Malaria. Prevention or cure?

[havingagiraffe]

but the reason symptons happen is being sweaty and hot attracts more mosquitos so they come take a drink and move the parasites to a new host! :yikes:

Now that's impressive....or should I say frightening... :yikes: I've read lots about malaria but you're the first person to explain why the symptoms occur.

P.S. Don't worry, I'll keep on taking the pills for an extra four weeks to allow for the incubation period...

 

[Goose]

And it is apparently at its worst in the late afternoon/early evening, when the most mossies are around, really clever little bug(ger)s.

 

[BOD]

There are many types of malaria but there are 4 main types and the consequences are quite different and they respond (or do not respond) to different drugs. Your drug inventory may need to change as you travel in a region. So too should your risk assesment.

I do not take malaria medications of any sort in North Borneo. There is no malaria in Brunei, pockets only in Sarawak and m. falciparum in eastern SAbah.Were I to spend time in the bush in East Sabah I would take something but if I am passing through to dive on the islands I do not.

I have spent decades in South East Asia and apart from a stint in the military when we had to take pills before exercises and rarely feel the need to take any. I have never had malaria.

If I were in rural areas of Cambodia or parts of Thailand I definately would.

the best thing to do is wear long sleeved shirts and trousers and socks after dark or when travelling in the bush and spary your self and the clothes liberally with DEET or whatever alternative you have faith in. If you run around in T shirt and shorts well you deserve whatever happens to you.

Had a talk from a RAMC doctor sometime ago who gave us the actaul and official situation in Asia and in the forces. The thinking has changed somewhat. Training staff and in-country based units do not take it in Brunei even though they are in the bush and close to the border. Units coming in for jungle training were told to take it in the UK and some squaddies fell flat on their faces on arrival coping with acclimatisation and the drugs. Local troops are supposed to take it but chuck it away as they think prolonged use affecct the sex life. No idea if that is true.

One thing I do know having seen so many people come to Borneo with misleading advice is that a local GP in the UK is unlikely to be able to advise you as he will not know the malaria profile for the region and anyparticular country. Even "specialists" cover themselves by getting you to buy the stuff.

BCUK's Stuart travels around the region and if he reads this perhaps he will tell you his strategy and reveal the contents of his drug inventory!

 

[Ketchup]

Havinagiraffe,

Malaria is no laughing stuff. The old African m.vivax was something you could live with for years, having a feaver attack every fifty days or so, but the South American and Pacific malaria might kill you on the first attack. They are also chloroquine (nivaquine) resistant in growing numbers.

I took chloroquine in Mauritania and it created havoc with my eyesight. Couldn't see the letters on my PC screen, which is rough if you're there to write reports. I gave up taking pills after a locally based european medic told me there was no danger for malaria in the capital Nouackshott, where I worked. (There is around the Senegal river)

Go and ask your national tropical medical institute (don't knw what its called in GB). They will be the best nformed about what to take and where. GP's are generally not informed on the subject

The, watch out for fake drugs, there 's an international scam with false drugs everywhere in the tropics. Buy your pills from a reliable source (official hospital).

 

[Stuart]

don’t mess about with malaria, its stupid to end up with a potentially life long reoccurring illness just because you failed to take some simple preventative measures.

this is the clearest source of advice i have found on all aspects of malaria and other tropical diseases:

http://www.rgs.org/NR/rdonlyres/05FAEFF9-A3AD-4A21-8755-CB235D5206B7/0/20ch19.pdf

I avoid larium, too many people have adverse reactions to it. my personal drug of choice is doxycylcine (just don’t go sun bathing whilst on it, its a foolish pass-time anyway). the best is malarone but its expensive

 

[havingagiraffe]

I've read some pretty worrying reports of side effects associated with the drugs "Chloraquine" and "Proguamil" which are used to prevent malaria. Figures like one in five suffering from mood swings, anorexia and insomnia along with one in ten thousand suffering long term problems with mental health and loss of sight. :yikes:

On the other hand, contracting malaria is even more unpleasant...

I'm in two minds whether to take the tablets, which don't guarantee you won't contract malaria, or whether to take nothing and sign myself into hospital for treatment if I do contract the disease.

Any thoughts?

I've been taking the pills for just over three weeks now, and haven't had any serious physical side effects. My eyesight isn't as good as usual but this could just be subjective. I have had two mouth ulcers though. I can't remember the last time I had an ulcer, so to have two in less than a month suggests that something's amiss. My head's also been generally fuzzy...for example, I say things like "The tasty is dinner" rather than "The dinner is tasty."

BCUK member Wenie, however has been less lucky. In addition to poor eyesight and ulcers, she was ill enough to call the doctor after taking the pills for about two weeks. The doctor put her painful tummy and bad head down to the Avloclor tablets (chloroquine phosphate). He said that it was a pretty common reaction. Luckily, being in India the private doctor's call out charge was about a fiver, and the medicine he prescribed cost seventy odd pence from the village's pharmacy which was still open at ten pm.

I've used Chloraquine and Larium, not at the same time you understand, and i didn't suffer any side effects at all. Also, I never saw any side effects in others, but the Larium gave my mate vivid dreams of attractive antipodean women and it gave me a permanently itchy head! I think I got done in that deal!!

No such luck with my dreams - I've had really frightening nightmares nearly every night since taking the tablets. I think this accounts for the insomnia reported by many people who take the pills. Unless I'm ill or cold I always sleep through to the morning, but I haven't had an uninterrupted night's sleep since starting the pills.

On balance, I don't think the tablets are worth the hassle, especially as they don't offer a particularly high level of protection against malaria. If they guaranteed you wouldn't get malaria then the side effects would be justified. Also, there's the ethical issue of casual use of anti malarial drugs helping the disease become resistant...just as the casual use of antibiotics has helped superbugs develop in Europe. We Westerners can afford expensive treatment if it all comes on top, local people aren't as lucky.

If you're going to spend a lot of time working in a swamp miles away from civilization then they can probably be justified, but otherwise I wouldn't bother with Paulodrine/Avloclor tablets again. I might try the other more expensive anti malarials though...mostly because I'm a total wuss

As an aside, Jungle Formula insect repellant makes a pretty effective paint stripper - we sprayed some on the door frame to deter the nocturnal visitors and woke to find the gloss paint bubbling as though it had been treated with Nitromors or brake fluid...

Also, mosquitos are unable to fly in the draft created by ceiling fans. Which is great as long as the ceiling fans work, but not so useful when there's a power cut when you're sleeping...as there is every night in India...

 

[SowthEfrikan]

If you are going to get malaria, then you will. Finished and klaar. Destiny. Fatalism. All that stuff.

I'm African and while not living in a malaria area, lived within hours of one for a chunk of my life. My brother contracted malaria and was on proper medication, properly prescribed and used. I know of another case where proper medication was taken and the guy got malaria,when first it hit it took even a while for doctors to work out what it was, while his friend who took no precautions on the same veld trip came back just fine.

Mozzies are drawn to some people more than others. I'm sure there is a physiological reason for that.

I've been into malaria areas with and without medication and was just fine. However, I wore long sleeves, long pants (lightweight, wicking hiking clothes are great), and had the deet out big-time, always in a pocket with me. I kept the doors and windows to my room closed, my tent netting sealed etc, and didn't bother with mosquito netting although some places will have it up because it's a) useful and b) cute. Foreigners think of it as exotic and it's part of the picture they have of us.

Now this is the fun thing about malaria which should be mentioned: It's recurring. Catch it today, suffer at odd periods for the rest of your life. It is extremely nasty.

As to side effects, I didn't change moods while on medication, I just felt queasy. That's why I chucked it and went for the cover-up/Deet/keep doors closed/keep a breeze on me with fans/ method.

Basically, be sensible. Perhaps start with medication, but definitely follow up with everything else.

What's really aggravating are the malaria deaths that could have been avoided, but some dumb blonde read a report, got it wrong, and decided birds would die. Too many drugs going around in the 60s. It's especially ironic now that some think birds could kill them with flu, they are all for slaughtering them.

Enjoy your trip, come back safely and well. Where are you going?

 

[leon-1]

I've read some pretty worrying reports of side effects associated with the drugs "Chloraquine" and "Proguamil" which are used to prevent malaria. Figures like one in five suffering from mood swings, anorexia and insomnia along with one in ten thousand suffering long term problems with mental health and loss of sight. :yikes:

On the other hand, contracting malaria is even more unpleasant...

I'm in two minds whether to take the tablets, which don't guarantee you won't contract malaria, or whether to take nothing and sign myself into hospital for treatment if I do contract the disease.

Any thoughts?

Chloroquine and Nivoquine never had any effect on me, however I was part of the trial for Mefloquine (Lariam (sp?)). They did have side effects on people along the lines of Insomnia, mood swing and paranoia.

However the side effects from any of the drugs mentioned (sorry missed paludrin) are acceptable in comparison to what Malaria could do to you, a friend of mine contracted it and believe me you don't want it.

 

[Jodie]

Thankfully I know nothing about malaria other than what I've read but it
sounds pretty grim. I'm reading chapter one (quinine) of Seeds of Change
and the description of the changes in the blood cells as well as the
symptoms and long term effects on the liver etc do not make a happy
read

Dwardo makes a very good point about the side-effects noted on
regular meds as well as antibiotics - the full listing for all UK drugs
is available at the eMC (electronic medicines compendium) and
is quite interesting / sobering reading - hence it's quite sensible to
compare with paracetamol!

The SPC (Summary of Product Characteristics) is the "more than
you wanted to know" of patient information and the PIL is the patient
information leaflet (the instruction / advice leaflet enclosed with the
medication). http://emc.medicines.org.uk

Type in the name of your drug and baulk as the side-effects unfold
before you

The BNF (British National Formulary) has lots of useful information
about antimalarials - it's free to register and use at http://www.bnf.org

Stuart's PDF covers everything though.

As to mozzies being drawn to some more than others - that certainly
seems to be very likely. At the Royal Society summer exhibition (by
the way it's great, on every year, go if you get the chance!) this year
a team were displaying work they'd done on "why do mosquitoes
always pick on me?"
http://www.royalsoc.ac.uk/news.asp?year=&id=4871

Speaking of more than you wanted to know about malaria - The
Wellcome Trust have a malaria CD-ROM:
http://www.wellcome.ac.uk/node5816.html
and a dedicated malaria website:
http://malaria.wellcome.ac.uk/

Jo

 

[Mikey P]

Just to throw in my two penny-worth: I took chloroquine and paludrine. I suffered no side effects at the time but returned from the area with a skin condition where I'm allergic to sunlight!!! Solar Urticaria. It's miles better now (was nearly 4 years ago) but I read up on anti-malarials and they can cause sensitive skin. However, I suspect that it may have been a combination of the anti-malarials and other stuff we were taking at the time.

Mind you, I would take them again if going to a known malarial area. Malaria's a lot worse than a skin rash...

 

[Wenie]

My head's also been generally fuzzy...for example, I say things like "The tasty is dinner" rather than "The dinner is tasty."

Dude, your head was fuzzy before you started taking the tablets...

I haven't had an uninterrupted night's sleep since starting the pills.

Unless you've started snoring while you're awake, you slept fine the whole time we were there, as far as I could tell...

 

[havingagiraffe]

Thanks for the good information people... :You_Rock_

Mozzies are drawn to some people more than others. I'm sure there is a physiological reason for that.

I've been advised that Indian insects are drawn to white people who eat meat, drink and smoke because they know they'll have less resistance to malaria than the local vegetarians.

Dude, your head was fuzzy before you started taking the tablets...



Unless you've started snoring while you're awake, you slept fine the whole time we were there, as far as I could tell...

Thanks for the sympathy dude I think the locals were quite impressed at seeing a Westerner sleeping while sitting cross legged on public transport...of course, I can't be sure of their reaction because I was sleeping at the time... Seriously, even now I'm back home I've yet to sleep all night through. Despite my reservations about the side effects, I'm going to keep on taking the pills for another three or four weeks as the instructions say. If anyone needs someone for the night shift for the next month or so give me a shout...I don't mind being awake all night if I'm getting paid for it...

 

[locum76]

i was prescribed doxycyclin recently as a malaria preventative for a recent trip to kenya. no side effects to report and no malaria.

doxycyclin is merely a strong antibiotic.

 

[Jodie]

Taken from Jan 6 issue of BMJ

"New guidelines on malaria for UK travellers going overseas revise
the chemoprophylaxis regime recommended for some parts of the
world. Some areas, including Rajasthan and Goa in India, no longer
require chemoprophylaxis, although repellent should be used to
avoid bites."

See: http://www.hpa.org.uk/publications/2006/Malaria/guidelines.htm
to download entire document or individual chapters in PDF form.

(chemoprophylaxis = chemical prevention, fancy word for)

 

[havingagiraffe]

Taken from Jan 6 issue of BMJ

"New guidelines on malaria for UK travellers going overseas revise
the chemoprophylaxis regime recommended for some parts of the
world. Some areas, including Rajasthan and Goa in India, no longer
require chemoprophylaxis, although repellent should be used to
avoid bites."

See: http://www.hpa.org.uk/publications/2006/Malaria/guidelines.htm
to download entire document or individual chapters in PDF form.

(chemoprophylaxis = chemical prevention, fancy word for)

Big thumbs up for the good information. India's huge, so this makes a lot of sense.