Will I need Malarone in these destinations?
 

I'm going to be spending a month in Thailand/Cambodia this August, and will be in Bangkok, Mae Hong Son, Chiang Mai, Lampang, Siem Reap and Koh Samui.

I understand that I'll need anti-malarial pills for Siem Reap. Will I need them for the rest of my destinations as well?

Thanks in advance,
tania

cambodia definately....we like malerone

ttt

In Thailand? Anyone?

You'll definitely need malarone in rural areas around Chiang Mai. This includes both Mae Hong Son and Lampang.

Considering the amount of time you need to take malarone before and after being in malarial areas, my guess is you'll be on it for your whole trip (unless you're going to be there for a month or so.)

No worries--it's not as bad as it sounds. Every trip we take, we're basically on it the whole time as well.

As far as Thailand is concerned, you only need anti-malarials in the border areas. If you are just doing day trips to Lampang and Mae Hong Son, then anti-malarials are not needed, but if you will staying in the areas, they are considered malarial risk. The mosquitos that transmit malaria are active dusk to dawn.

Thanks for the replies....

Okay, so I'll take it for Mae Hong Son, Chiang Mai, Lampang, and Siem Reap.

What about Bangkok at the beginning and Koh Samui at the end?

Should I take it for the whole trip, or can I leave out the first 4 days (Bangkok) and the last week (Koh Samui)?

You don't need it for Bangkok, Chiang Mai or Koh Samui.

Start the malarone one or two days prior to entering the malarial risk area and continue for 7 full days after leaving the malarial risk area. Take it with food at approximately the same time each day. The food you take it with should include some fat (as one of the active ingredients is fat-soluble).

Thank you, all....that's exactly the info I needed.

Is it necessary for Koh Tao?

I'm also wondering about Chiang Rai since we will be spending a couple of nights up there and in the Golden Triangle area.

Chiang Rai is not considered malarial risk, but the Golden Triangle is. So you would need to make the decision based on whether you are staying in the Golden Triangle area or simply visiting there during the day. The Golden Triangle area is an hour's drive from Chiang Rai.

Koh Tao has not been considered a malarial risk area. However, there were a couple of reported cases on Koh Samui last year, so it is being watched.

Note that whether or not you are in a malarial risk area, you should do everything you can to prevent mosquito bites, as dengue is endemic as well. Also, areas that are not considered "malarial risk" have a very low incidence of malaria, not no risk.

On all of these matters you should consult a travel medicine specialist and not simply take my word for it. I may be well-informed (or just making it all up) but I am not your physician.

check out www.cdc.gov/travel

My doctor wrote a prescription for Malarone for me and the pharmacist just told me my insurance won't cover it and it's almost $200 -- I've never heard anyone here complain about the cost before so I'm a bit curious if anyone else has encountered this.

We're in Siem Reap for five days -- I tend to get bitten almost everywhere I go so I thought it wise to take something. Am now thinking to ask for doxy.

My insurance covers malarone, but not all insurance does. The lowest cost malarone in the US is at Costco pharmacies, so it is worthwhile to call the closest Costco pharmacy and get a price quote.

Doxy is an effective anti-malarial, and must be started one or two days before entering the malarial risk area and for a full 4 weeks after leaving the malarial risk area. It should be taken with food at about the same time every day.

Jenskar, it may be worth calling your insurance company and see if they will budge on whether it is covered.

Thanks Kathie -- I tried my health care provider. They won't budge. They would cover it if I actually HAD malaria. Nice huh?

Costco is not really much cheaper but thanks for the thought:
MALARONE 250-100 MG TABLET(GSK) 30 $181.04 50 $302.59 100 $608.87

As I get bitten anywhere a mosquito thinks about living -- I may just end up going for the Malarone regardless as it's a shorter treatment course. Hate taking antibiotics.

Well, it never hurts to ask. While my insurance pays for anti-malarials, they wouldn't pay for my typhoid vaccine! Yes, they'd pay for treatment if I contracted typhoid but they wouldn't pay for the vaccine. The decisions made by insurance companies often don't make sense.

actually, hang on a sec, jen.

didn't you say 5 days?

if that's the only malarial area you're going to be in (Siem Reap) then you're looking at 2 days beforehand + the 5 days you're there + 1 week. which equals 13 days (or 13 pills)...there's no way you'd need 30 pills!

am i missing something here? if not, why not just get 13 or 14 pills and you're looking at a cost of about $80 or so, based on the figure you were quoted for 30 pills.

I won't bother with my customary 'I've been there 7,000 times and have never taken anti-malarials...'

Do whatever gives you peace of mind.

The only drug I think you need there is Valium [so you can cope with the long, long wait for dinner at Samot without killing the owner.]

Does anybody know the ACTUAL figures for Malaria transmission in Siem Reap? Any real figures on how many tourists per year there are recorded as actually getting Malaria? Maybe offwego knows...

I think offwego lives in Siem Reap. Does she take anti-malarials every day? I'm certainly not aware of anybody who lives there who does - but, I'm eternally proven wrong in here - so help my education...

The issues for prevention of malaria for someone living in the area vs. a short -time visitor are quite different. Indeed, people living in an area do not take anti-malarials all the time, though for instance, Peace Corps workers who are in a high malarial risk area, usually do take anti-malarials for their full two year assignment.

Lori (Offwego) and I had a conversation in a thread about this a year or so ago. Indeed, in the last couple of years there has been a decline in reports of malaria in the immediate area around Siem Reap (though the incidence remains high at some of the more remote temples such as Koh Ker).

Recommendations about malarial risk are made by WHO, the CDC, the NHS for example, based on reported cases. In some areas (like much of India), there is a seasonality to malarial risk. That is not the case in Cambodia. But the incidence of malaria naturally waxes and wanes, so in a case like this, a couple of years of lower incidence is not an indicator that the real risk has changed. There is also some new data on another strain of malaria which had been confined to monkeys has now jumped to humans. The pattern of transmission and virulence for this strain is different from others. So public health officials are watching the situation carefully.

I tried to find the previous thread to give you a link here, but have not yet found it. If I do I will provide a link here.

Ok, I finally found the previous discussion: http://www.fodors.com/forums/threads...p;tid=35098930

2 YEARS ON MALARONE????

I should think two years on malarone would be about enough to trash any healthy person's liver.

As someone who stays there for long periods of time, my choice is to treat the malaria if I get it rather than deal with the long-term effects of prophylaxis. in fact, my Doctor here in states advised against it.

The first time I went, I took the malarone, AND sprayed with DEET.

There is a MUCH higher risk of getting Dengue in Siem Reap than Malaria.

It's worse than that, Lori - the Peace Corps workers in Africa typically take larium for two years!

But as I said, the issues are different for a some one who is living in a place. Your solution, Lori is the one typically advocated.

Update on Costco, costs, etc:

Filmwill -- there's a mr. jenskar too, so we need 28 pills

My pharmacy for reasons too mundane to go into here, was quoting the 200 for 20 pills -- they wanted 275 for 30

So ... Kathie, thank you. I called Costco to make sure they had it in stock, called my doctor, had the script transferred and filled it.

Dogster -- I used to take your tack on these things but given how much mosquitos like me, deet, no deet, long pants or not -- I'm taking the Malarone.

Lori -- I cannot wait !! Have been e-ing with Pon and we seem to be all set. Cannot wait to meet the teachers and students at Tchey and of course, Poneary herself.

jenskar, when are you headed to SR? I'll be there later this month and also seeing Ponheary.

I am glad you are taking your malarone- I am always surprised that people are willing to spend thousands of dollars on their trip, and won't spend a bit more on their health because they have to pay.

I think everyone should go to travel medicine clinics for their travel advice- malaria prophylaxis changes depending on where you go in the world, and what was correct this year may change next year, as resistance to various medications changes.

doxycycine is a good antimalarial, but remember that it has an important side effect that is photosensitivity- important in a country like thailand! it is not appropriate for all malaria areas in the world either.
there is of course typhoid/ meningitis/hepatitis to consider as well in much of asia, so a good travel clinic will have all the vaccines available to you. plus, you can get a script to take for travellers diarrhea as well...

not everyone responds well to Malarone..i had a terrible reaction to it...couldn't sleep, felt anxious and angry..took it in Africa..It occured to me that malarone was probably the culprit...so i figured malaria was better than feeling so miserable...so i stopped and the next day was back to my cheerful self and could finally sleep.........and i didn't get malaria..the best part

reenie, I expect you are referring to melfloquine (Larium) which has psychological or psychiatric side effects in about 30% of the people who take it. However, it is taken weekly so feeling better the next day after taking it is unlikely.

Malarone is a newer anti-malarial and is not noted for any of the side effects you mention.

I hope you switched to a different anti-malarial rather than simply discontinuing your medication. One of the possible side effects of malaria is death.

I was definitely taking Malarone...I was aware of the other medication you mentioned but in discussion with the tropical medicine dept. at the nearby hospital learned that this newer medication (Malarone) had little to no side effects....my doctor prescribed malarone which was to be taken once a day....when i got home i mentioned this unfortunate reaction to another traveler to Africa and he said on Malarone he had the same reaction...couldn't sleep the entire trip and was miserable...I think this isn't typical and perhaps unusual because Malarone isn't supposed to have these effects...but we were two travelers who couldn't tolerate it......and i improved right away after discontinuing it .....i took nothing and since it was the dry season my risk factor was fortunately low...and i made it home...without a case of malaria...

It is a rare reaction, I've not heard of others with the same reaction.

I'm glad you made it home safely!