CDC says malaria at Borobudur, but...

Old Apr 18th, 2006, 08:45 AM
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CDC says malaria at Borobudur, but...

The CDC website says that there is no malaria risk in Java EXCEPT FOR the "temple complex of Borobudur". This sounded strange to me, so I contacted Amanjiwo (located at Borobudur) and the manager said that there has not been a case of malaria in the 5 years he has lived there. His family is not on anti-malarials.

I know some of you (like me) have upcoming trips to this area. I thought I'd share this and let you discuss options with your travel doctors.
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Old Apr 18th, 2006, 09:01 AM
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Here is the direct quote from the cdc: www.cdc.gov/travel
"Indonesia: Risk in all areas of Irian Jaya (western half of island of New Guinea) and at the temple complex of Borobudur on Java. Risk in rural areas only in remainder of islands and in the province Aceh. No risk in cities on Java and Sumatra and no risk in the main resort areas of Java and Bali. "

(BTW, Personally, I would not consider a hotel manager to be a reliable source of health information. Tour companies to many parts of the world routinely tell their customers that there is no malarial risk where they are going, despite the fact that there is well-documented risk.)
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Old Apr 18th, 2006, 09:12 AM
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I think as well one can distinguish the medical advice that a long-term worker to such an area would receive as compared to a short-term visitor.

When I worked long-term in malarial areas, I was advised that anti-malarials were not appropriate, due to the length of my minimum stay. Of course, there are different drugs now so things may have changed and I live in the UK and went with a UK based agency so the advice I received might differ from US advice.

Borobudur is fantastic btw, have a great time
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Old Apr 18th, 2006, 01:55 PM
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Hi Kathie,

Would you say that my synopsis is correct - that aside from Borobudur, the CDC is saying that all other areas of Java should be fine? It is an important question for us since we are making a few stops in Java.

P.S. Didn't you used to work for (or with) the CDC? Or am I thinking of another fodorite?
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Old Apr 18th, 2006, 02:18 PM
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I had read the CDC warning a few weeks ago and wasn't sure if we should use anti-malarials since we will be at Borobudur for just one over night. I decided to get a prescription for Malarone for me and Eric. I decided this was the best course since last year, we went to Costa Rica and read the malaria risk was small (but there). We didn't take anything and when we got home, I developed a very high fever and had to get tested. It wasn't malaria, I tend to run high fevers, but it was scary. I decided that I'd rather be safe than sorry since running fevers is not abnormal for me. If I run a fever after coming home and it doesn't go down in a few days, I would still get tested for malaria though, since no preventative is 100%, but at least I wouldn't be so worried.
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Old Apr 18th, 2006, 02:39 PM
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Good advice laurico about getting tested for malaria should you run a fever. We were advised (by a travel clinic in Tokyo) that if any of developed a fever any time within a year after being in a malaria zone to be tested for malaria...whether we took malaria preventative medicine or not, as the meds are not 100% effective at prevention...but much better than nothing. This was backed up by the Thai doctor we saw in Khao Lak when our daughter was ill there...she was tested for malaria among other things, and he too, told us that if any of us developed fever within a year to be tested for malaria, as it can lie dormant for a long time before causing symptoms.
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Old Apr 19th, 2006, 06:43 AM
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Ericka, I must apologize. I started posting a reply to you and was interrupted, so cut it off and sent it. Yesterday I was so busy I didn't get back to follow up on it.

(By the way, I'm not the person who worked for the cdc...)

Several points I wanted to make have been made by others (a visitor vs. someone living there will get different advice about how to manage the risk; the point about the best anti-malarials being only about 98% effective is important, too.)

It's a bit difficult to know how to interpret the cdc on this one. A travel med doc I spoke with said she understood it to mean that there is malarial risk in rural areas outside of the cities and major tourist areas in Java, but admitted that the wording was awkward. She said she would (for herself) take antimalarials if she was staying more than one night in the immediate vicinity of Borobudor or staying more than one night in rural areas of Java. Also, going to Borobudor at sunrise (which is a time the mosquitos are active) increases your risk. So talk with your travel med doc and see what his/her take is on it.
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Old Apr 19th, 2006, 07:37 AM
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Yep. Sounds good.
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Old Apr 19th, 2006, 07:54 AM
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I'm glad someone pointed out that no anti-malarial is 100% effective - I caught malaria whilst on a six month trip to Ghana in 97. I was taking Larium at the time and only got bitten 11 times in the whole time I was there and still managed to get malaria - not one of my best trips . (I know which mosquito it was - right ankle, after got off minibus as the sun was setting, forgot to put on Deet as was so excited to finally arrive at destination - duh!!)

But also wanted to mention re. the fever that the pattern of the fever with malaria varies depending on the type of malaria contracted. So don't just look for a fever that lasts a few days and doesn't go down. Don't wait that long!

My fevers would last 12-24 hours and then go for 2-3 days and then reappear. Malarial fevers will not necessarily be continuous - in fact the pattern of the fevers and the gaps in between would help a physician diagnose what type of malaria had been contracted in the absence of blood test results. I didn't realise this and because the fever came and went, didn't seek medical advice after the first fever, travelled to a rural area once I felt better and got the second fever whilst in a rural area. By the time I got effective drug treatment back in the capital, my malaria was quite advanced. Hope you never have to learn from my mistake but thought I would pass this on

Looking forward to some beautiful Borobudur photos and stories from you all...
BB
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Old Apr 19th, 2006, 08:40 AM
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Excellent point, Bella!
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Old Apr 19th, 2006, 12:19 PM
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While I certainly use the CDC as a guide the malarial maps are often rather conservative for example they mark certain areas in Africa or the Amazon where the malarial risk may be very variable, by smaller regions.

Obviously health risks like all risks are personal.

We recently visited Borobodur and took no malarial drugs. However, when we were in Mali several people who where on our trip and taking anti malarials contracted Malaria.
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Old Apr 19th, 2006, 01:17 PM
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Bella, you make a good point but for me, I tend to run fevers every few months and they sometimes go as high as 102 (Fahrenheit) and since I go to a Malaria infected region at least once per year and usually twice per year, I would be getting tested for malaria an awful lot!! Of course, if the fever came back after going away for a day or two, I would run to the doctor.
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Old Apr 19th, 2006, 06:04 PM
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Actually, from recent news reports, it sounds like the greater risk is that Mount Merapi is about to blow.
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Old Apr 20th, 2006, 03:45 AM
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Oh my! Thanks for bringing this to our attention. We'll have to keep an eye on the news.
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