According to the CDC, Chiang Mai is not a malarial area. We just returned from BKK, Siem Reap and the Golden Triangle (north of Chiang Rai on the border with Burma & Laos). Four of us(2 adults, 2 teens) took malaorone for 11 days with zero side effects. The General Manager of the Anantara Golden Triangle was shocked that our travel doc has said to take anti-malarials. He had previously lived in Vietnam and Luang Prabang and swore that the GT has no malaria. We discussed this with various other guests from the US, Europe and Australia and we seemed to be the only ones who were advised to take malarone. (It was probably a non issue at this chilly time of year anyway because we encountered no mosquitoes during- more about this in my upcoming trip report.)

As crosscheck says, Chiang Mai is not a malarial risk area. The Golden Triangle is. The statistics collected by the Thai government and reported to WHO indicate that there are significant numbers of malaria cases in that area. (Crosscheck, you were lucky not to have many mosquitos there - we had swarms of them each evening when we were there at the end of November.)

Doxycycline is an antibiotic that works as an anti-malarial. Do note that you must take it at the same time each day and continue it for a full month after leaving teh malarial risk area.

Hoodlims, take a look at www.cdc.gov/travel for more info on malaria and travel medicine issues

Thanks Kathie. I did check that out after my post - my edition of Fodor's stated that Chiang Mai was a malarial area, but then again, they wrote the book immediately after the tsunami. Do you think it is a good idea to bring them anyway in case of a possible side trips?

Chiang Mai has not been a malarial risk area for many years. Fodors is simply wrong on that count. (The tsunami had no impact on Chiang Mai)

Bring mosquito repellant. Anti-malarials aren't something you can take for a "side trip." It sounds like you are unlikely to be in any malarial risk areas, which are the border areas with Cambodia, Laos, and Burma. Do note that there is dengue in Thailand, so you want to prevent mosquitos bites in any case.

I agree with Kathie about repellant, but if you think there's a chance you might go into the Golden Triangle area, it wouldn't hurt to bring Malarone with you. But remember that you need to start taking it a day before your side trip. We ended up going on a day trip into Burma and we weren't sure we were going to do that before we left.

Kathie-We are going near the Golden Triangle area for about 3 hours as part of a side trip from Chang Rai. The itinerary says "From Chang Saen take a short boat ride on the Mekong River towards the Golden Triangle" and then visit Mae Sai to stroll through a local market. Would you take Malarone to be covered for those few hours. I was inclined not to. I will wear my Buzz Off clothing, spray well with Deet and hope for the best. What would you do?

For a few hours during the day in a malarial risk area, personally, I would not take anti-malarials. The mosquitoes that carry malaria are active primarily from dusk to dawn and most active at dusk and dawn. I would use repellant religiously.

Dependinging on individual differences and health issues, someone might be advised to do so. Talk with a good travel med doc about this.

Kathie, thanks so much for your prompt reply.

I have been reading all these comments with great interest. I will be visiting Chiang Rai and the Golden Triangle for 3 days during my stay in Chiang Mai in early February and really do not like the idea of taking anti malarials (my stomach reacts badly to many medicins).

I found an article by someone who used a plant based anti malarial called Artemisinin and thought this looked very interesting. Does anyone know anything about this? You have to take it for at least 3 months (starting 2 weeks before the trip). There are no known side effects.

I have bought the high and medium strength DEET and sprayed my clothes with long lasting stuff (stays in during 3 washes).

Artemisinin is used to TREAT malaria, not as a preventive. WHO has requested that in using Artemisinin for treatment of malaria it be combined with at least one other drug to reduce the development of resistant strains of malaria.

Artemisinins purchased in SE Asia are exceptionally likely to be fakes.

Note that there are no drugs which have no side effects.

Do some more reading on malaria, and talk with a travel med or infectious disease doc before you make your choices. Knowing more about the transmission of malaria can help you reduce your risks, even if you opt not to take anti-malarials.

From what I understand, it must be taken 2 - 3 times a day because its half life is so short. Also, it is not recommended as a prophylactic medication due to the frequent dosing and to try to prevent resistance. There are a couple of semi-synthetic versions of the drug, as one of the problems with the original version is poor bioavailability. All of them have a short half life though.

As a treatment medication, it is recommended to be given along with lumefantrine to try and counteract the very short half life of it. This treatment can be used for uncomplicated falciparum malaria, but apparently none of the other types.

Side effects...everything has side effects. http://www.drlam.com/A3R_brief_in_do...rtemisinin.cfm is fairly easy reading and lists some of the possibilities. Note that it is an herbal medicine, and as such, is not subject to the kinds of testing that is required of drugs...meaning that what you buy may or may not be what you think you are buying and there is no tracking of side effects when and if they occur in people who use it.

Anti-malarials are not generally recommended for a 3 day stay in Chiang Mai, with a day trip to the Golden Triangle and Chiang Rai.

And not being a drug means it is not required to be tested for safety and efficacy.

Thank you for all your replies to my question about Artemisinin. The article that I read was on "what really works.co.uk"

Maybe people are mixing up the uses for this product because when I rang revital who supply the artemisinin mentioned in the above article they said to use it for prevention.

My doctor here in France has given me a prescription for doxycyxcline but after reading the enclosed leaflet I really did not want to take this. I will be one week in Chiang Mai and 3 days in the Golden Triangle area visiting hill tribe villages, elephant riding, etc.

From there I carry on travelling to Singapore, Australia, New Zealand and USA before returning to France and do not want to be taking pills that make me feel ill during my whole trip.

roofr, I took a look at the websites you cited. Note that neither are mainstream sites, both advocate homeopathy. There are alerts on many of the travel medicine websites about deaths of travelers to malarial risk aeras who were using homeopathic remedies to prevent malaria.

Promoting the use of Artemisinin for prevention of malaria goes against all the research that has been done on this very useful medicine. As I mentioned earlier, it is a medication used in combination with others for treatment of malaria.

You have two choices for effective anti-malarials for this region:

1. doxycycline, an inexpensive antibiotic that is taken daily for one day prior to entering the malarial risk area, every day while in the malrial risk area, and one month after leaving the malarial risk area. The most common side effects are stomach upset if taken without food and increased sun sensitivity. Some women maye develop vaginal yeast infection from use on an anitbiotic. Doxycycline is safe for use for at least two years as an antimalarial.

2. malarone, the newest anti-malarial. It has the lowest side effect profile of any anti-malarial. The most common side effect is stomach upset. It is taken beginning one day before entereing teh malarial riak area, every day while in the malarial risk area, and for one week after leaving the malarial risk area.

Of course, you may opt to simply do everything you can to prevent bites: spraying you clothes, using a deet-based repellant to cover all of your exposed skin, sleeping indoor in an air-conditioned room or if the room is not air-conditioned, using a bed net. It takes only a singel bite by an infected mosquito to trnasmit malaria. If you opt to go without anti-malarials, then do note that you should immediately seek medical attention if you develop a fever or other posssible signs of malaria.

Kathie, thanks for your detailed reply. I think I will ask my doctor to change the prescription to Malarone as it seems to be easier to tolerate and also taken for less days.

Talk about confused!

We just booked and paid for a trip to Thailand; if I had seen this malaria thread, we'd be going to a safer destination.

Katherine

I'm making my 11th trip to Thailand in another week, and I have yet to take any meds before any of these trips. But I've not been to places other than Bangkok, Phuket, Samui, and Chiang Mai. I know any number of people who have been to these smae locations without taking anything before going. I would never say that Thailand is not a safe destination! Have a wonderful time!

Katherine, do read this thread, there are only VERY SMALL areas of Thailand that are malarial risk. Most visitors to Thailand do not go into malarial risk areas.

It is certainly true that one should always read about health issues before booking a trip.