Malaria Risk India: CDC vs. UK Guidelines
 

We are traveling to India in early October. I am trying to avoid taking meds because of a past blood reaction.

The CDC recommends anti-malarials but the UK publishes a map outlining high and low risk areas. According to the UK, everywhere we go will be low risk except for 1 day in Khajuraho and 1 day in Orcha. These cities in Madhya Predesh are at the edge (but still in) the high risk areas and we will not be outside from dusk to dawn.

I am trying to determine the relative risk in mid October vs. other months. Is it worth rescheduling to a time with lower risk or does the risk stay fairly constant?

Any perspectives would be appreciated.

Roosevelt.

This is a tough question, Roosevelt. Ideally, you would sort this out with a good travel med doc. Some areas of India have more seasonality to malarial risk than others.

The mosquitos that spread malaria are most active around dawn and dusk; the mosquitos that spread dengue are city-dwelling and are most active during the day. You are at lower risk if you are staying in air-conditioned rooms.

You will need to be meticulous about applying mosquito repellant, either a deet-type repellant or a picardin-type repellant. Note that these repellants must be applied to every cm. of exposed skin to be effective. Consider an encapuslated type like Sawyers.

There are several medications that are effective anti-malarials in India, doxycycline and malarone and meflouquine are all effective.

Good luck to you.

I fear you are seeking definitive answers that even a specialist travel physician as Kathie's suggests would be hard pressed to answer. The schools of tropical medicine in London and Liverpool are still pre eminent in the collation of data on malaria and other tropical diseases, but the maps tha they produce are only ever intended as guides. To try and determine the risk from mid Oct to other months is impossible as it is mot the actual month which is the issue but the change in seasons which, with global climate change is a moveable feast!

Kathie's suggestions re repellent etc. are your best option as the only certain way to avoid malaria is not to get bitten. I contracted the diesel es 20 or so years ago and, believe me it was not a pleasant experience. I had a severe allergic reaction to the drugs used to treat me and for years did not take any prophylactics. New meds have since come to market with which I have had few problems.

That said, I am about to embark upon a trip into the Amazon basin and given the relatively low degree of risk have decided against prophylactics in favour of a taking a treatment course of drugs with me, to be used only if I succumb to the disease. I will of course be ultra cautious re repellent, covering up etc.

You are right to be concerned as malaria is still the biggest killer in the world. Many assume that because other have not been affected they will not be either which IMO is bizzare assumption.

I appreciate the perspectives.

It would be helpful to know:

1. How many US citizens visit India each year?
2. How many cases of malaria are diagnosed each year in that group?

If the chances are low, not taking meds may be reasonable. We are staying in good hotels and will only be outside at dawn in Varanassi.

Roosevelt.

I do not know how U will find those stats tho a web search will probably get most of what U need. I think it best to consult your PCP as this person knows your condition best. Is taking malaria meds impossible for U?

Roosevelt, I don't believe that data you mention will be of much help you you. There are too many variables involved. It makes a difference exactly where people traveled to, what kinds of precautions they took (anti-malarials, repellants), what kinds of activities they were involved in.

I don't know what kind of anti-malarial you took that caused the problems, but the three effective anti-malarials in India are all quite different from each other , have different modes of action. At the very least, do talk with your primary care provider. And if there is a medical school in your city, see if they have a tropical disease division.

Katie gives good advice. Don't try this on your own. Let your PCP advise U. Good luck!

Thanks for the all the replies. I will be using DEET, avoiding being outside between dawn and dusk and wearing mosquito repellant clothing.

I am a physician myself and this decision has been a challenge!

The safest thing is to stay home but I hate to miss the opportunity to explore the world.

Roosevelt.

Roosevelt, I always go with the Uk recommendations because they are often more nuanced, as your description suggests. However, I often check with a pharmacist locally about what they recommend as they have a more comprehensive knowledge of the local conditions. In India (if we're going to a malarial area) I always opt for doxycycline because the research suggests it offers some protection against travelers diarrhea.

welltraveledbrit, If you have chosen doxy in the past because of its effectiveness against bacterial travelers diarrhea, you can now choose on the basis of something else instead. Because of the wide-spread use of doxy for all kinds of things, the various types of bacteria that cause travelers diarrhea are now resistant to it. Indeed, the bacteria that cause travelers diarrhea are resistant to cipro in Thailand and Nepal, I'm not sure about the situation in India.

We had anti malarial pills on our first trip to India but we did not end up taking them because it was in January and we were mostly in the north. However, this time around we are visiting Bihar and Orissa so have decided to take Malarone and will spray permethrin on clothing and hope for the best.
Good luck to you Roosevelt!

Any thoughts on using a mosquito net at night or some kind of electrical mosquito zapper if staying in top flight hotels? Overkill?

Thanks for any opinions.

Roosevelt.

I am not trying to minimize the risk of malaria but read that out of 800,000 visitors to the UK last year, 2000 contracted malaria (0.25%).

There are no guarantees but with precautions, good hotels and only 48 hours in the northern part of Madhya Pradesh; the odds should be low. No guarantee of course, but decent odds.

Roosevelt.

Overkill. No need for bed nets if you are staying in air-conditioned rooms. Likewise, I'd nix the mosquito zappers.

Enjoy your trip!

Kathie:

Thanks for your input. I probably would just take malaria meds but I have a hematology issue that can be affected by medications.

Roosevelt.

I live in Thailand and one of the most effective device that I use is the "Black Hole" mosquito trap. It doesn't get rid to the mosquitoes immediately but if you leave it on for a few hours it does trap most, if not all, the mosquitoes in the room. Might not be too practical to travel with them but they do work, even the "Junior" version which is very light.

http://www.panscience.co.th/en/produ....php?BrandID=6