tabs. Yes, I know what the "experts" say ...
IMO, there is considerably more risk of poisoning your system with unnecessary chemicals, than of contracting malaria. Most "First World" folk are very concerned about their health what they eat and put in their bodies, and yet do not hesitate to ingest chemicals they don't know to protect themselves from a risk that is negligible. I don't see the sense in that.
I've always been interested in the "partial immunity" issue - it may be possible, but seeing that I've never contracted malaria, I'm not sure how I could've built up an immunity. Just a thought ...
I don't claim to be an expert, I'm simply sharing my own experience. I think that each individual must make their own choice.
But my recommendation would be ...
Enquire locally before you buy, and then buy locally - at a fraction of the price.
Dec 17th, 2009, 08:36 AM
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My father was of the opinion of bushkido until he nearly died of malaria a couple of years back. And this was back in the UK, after being admitted into a hospital with a unit specialising in treatment of tropical disease.
There are 4 strains of malaria, one of which is often more serious and yet this is not the strain he had. But the staff explained that his strain was displaying symptoms as though it were the problem strain. It was pretty serious, and there genuinely was a point at which I was very scared.
Keep in mind my parents are both doctors, now retired, so we're not a family of hypochondriacs, or failing to understand what was happening/ how serious it was/ wasnt.
In the end they were able to treat effectively including the treatment that ensures no recurrence, by killing off dormant malaria in the liver, I think it was, might be wrong on that bit. So he is fully clear and won't get the recurrences many do.
He is now very careful to take anti-malarials.
The incidence of side-effects to ant-malarial drugs is far lower for malarone (though not non-existent) than for other drugs.
There are 4 strains of malaria, one of which is often more serious and yet this is not the strain he had. But the staff explained that his strain was displaying symptoms as though it were the problem strain. It was pretty serious, and there genuinely was a point at which I was very scared.
Keep in mind my parents are both doctors, now retired, so we're not a family of hypochondriacs, or failing to understand what was happening/ how serious it was/ wasnt.
In the end they were able to treat effectively including the treatment that ensures no recurrence, by killing off dormant malaria in the liver, I think it was, might be wrong on that bit. So he is fully clear and won't get the recurrences many do.
He is now very careful to take anti-malarials.
The incidence of side-effects to ant-malarial drugs is far lower for malarone (though not non-existent) than for other drugs.
Dec 17th, 2009, 03:09 PM
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Kavey - thanks for retelling your dad's experience.
Similar situation happened here in the States to Chris Mathews of MSNBC's Hardball. Had visited with family at a few southern African countries, took the malaria meds. Then for business off to the Middle East and took precautions. Low-n-behold on return he took ill and when diagnosed with malaria, almost died.
So, even with prohylactics, it's possible.
And, though for those who (as bushkido) are regularly in infected areas do not take meds - long-time use of these meds aren't the best answer - rather follow other precautions. But, for those visiting for a few weeks (even months), better somewhat safe than sorry, along with following the rules to cover-up and use repellent.
One of these days, hopefully, there will be an inoculation and even that may not be 100%.
Similar situation happened here in the States to Chris Mathews of MSNBC's Hardball. Had visited with family at a few southern African countries, took the malaria meds. Then for business off to the Middle East and took precautions. Low-n-behold on return he took ill and when diagnosed with malaria, almost died.
So, even with prohylactics, it's possible.
And, though for those who (as bushkido) are regularly in infected areas do not take meds - long-time use of these meds aren't the best answer - rather follow other precautions. But, for those visiting for a few weeks (even months), better somewhat safe than sorry, along with following the rules to cover-up and use repellent.
One of these days, hopefully, there will be an inoculation and even that may not be 100%.
Dec 17th, 2009, 11:57 PM
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Thanks guys, for your comments above. And they actually bear out some interesting aspects.
Firstly, Kavey, thanks for sharing that, because most forum visitors "have only heard of cases ..." (2nd/3rd/4th hand), and have no personal knowledge or experience. It's good to hear from somebody who has actual experience. It would be interesting to know where your father visited. I used to live in an area of Mozambique with a 30% infection rate at all times. I didn't pick it up in 6 months of residence there. I'm not denying the risk. About 10 friends have had malaria. But that's because, as safari guides operating throughout Southern Africa, we live and work in those areas, and are constantly exposed, all the time.
The same applies to Sandi's story. This guy Chris had obviously visited a number of countries, both in Africa and the Middle East. Some countries have very high infection rates (because they don't isolate patients). What is interesting is that he took the meds.
The meds don't really prevent you getting the malaria. All they are is a low dose of the antibiotic, and hopefully, they kill the parasite reasonably quickly if you do get bitten by a carrier. However, if they don't kill it, it can take longer to establish itself, and become even more dangerous. The meds may even mask the symptoms of malaria (one of the biggest problems when folk return home). I believe it is far more effective to prevent getting bitten in the first pace, and good precautions reduce your risk far more than the meds.
I use repellants judiciously. I always wear long sleeves and trousers at night in mosquito areas, and light colours to avoid attracting them. And I always sleep under a net. It just makes so much sense. Because I don't like bugs on me at night. Any of them.
Spassvogel mentioned that he carried a back-up medication. It's normally in the form of a 24 or 36 course of antibiotics and is extremely effective. Whenever I live or work in high-risk areas for a longer period, I carry the antibiotic with me. I would rather get malaria, know that I have it, and treat it appropriately, than live believing I'm safe because I'm on anti-malarials (and not really be safe in the first place).
But this type of discussion always amuses me, because I can only imagine how much money is made from the malaria-paranoia. Can you imagine if that type of money was pumped into primary health care and prevention (like supplying $10 mosquito nets to impoverished countries), the pharma-companies wouldn't be the fat cats that they are. Every mosquito net in a high risk area would possibly prevent a hundred cases of malaria or more (just at a wild guess). Crazy.
Firstly, Kavey, thanks for sharing that, because most forum visitors "have only heard of cases ..." (2nd/3rd/4th hand), and have no personal knowledge or experience. It's good to hear from somebody who has actual experience. It would be interesting to know where your father visited. I used to live in an area of Mozambique with a 30% infection rate at all times. I didn't pick it up in 6 months of residence there. I'm not denying the risk. About 10 friends have had malaria. But that's because, as safari guides operating throughout Southern Africa, we live and work in those areas, and are constantly exposed, all the time.
The same applies to Sandi's story. This guy Chris had obviously visited a number of countries, both in Africa and the Middle East. Some countries have very high infection rates (because they don't isolate patients). What is interesting is that he took the meds.
The meds don't really prevent you getting the malaria. All they are is a low dose of the antibiotic, and hopefully, they kill the parasite reasonably quickly if you do get bitten by a carrier. However, if they don't kill it, it can take longer to establish itself, and become even more dangerous. The meds may even mask the symptoms of malaria (one of the biggest problems when folk return home). I believe it is far more effective to prevent getting bitten in the first pace, and good precautions reduce your risk far more than the meds.
I use repellants judiciously. I always wear long sleeves and trousers at night in mosquito areas, and light colours to avoid attracting them. And I always sleep under a net. It just makes so much sense. Because I don't like bugs on me at night. Any of them.
Spassvogel mentioned that he carried a back-up medication. It's normally in the form of a 24 or 36 course of antibiotics and is extremely effective. Whenever I live or work in high-risk areas for a longer period, I carry the antibiotic with me. I would rather get malaria, know that I have it, and treat it appropriately, than live believing I'm safe because I'm on anti-malarials (and not really be safe in the first place).
But this type of discussion always amuses me, because I can only imagine how much money is made from the malaria-paranoia. Can you imagine if that type of money was pumped into primary health care and prevention (like supplying $10 mosquito nets to impoverished countries), the pharma-companies wouldn't be the fat cats that they are. Every mosquito net in a high risk area would possibly prevent a hundred cases of malaria or more (just at a wild guess). Crazy.
Dec 18th, 2009, 06:37 AM
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Let's not even get into the thieves the pharmas are whether for malaria meds or many others, i.e., HIV anti-virals that are now at least available are minimal cost and being subsidized. The'll alway get rich, so my heart doesn't bleed for them one iota! But for those innocents who die needlessly.
As to Chris Mathews, who was one of the first Peace Corp volunteers when President Kennedy started the program in the '60s. Spent a few number of years in Africa, believe it was Zimbabwe, fell in love with the country and people and over the years has returned with his family to other African countries. Always taking malaria meds. Needless to say, was surprising to return home (as told above) to have contracted malaria, near death and in hospital and out of work for an extended period.
As to whether to take or not, it's understandable that those who live/work in affected areas don't, but for those who visit for 2-3/weeks or a few months, in the scheme of things the cost of malaria meds whether Lariam, Malarone or doxcy are inconsequential.
And, even with the nets being offered by such as Noting but Nets thru the Gates Foundation, locals wouldn't take if they were "free" felt they weren't worth it, so there had to be a charge (about $1 in whatever local currency). However, for as may who did buy and use, especially to protect children, there were mamy who used these as "fishing nets." As they say "no good deed goes unpunished." For many it seems it was better to feed the family than keep them alive??? One wonders.
Maybe it's paranoia for us Westerners where years ago the US used DDT to rid malaria from swamplands (till the "greens" and farmers complained this was killing their crops)... can't win for loosing... till one takes ill. Have a friend who contracted malaria in the 70s and is still bothered by it. And most everyone I know in East Africa has contracted malaria at least once or twice, even in Nairobi or Arusha; guides especially come down with this regularly.
In the end for as many of similar threads, no one can make a decision for another. Get the info (there's plenty out there), discuss with your personal physicial or tropical diseases specialist and go from there.
As to Chris Mathews, who was one of the first Peace Corp volunteers when President Kennedy started the program in the '60s. Spent a few number of years in Africa, believe it was Zimbabwe, fell in love with the country and people and over the years has returned with his family to other African countries. Always taking malaria meds. Needless to say, was surprising to return home (as told above) to have contracted malaria, near death and in hospital and out of work for an extended period.
As to whether to take or not, it's understandable that those who live/work in affected areas don't, but for those who visit for 2-3/weeks or a few months, in the scheme of things the cost of malaria meds whether Lariam, Malarone or doxcy are inconsequential.
And, even with the nets being offered by such as Noting but Nets thru the Gates Foundation, locals wouldn't take if they were "free" felt they weren't worth it, so there had to be a charge (about $1 in whatever local currency). However, for as may who did buy and use, especially to protect children, there were mamy who used these as "fishing nets." As they say "no good deed goes unpunished." For many it seems it was better to feed the family than keep them alive??? One wonders.
Maybe it's paranoia for us Westerners where years ago the US used DDT to rid malaria from swamplands (till the "greens" and farmers complained this was killing their crops)... can't win for loosing... till one takes ill. Have a friend who contracted malaria in the 70s and is still bothered by it. And most everyone I know in East Africa has contracted malaria at least once or twice, even in Nairobi or Arusha; guides especially come down with this regularly.
In the end for as many of similar threads, no one can make a decision for another. Get the info (there's plenty out there), discuss with your personal physicial or tropical diseases specialist and go from there.
Dec 18th, 2009, 09:05 AM
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Bushkido, am not sure where he got it, though I think it may not have been Africa. He was, at that point, taking about 10+ trips a year, around the world (for leisure, being retired) so could have been a number of places, have vague feeling they thought he might have been bitten in South America.
It's true that taking anti-malarials can mask the symptoms but best advice for short-term visitors is to take the drugs BUT also to be vigilant about symptoms not just whilst there but for several MONTHS after returning home.
The trouble, I think, is that many people have heard anecdotes about folks who got malaria, suffered a bit of a nasty fever and were then fine, the worst of it being the recurrences of said fever over the years. And because they figure that doesn't sound too bad, they figure it's worth the risk of getting it rather than the cost of the drugs, not to mention the potential side-effects!
I can understand their thought processes but know that it's not always the case that it's not life-threatening for those with access to proper health care.
The other thing to note is that native populations in malaria-ridden regions of the world have, over the millenia, developed some natural immunity to malaria, though of course, millions still die every year. I remember listening to a researcher (on TV) theorising that the high incidence of sickle cell anaemia within the black, African population might be the result of a mutation which both caused the disease AND conferred some natural immunity from malaria, hence it was a mutation that lead to it's own survival. Not sure if that's true but it does make me wonder if there are genes that provide some element of immunity.
One thing I do know is that something about me attracts mosquitos like nothing else. We've been to camps where the managers have said that they've not seen any mossies for weeks, not even a single one, literally. And within 24 hours, I've been bitten to hell by all manner of insects, including mossies - I recognise that horrible noise they make, nothing like it, lying there knowing that little critter is going to find me and suck my blood!
It's true that taking anti-malarials can mask the symptoms but best advice for short-term visitors is to take the drugs BUT also to be vigilant about symptoms not just whilst there but for several MONTHS after returning home.
The trouble, I think, is that many people have heard anecdotes about folks who got malaria, suffered a bit of a nasty fever and were then fine, the worst of it being the recurrences of said fever over the years. And because they figure that doesn't sound too bad, they figure it's worth the risk of getting it rather than the cost of the drugs, not to mention the potential side-effects!
I can understand their thought processes but know that it's not always the case that it's not life-threatening for those with access to proper health care.
The other thing to note is that native populations in malaria-ridden regions of the world have, over the millenia, developed some natural immunity to malaria, though of course, millions still die every year. I remember listening to a researcher (on TV) theorising that the high incidence of sickle cell anaemia within the black, African population might be the result of a mutation which both caused the disease AND conferred some natural immunity from malaria, hence it was a mutation that lead to it's own survival. Not sure if that's true but it does make me wonder if there are genes that provide some element of immunity.
One thing I do know is that something about me attracts mosquitos like nothing else. We've been to camps where the managers have said that they've not seen any mossies for weeks, not even a single one, literally. And within 24 hours, I've been bitten to hell by all manner of insects, including mossies - I recognise that horrible noise they make, nothing like it, lying there knowing that little critter is going to find me and suck my blood!
Dec 18th, 2009, 10:05 AM
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Hey guys, thanks for all your thoughts and the fascinating discussion. We'll never have all the answers, and it's great to bandy some ideas around with folk who contribute valuable ideas.
At the moment I have one of those nasty guys buzzing around me. I'm going to be in the Sabi Sands area in two days, and it really bugs me when those critters (I love that word) try to suck all the blood out of me before trying to abduct my earthly body.
Interesting that the greatest deterrent I've found is the overhead fan working its hardest. I don't know if it keeps the mozzies away, but it makes so much noise that I can't hear them coming for me!
Go well guys.
At the moment I have one of those nasty guys buzzing around me. I'm going to be in the Sabi Sands area in two days, and it really bugs me when those critters (I love that word) try to suck all the blood out of me before trying to abduct my earthly body.
Interesting that the greatest deterrent I've found is the overhead fan working its hardest. I don't know if it keeps the mozzies away, but it makes so much noise that I can't hear them coming for me!
Go well guys.
Dec 18th, 2009, 12:46 PM
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Ha haa, yes not hearing them coming at least allows for a decent sleep...
The worse mossie attack I've ever had was in India, probably not in a malarial area, but I was bitten hundreds and hundreds of times that night. I had the strongest fan I've EVER come across switched on, positioned right next to the bed, so strong it was hard to keep the sheet over me, I had it tucked in beneath feet etc. I had the sheet pulled up over me. And somehow, these uber mossies seemed to be able to land in that gale and bite. I even felt a couple land. They were big (and yes, definitely mossies, I could see them). One of worst nights ever.
The worse mossie attack I've ever had was in India, probably not in a malarial area, but I was bitten hundreds and hundreds of times that night. I had the strongest fan I've EVER come across switched on, positioned right next to the bed, so strong it was hard to keep the sheet over me, I had it tucked in beneath feet etc. I had the sheet pulled up over me. And somehow, these uber mossies seemed to be able to land in that gale and bite. I even felt a couple land. They were big (and yes, definitely mossies, I could see them). One of worst nights ever.
Dec 18th, 2009, 01:42 PM
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They say altitude, cold and wind deters those critters. So fans and air conditioning can work. Sometimes yes, others not!
Like the cockaroach, those mossies will still be around after we're all gone
Like the cockaroach, those mossies will still be around after we're all gone
Dec 19th, 2009, 03:28 PM
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blonde,
i tend to agree with the writings of bushkid on this topic. i know from your other posts you are considering a trip to the sabi sands. there has been one confirmed case of malaria in the sabi sands since 1975 and they are not sure if the person came into the area already infected.
another malaria free game viewing area would be the eastern cape. i know you are on a high budget trip so perhaps considwr kwandwe or gorah elephant camp.
Craig Beal
i tend to agree with the writings of bushkid on this topic. i know from your other posts you are considering a trip to the sabi sands. there has been one confirmed case of malaria in the sabi sands since 1975 and they are not sure if the person came into the area already infected.
another malaria free game viewing area would be the eastern cape. i know you are on a high budget trip so perhaps considwr kwandwe or gorah elephant camp.
Craig Beal
