Malaria
 

Going to Thailand (Bangkok, Chiang Mai, Chiang Rai) Vietnam and Cambodia.Know we need Malarone for Vietnam and Cambodia. Do we need it for hailand>
What kind of reactions have you had to the Malarone pills. Thanks for your input

Yes you will need malaria. I take doxcy rather than malarone. Side effects for malarone tends to be an upset stomach.

I used Malarone in India for about 3 days. Because it had a severe (!)laxative effect on me, I had to switch to doxcy which fortunately, my wife was taking. With the doxcy, we found that we sunburned easily so if you go this route, be sure to protect yourself.

Here's the best travel medicine resource: www.cdc.gov/travel

Do your reading before consulting with a travel medicine doc.

Your two options for anti-malarials for this area are malarone and doxycycline. There is larium-resistant malaria in the border areas.

Since you don't need anti-malarials for your whole trip, try to cluster your malarial risk areas together so you can take anti-malarials for the shortest time possible. Remember that you have to continue taking malarone for a full week after leaving the malarial risk area; you must continue doxycycline for four weeks after leaving the malarial risk area. Either doxy or malarone can cause stomach upsets if not taken with food. Both have relatively low incidence of side effects (I've taken Malarone on a number of trips and never had any side effects.)

Never had any side effects from Malarone--we've taken it for as long as a month at a time.

I took Malarone for two recent trips to Ghana,West Africa(Dec2003/Jan2004 and Dec2004/Jan2005)and the problem I had with it was stomach problems. The first time I took it I had a worse reaction than the second time and was in bed for a day and feeling queezy off and on the whole time. I always felt just out of it and was counting the days until the last pill so that my system could get back to normal. It wasn't an unbearable situation,however. The first time I also had a bit of loss of appetite and dropped about 10 pounds in 2 weeks.But, it beats Larium I hear. I personally would never take Larium. Happy Travels!

Guenmai- Just out of curiosity, why would you never take Larium. I am leaving for SEA very soon and I am taking it as of last night. My doctor said I could have side effects from any of the pills, and he feels larium is the best. But you are the second person who has said something about this drug. I would really be interested in what you have heard, and what any one has heard about Larium. I must say I do not feel sick as of now, but then again I just started taking it.

Larium can be extremely dangerous. If you have a side effect it can be a major psychotic episode or worse. I would never ever take this drug. Yes there are side effects with malarone and doxcy but they are mild and can be controlled. I know several people who were hospitalized because of larium side effects. Most doctors do not recommend it any longer.

Larium has a reputation for severe psychiatric side effects. While the majority of people can take this medication with no ill effects, when side effects do occur they can be serious. Consumer Reports did an article on larium side effects a year or two ago. I'd suggest that you read that (available on their website). Note that there is no one "best" antimalarial - the best one for you depepnds on your medical history, where you are going, etc.

I'd also recommend that you read the malaria info on the cdc website. Note there are parts of SE Asia where there is larium-resistant malaria. For that reason, many physicians will not prescribe larium for people traveling to SE Asia at all. The pockets of resistance are located in the border areas of Thailand/Cambodia/Laos/Burma. If you are going to these areas, do contact your doctor about this.

I won't take lariam either for the reasons mentioned above, but my husband takes it and has no side effects. I take malarone and have never had any stomach problems or any side effects but everyone is different. Malarone is supposedly the anti-malarial with the least side effects, at least according to the fancy travel medicine clinic I go to but some people do react to it. Unfortunately, you won't find out if you are one of them until you start taking it.

I also had an upset stomach for the first few days taking Malarone (I did take it with food), but it wasn't severe enough for me to stop taking it and went away after a few days.

My best friend has taken Larium several times without problem and has given it to her daughter without problem...which is great for them. Although I know that people react differently to different drugs...some with no reaction and others with bad reactions, I'm just not taking the chance having read so much info on Larium and having met and talked to a young woman in the Bangkok airport who was on her way on vacation to Vietnam and stated that she had ended up with permanent liver damage having been on Larium. Years before having talked to her I had decided to not take Larium. Happy Travels!

I've travelled to Bangkok, Hanoi and Siem Reap. I didn't take any malaria pills. I don't know if you'll need this in Chiang mai and Chiang Rai.

Purplefish, Bangkok and Hanoi are not malarial-risk. SIem Reap is, as is Luang Prabang. Chaing Mai and Chaing Rai are not risk areas in town, but the Golden Triangle is. The cdc website give accurate and up to date info on malarial risk areas.

Folks!

Lariam(Mefloquine) has a long list of contraindications for those who have had any previous psychological disorders, including depression and anxiety. It has serious side-effects above all among antimalarial drugs.

My suggestion is: Talk to your local International Travel Clinic to get the latest advisory warning and shots.

Personally, I am not an advocator for using drugs in prevention. Washing hands and use DEED bug spray, are much more effective and safer than those drugs. I am a health care worker who has spent considerable amount of times in SEA and Africa(working with the refugees), and never used any of these preventative drugs. Just use your comment sense: hand washing alone would eliminate most of the GI problems, including the Hepatitis A(food and water), bug spray and mosquito net would take care malaria and other infectious parasites that could transmit by mosquitoes. The latest warning from the Internation Travel Clinic: stay away from birds and poultry due to increasing numbers of Avian Flue cases in SEA. What most people do not often talk about, and they should, is TB. But that's another topic. Again, prevention an ounce, a pound of cure, folk.

Well, if you still want to take the drug so it makes you feel more prectected, please talk to your doctor First. You may need to have baseline blood work to check your liver function and others.

Enjoy the trip.

Bayon, you're a health care professional and you are encouraging people to simply wash their hands to avoid Hep A? There is no question that hand-washing is effective in reducing GI upsets and the transmission of a number of viral and bacterial illnesses. But Hep A is more likely to be transmitted by someone handling your food who has not done proper handwashing! (something the traveler has litttle control over) Hep A outbreaks occur not only in developing countries but also in North America and Europe.

While using a repellant that contains DEET (25-50%) is certainly advised to help prevent mosquito bites and reduce the likelihood of contracting mosquito-borne illnesses such as malaria, dengue, etc., it is not as effective as a combination of repellant and an anti-malarial. As a health care professional, no doubt you are aware that this is not only a personal health question but a public health question. Also, I'm sure you are aware that the "I didn't take an anti-malarial and was fine" argument is not useful infromation for anyone in making a decision.

The discussion on TB can be very short, as travelers are at low risk for contracting TB. Persons working with refugees are certainly at greater risk for a number of diseases not of special concern to the traveler such as TB and cholera.

As you correctly point out, everyone should consult with a travel medicine doctor as well as reading the info from the cdc before travel.

Volunteer workers working in malarial Asia and Africa (including health care workers) frequently don't take malarial prophylaxis drugs as most cannot be taken for more than three months - perhaps you fall into that category Bayon?

I don't take anti-malarials whilst travelling in Thailand or SE Asia but then have never been very far from good medical centres where I can pay to get treatment v quickly.

I have taken anti-malarials when undertaking short term volunteer projects in rural areas of West Africa - and contracted falciparum malaria when taking Larium. No drug is 100% effective! However, when I am in areas with a lower risk and will be near medical centres I prefer not to suffer the side effects of the drugs - I've tried them all and found them all pretty horrid (stomach upsets mainly) and I am not keen on burdening my body with pharmaceuticals! Nor do I take them if I am in a malarial area for longer than three months.

However, that is my informed choice and I am in good health generally. I agree that the best approach is to seek medical advice and undertake some research on the internet. The most up to date site for malaria info for international travellers is the World Health Organisation, part of the UN - http://www.who.int/ith/countries/en/

Actually, Bella a number of anti-malarials are fine for long term use. Whether you chose to take anti-malarials or not is your choice, but I would plead for accurate information to be posted on public boards rather than misinformation (which is why I felt compelled to respond to Bayon's post and why I feel it is important to respond to the portion of your post that says "most [antimalarials} cannot be taken for more than three months." Doxy can be taken for years at a time, as can larium (for those who do not have contra-indications). Malarone is only advised for shorter-term use, but only because there is not adequate research yet on long-term usage.

What I said was: by washing your hands alone would eliminate MOST of the GI complications, including Hep A. And as we already awared that Hep A is only transmits from person to person through food and water, which in turn from people who handling it.

To say that the tourist themselves have no control whatsoever is entirely inncorrected. The moment you step off that plane, you are handling moneys, passport, shaking hands, and whatever you touch the objects all around you (gifts at the flee markets) you become the carrier of the same germs like those who prepare the foods at the restaurants. You CAN control how this cycle of transmition by a simple washing hands. That's simply my message.

That said, for all the possible precaustions that anybody can come up, hands washing, malaria pills, many shots given by your travel clinic, etc..there is NOT an absoluted protection for travellers. The risks are there; that's why it called Adventure.

The safest way(100%), I know, is to get a flat screen HDTV and watching discovery channels. :)

I am going to Kenya & was told I need Malaria Pills. I was all set to get Larium but I've read quite a few articles not to get it. Is that the only one available that you only take once a week?

There is just one other once a week pill and it is not effective in Africa.

I don't mean to prolong the conversation on this topic, but I just read the response from Kathie that because I am a health care provider I shouldn't advice people from taking preventative drugs.

I was NOT advice people/travellers not to take preventive drugs. I myself never have taken them, and I never will, but if anybody is interested about taking them, please discuss it throughouly with your doctor.

Here's why preventive drugs used is a PUBLIC HEALTH issues: several decades ago we rarely heard about drug resisitance strains of bacteria MRSA/VRE, drug resistant strains of Malaria and Tuberculosis, just to name a few. Now, these are common struggle for medical providers to deal with. It used to be easy to treat malaria with Quinine or Chloroquine, simple drugs of choice. Now, they like aspirin. Back in WWII Penicillin cured millions of all bacterial wound infections, and now, you rarely head anyone being treated with Penicillin for bacterial infection. Why? Because everyone wanted antibiotics from their doctor everytime they have common cold or flu, URI(Upper Respiratory Infection). All of which no treatment needed. Soon, we are running out of drugs to deal with all these new strains of parasites. My point is, once these bugs are mutated and resisted to all these new drugs, which in the recent WHO health report it's already developed into such population), the side-effects from taking them outweight their benefits.

And that's, in my opinion, is A SERIOUS PUBLIC HEALTH ISSUES.

Why, you asked, there are still advises for travellers to take these drugs. I am not sure. Perhaps, it has something to do with a question such as, why the drug rep(pharmaceutical company) sponsoring health care professionals to a golf trip-continuing-education program every year, say somewhere in exotic places like Hawii resorts?

Again, it's just a penny of my thought.

Hi Kathie - from the websites you have suggested people refer to for advice on malaria and jabs, I think you are in the US and speaking from a US perspective. I am in the UK (although previously lived in the US) and I think that this may account for some of the differences in information being posted here. I think it is therefore inappropriate to speak of misinformation in these circumstances.

The specialists I have seen here in respect of various long term trips to highly malarial areas in Africa have not, despite the fact that UK licensing laws would allow them to to prescribe for longer periods than 3 months, done so. Although, I would add that the outer (UK licensed) time limits are much less than the 'years' you cited as being appropriate for usage of doxy and larium - I believe Larium for 1 year max and Doxy for 6 months.

I prefer the more cautious approach of the specialist practitioner that the organisations that I have worked with have referred me to than time limits that I feel may have been pushed to extremes by research studies funded by companies with a vested interest in long licensing periods.

I think that we need to accept that different countries will have different licensing periods and different medical practitioners within those countries may have lower limits in practice that they are comfortable with.

For those with questions about malaria, I think everyone has agreed that independent medical advice from a specialist or general practitioners should be sought.

On reflection, it is highly inappropriate for any of us to advise on what drugs should be taken on this forum - perhaps we shouldn't even be stating what we do in similar circumstances.

Bayon - I really agree with your views expressed in your last post. It is a grave concern.

http://www.who.int/mediacentre/facts.../en/index.html

For those who cares, click the link above, read and judge for yourself.

Whoa! We have too many topics going here - no wonder there are misunderstandings.

It is true that I am from the US and that I use the cdc website frequenty. The WHO website is certainly a very reputable site, but they do not update their malarial maps frequently (no doubt a budget issue). When I want to check on malarial risk areas, I typically check both sites and look for most recent updates.

Here are the issues I was concerned about:

1. Bayon posted two things I thought were not accurate: "Washing hands and use DEED [DEET] bug spray, are much more effective and safer than those [anti-malarial] drugs." Hand-washing, while always wise, is not an effective prevention for malaria. While not taking drugs to prevent malaria means that one would not have side-effects, repellants alone are not as effective as the combination of repellants and anti-malarials. While one might make the decision to not take anti-malarials, and that is an individual decision, I believe it is important to give accurate information on a public board such as this.

2. In the same post, Bayon writes: "hand washing alone would eliminate most of the GI problems, including the Hepatitis A" As i responded in my earlier post, hand-washing (along with other standard food and water precautions) is a good prevention for many GI problems. However, Hep A is transmitted primarily in poor sanitation and handwashing by the people preparing and handling the food you are buying. This happens not only in developing countries but in developed countries as well. It is hard for me to imagine why a health care professional would discourage people from getting the Hep A vaccine, which has very long term effectiveness.

3. Bella, I agree with most of your comments, and certainly respect what appears to be a conscious and infromed choice not to take anti-malarials in SE Asia. As you know, only limited areas of SE Asia are malarial risk. However, I do disagree with your statement about anti-malarials not being appropaiate for long term use. Volunteer workers from the US do typically take anti-malarials for longer periods, often two years (Peace Corps workers in malarial risk areas typically take the appropriate anti-malarial for a full two year period.) There is good data on these groups. Also, Doxycycline was (and still is) use for intractable acne in the US, and adloscents often take it for two or three year periods. WHile I respect differences in practice among practitioners, I am simply advocating for the posting of accurate info as possible. Wheterh prescribing long-term anti-malarials is more cautious or less cautions is a matter of perspective.

4. Bayon - You posted quite a bit about antibiotic resistance. The citation from WHO from 2001 is a good one. The over-prescription of antibiotics and patients not completing the full course of antibiotics for for an infection has contributed to antibiotuc resistant strains of many bacteris. This, however, is not especially relevnt to the topic of anti-malarial drugs. Only one anti-malarial medication (doxycycline) is also an antibiotic. Interestingly, despite the fact that doxy has been used effectively as an anti-malarial for many years, there has never been any documented malarial resistance to doxy.

I believe that one must be an informed consumer of medical care to get the best care. I advocate that people read the cdc website (or the WHO website) prior to consulting with a travel medicine specialist.

http://www.tulane.edu/~dmsander/WWW/...esistance.html

The quote below is a short version of the link above.

"It is clear that imported malaria cases will continue to be a problem for the foreseeable future, as the mobility of tourists and workers is increasing all the time, and non-immune individuals are bound to find themselves at risk. The common prophylactic drugs are, for many areas, obsolete (19), and the use of advanced drugs such as artemisnin derivatives for uncontrolled prophylaxis would be downright irresponsible given the obvious ability of Plasmodium falciparum to attain a high degree of resistance in a short period. It has already been suggested that strains resistant to Artemisnins will appear by the end of the decade (16), and this does seem inevitable."

http://www.tulane.edu/~dmsander/WWW/...Treatment.html

Just another quote to entertain folk.

"The use of drugs such as mefloquine and chloroquine in the prophylactic role appears somewhat questionable, given the deteriorating global resistance situation, and the NHS no longer prescribes prophylactic antimalarials. Perhaps insecticide impregnated mosquito nets and insect repellent creams are the best prophylaxis for a traveller, especially due to the problems of unpleasant side effects and non compliance. Indeed, it seems that the initial widespread prophylactic use of the now outdated antimalarials was responsible for the rise of resistance in the first place (19). This is a cautionary indicator for how we use our new drugs such as artemisnins in the field. It seems that many travellers still take antimalarials in the prophylactic role, however."

Bayon, because of the mobility of travelers it is important to use prophylactic medications. I was unable to get your links to work, but I wonder when and (where) this was written, as there are interesting errors in terms of what we know today. There has been widespread chloroquinine resistance in many areas of Asia, Africa and some parts of central/South America for decades. There is mefloquine resistance in small parts of Africa and SE Asia. The quote you give seems to indicate that these two are the only common prophalactic drugs, which is simply not true.

There has not been any demonstrated malarial resistance to either Doxycycline or to Malarone anywhere in the world.

Artemisnins are used for treatment only, so the quote about using them prophylacticly is curious.

Bayon, I was finally able to get your link to work. I note that this is an article out of a textbook from 1996. The options for treating malaria have changed substantially since then.

During the Rwandan crisis in Republic of Congo(formerly known as Zaire) I had spent a year working in the region(Rwanda, Zaire, Urganda, Burundi, Tanzania, and Kenya). Even then, 1994-1995, Lariam has shown sigfinificiant resistant in the large population. Initially, Medicin San Frontier (Doctor Without Border) protocol called for Quinine and Chloroquine, but they got very limited results. Later, Lariam and combination drugs treatment was implemented.

Similar situation is presently existed in Cambodia, Vietnam, and Lao(perhaps Thailand too). Even though, the UN had spent Billions of dollars since the early 90s in the region, esp. Cambodia. In my humble opinion, things are getting worse, regarding health concern, than getting better. Mutated microbial strains will never revert back themselves, as far as the genetics concern.

Can't help but throw my two cents in based on profession and personal experience. I have degree Public Health and Epidemiology, and I just got back from trips to east Africa, Cambodia, Vietnam, and Bangkok.

First go to www.cdc.gov.

This website has the most up to date info about outbreaks and hotspots, and can give you info specific to the areas you will be travelling in in Thailand.

Second, take Malaria pills. One of the people in our group in Africa missed her pills a day or two, and ended up with Malaria. Definitely not fun. She got treatment early, but was still completely knocked of her feet for days, so I can't imagine what it would be like it you don't happen to get treatment earlier. Even if you get treatment early, please recognize it is not just like having the flu.

The majority of our group took Malarone. As long as you take it with food, you are unlikely to have problems. No side effects reported by the 10 people on Malarone.
I have heard reports of a laxative effect, but sometimes that is actually due to eating or drinking contaminated food or water.

Talking with our guides, Malarone seems to have the fewest problems. Lariam can cause psychiatric problems, dizziness, fogginess, etc., and sometimes were severe enough that people had to be sent home. Doxy is another option. However, in the warm moist climate that is southeast Asia, women may be more likely to develop yeast infections.

We still got bit by mosquitos even though we used 50% DEET products and long sleeve etc in the evenings. The problem is they are unpredictable. You can have no problems for days, and then hit one small area or day, and the mosquitos are everywhere and are biting.

Hope this helps

Better safe than sorry.

Just for the record - I had the "laxative effect" from Malerone and had not even arrived at my destination (still on the plane) - so you can rule that theory out.

While Malarone didn't have a laxative effect on me, it did upset my stomach and since I also started taking it before arriving at my destination, I think it's far morely likely that it was caused by the medication itself and not any contaminated food or water.

Craig,
Please note I said SOMETIMES the laxative effect can be due to dietary changes or contaminated food. It is also suggested that Malarone be taken with food to reduce likehood of stomach problems, but it make not completely knock them out. Yes, there are always side effects to taking any drug, however my main purpose for making these statements is to try to impart that malaria is far worse than most of the side effects of any of the malaria drugs (although Lariam can have signficant pyschiatric problems in certain indivduals), and that the majority of people won't experience problems of any real consequence. It is important to find that best fit for each individual. The CDC website spells out the contraindications and best uses for each of these drugs, and a good travel clinic will be up on these as well.

By no means was a trying to discount any one individual's reaction to the anti-malarials, rather wanting people to focus on the likelihood of having side effects, and to contrast that to the effects that malaria could have