Trying to figure out the risks of getting malaria in areas such as Inle lake and areas along the Irrawaddy such as Mingun, Kyaukmyaung, Katha, etc. and by extension, if malaria prophylaxis is an absolute neccessity.

I had no hesitation about needing Malarone for E.Africa, but am not so sure about SEA.

Can anyone rate areas on the mosquito index? For example, I had no problems in Lombok, Indonesia, but would have been eaten alive in Bali had it not been for 95% DEET (still got nibbled on).

Yes, I've read the CDC recs. but wanted more personal reports.

Thanks in advance.

Well here's a personal report - why risk it? We are going to Myanmar next February and, yes we will be taking antimalarials as we have in any area that the CDC recommends. The risk is there - unless you have really negative reactions why take the risk? When we were in Bali, we didn't see one mosquito - it all depends on when you go, but again, why take the risk? Malaria is a serious illness.

Thanks Craig. While I do not want to take foolish risks, I am trying to find a balance between that and being overly afraid of all the dangers of travel.

From what I understand, the risks of contracting malaria in Africa are far higher than in SEA.

I guess I've got more work to do in looking up the stats...

Forgot to ask: Did you take anything for your Bali trip?

Note than the malarial risk maps are made on the basis of government reports of the incidence of malarial. The Burmese government is not known for its international cooperation, and we know that their reports understate the actual incidence of malaria. Even from the reports we do have, we know that most of Burma is malarial risk. Since there is larium resistant malaria in the border areas, you must assume that all of Burma has larium reisistant malaria. That leaves you with two choices: malarone or doxycycline.

You were lucky on Lombok - there have been several outbreaks of malaria there in recent years. I certainly took malarone when I was there!

By the way, 95% deet is really overkill. While that concentration will be effective for perhaps an hour or two longer than a lower concentration, mostly you just increase your chances of a skin reaction without making the repellant any more effective. The general guideline is to use nothing more than 50% deet on your skin, and reapply after 6-8 hours if needed. Note that you must apply the repellant to all exposed skin. Some people think that if they "dot" on pure deet, it will be effective. It is not. Mosquitos are only repelled from skin that actually has the repellant on it.

You are correct that the incidence of malaria in Africa is greater than in SE Asia. But parts of SEA are certainly malarial risk.

PS, your question about mosquitos is really unanswerable. There are so many variables. I can't remember ever getting more than a bite ot two in my trips to Bali, but obviously, you got bitten. It depends on exact area, the weather pattern while you are there, as well as the time of year. So it's really not possible to predict. For instance, I saw swarms of mosquitos while I was in the Golden Triangle, and got bitten a bit despite the deet, but someone else reported few mosquitos on a visit to the same area.

Thanks Kathie, what you said about mosquito numbers makes a lot of sense.

So far I've only found DEET that's 35% or less OR the '100%' that I use.

Citronella or other more gentle products have just not done the trick for me.

I've been doing some reading in the meantime and it seems like 90-95% of malaria occurs in sub-saharan Africa.

Have seen your posts on the Africa board. I've been to both Africa (often) and Southeast Asia. I would never consider a visit to either of these destinations without taking malaria meds and using repellent when necessary.

You may want to do a search on the Africa board for a posting from Kavey - about her dad, who for whatever reason didn't take his meds... guess what? He returned home and shortly after diagnosed with malaria. Not very pleasant.

As many times as I've been to Africa, except for time on Zanzibar which is hot and humid and perfect for mossies, and bitten on the ankles, have never seen or heard a mossie. In SEA, however, we saw and heard a whole lot, but luckily never bitten.

Unlike living in an infected area where other precautions have to be taken, why, when on vacation chance it if there is even the slightest possibility. It's certainly worth the price of the meds and a bottle or repellent.

Hi Sandi,
Thanks for the reminder about Kavey's Dad. I went back and re-read the post, but I don't think she mentioned where he had been.

I'm not trying to be cavalier,
I've had malaria before and it certainly was not pleasant. But had this question put to me in Borneo: Why was I sooo concerned about catching malaria in my one week there, when others had lived there a whole lifetime without getting it?

Thanks to everyone who has responded so far. Just trying to seek balanced opinions.

Femi, the 35% deet is fine. You just have to reapply it after 4-6 hours.

Don't let yourself be mislead by the raw numbers: the fact that most malaria occurs in sub-Sahara Africa does not mean that it is rare elsewhere. Areas of SE Asia and of Central and South America are risky for malaria as well.

I know of more than one person who returned from SE Asia with malaria.

Hi Femi - I don't believe they were certain where her dad contracted malaria. He's a traveler, so could have been any number of places, but Kenya has been one of the countries he had visited.

There was an incident about three-years (maybe more) ago, about Chris Mathews of Hardball fame on MSNBC, who had traveled with his family to Southern Africa (including Zim), taken his meds used repellents, and some months later was diagnosed with a pretty serious strain of malaria. As he told the story, he had also after that family visit, traveled for the network to areas in the Middle East and was pin-cushioned with everything needed and took his malaria meds.

When he took ill, all tests diagnosed malaria, but he wasn't doing as well as one who should have had a lesser reaction. It was a sharp young tropical diseases physician who made the determination of this rarely seen malaria strain. Chris was in hospital for weeks on end, out of work, of course... told about his experience when he returned to work.

Having experienced malaria yourself, would you really chance a repeat episode?

For a disease that kills millions worldwide, we can only hope an inoculation was on the horizon sooner than later.

Good luck, whatever your decision and happy travels.

Thanks Sandi.

Like I said, I had no compunction about taking the meds for safari, but really cannot see that it's absolutely neccessary for Asia.

From what I can see my risks are already minimized by wearing my travel 'uniform' of long sleeves and pants, sleeping in air conditioned rooms, and being diligent about DEET.

I know malaria is serious business, but I really do think my risks for this trip are minimal.

However, the more I read here the more I am having second thoughts.

So far I've only gotten malaria while living in Nigeria.
It wasn't pleasant, but it was no worse than a bad case of the flu.

Frankly, I'm more worried about the severe colds I seem to come down with EVERY trip, and have spent more time and money preparing to combat that!!!

A tourist recently died in Thailand of malaria contracted in Burma - even with anti-malaria drugs. Be careful out there! The article:

We knew he was dying, say parents of Derry malaria victim

The heartbroken family of a young Londonderry man who died in Thailand from a deadly strain of malaria today expressed the overwhelming love and pride they felt for him.

Christopher Gallagher (23), from Liscloon Drive in the Shantallow area, contracted a deadly strain of the virus while fulfilling his life's ambition to travel the world.

The virus gripped the Queen's University graduate around a week ago, just a couple of weeks before he'd planned to return home from his gap-year style trek.

Christopher had been taking a course of anti-malarial drugs before and during his trip, but doctors revealed that they were useless against the virulent strain he picked up after being bitten by a mosquito, probably during a visit to the Burmese jungle.

He spoke to his devoted parents Martin and Mary from a Thai hospital less than 24 hours before his death - by the end of the conversation they say they knew their son was dying.

Fighting back tears today, Mr Gallagher told the North West Telegraph: "He was saying goodbye."

Christopher was an English Literature graduate from Queen's University and a former St Columb's College student. He was considering a career in journalism on his return home. He died from organ failure brought on by two strains of the malaria virus.

"He said while he was away that he would be living with us for a while when he got home, getting a job and paying us back for the trip and university," Mary said.

"I joked with him that he could never manage it but I know he would have tried.

"I remember he wanted to go away before university but I managed to persuade him not to. But he was so determined, it was his dream, he loved other cultures and new people.

"One of the last things he said to me was that he didn't regret a moment of his travels.

"It was heartbreaking that we weren't there holding his hand, the only thing that's keeping me together is human contact.

"All our friends, family and neighbours have been amazing, as have the Embassy, the insurance people and the PSNI.

"He told me in his last phone call not to lose it if he didn't make it, but I thought he might be exaggerating - a few hours later I realised he wasn't joking and then of course I did lose it."

The Gallagher family, including their other son, also Martin, today revealed the depth of their love for their "brilliant" son.

"He was a bit of a genius really," said his brother Martin. "Academically and artistically in particular. We were very close."

Christopher's wide circle of friends came to the family home to show their love and support last night, while his family endured a desperate wait to discover when his body can be repatriated.

-- belfasttelegraph.co.uk 2006-05-23

A link to this story was posted on another thread here. It is very sad, indeed. I find it especially sad that he was taking an anti-malarial that was known not to be effective in that area. It might have been larium or it might have been the proguanil plus chlorquine combination available over the counter in the UK. Note that both malaraone and doxycycline are effective world-wide.

Is the flurry of malaria threads sheer coincidence? Peak travel season approaching?

I probably would not be quite as relaxed about prophylaxis if I was going jungle trekking like the man in the article.

and perhaps the fact that current advice for thailand is not straightforward

My query was coincidental - the others were topped by a poster posting the article about the young man who tragically died.