Malaria

[Marmot]

How does malaria 'work', and what should i atke against it when visiting Borneo for 4 weeks?

[jbgraham]

Malaria is a blood borne disease transmitted by the bite of infected mosquitoes, and one of the leading causes of death in the third world. This is far too serious a topic to rely on advice from non-professionals. I suggest you contact either your physician or your outfitter and ask to be referred to a tropical disease specialist. I do know that the disease is treatable, but not curable, so prevention is preferable if at all possible. Now I understand the questions on wool socks rotting.

[Survivaldon]

Marmot,

You should have already had the required immunizations that you need to visit such a place as Borneo.

When you applied for your passport they should have given you a sheet listing the shots that you are required to have to go there. :confused: If not then contact your physician and schedule an appointment to get them "IMMEDIATELY!"

It takes a few weeks for for the injections to acclimate to your immune system and you DO NOT want to go there with out those innoculations.

Remember and ounce of prevention is worth a pound of cure! ;)

[Marmot]

Thanks for the concern, im sorting out all other jabs this friday, Hep A and typhoid being the two biggies.
I was just curious on how malaria actually worked and what other preventions i should take to avoid being bit.
Also as there are different strands of malaria i just wanted to know what other peoples take was on malaria in Asia, as you're right as it is so serious i didnt want the opinion of just one person.

nick

[Digby]

It's interesting to note that the mosquito is the most dangerous animal on the planet and accounts for more human deaths than all the others put together.

[Survivaldon]

Digby wrote:
It's interesting to note that the mosquito is the most dangerous animal on the planet and accounts for more human deaths than all the others put together.

Digby is very correct on this point. Besides transmitting such things as Malaria you also need to be wary of West Nile Virus too.

The one thing I took with me when I went to Argentina and Peru was a mosquito net suit. That way you can wear short sleeve shirts and shorts yet still remain protected from the mosquitos, black flies, and somewhat from ticks.

Let us know how your trip went when you get back? :D

[Marmot]

u bet i will

how does this net suit work then?

[ken_nerve]

Your mosquito net works?
Mosquitos in the more forested areas(military training areas) here are able to bite thru soldiers wearing BDUs.
There are campsites near these training areas and those mozzies bite thru my cargo pants unless I apply bug goop.

[jbgraham]

I tried these bug suits, but they are too hot to hike in. Try wearing loose fitting, light color, ripstop jungle pants and jacket, the old cotton ones, not the new military ones, which are hot, and a floppy brimmed boonie hat. Treat all your clothing with Permithrin(http://www.rei.com/product/6389.htm?) (http://www.rei.com/product/6389.htm?%29), and look for the new improved DEET such as this:
http://www.rei.com/product/12413848.htm? .
When you stop at dusk, the mosquitos are the worst, get in some bug protection right away. I might even carry my own personal bug screen.

[ChamberlainPC]

Some great advice, as stopping the little buggers bitting you is always better than any tablets. My experience in Africa is to use a good repellant - Lifesystems have a good one on the market, in the red bottle, this is their Max strength stuff and it works far better than burning little lemon candles.

As far as pills go the doctor may try and give you doxycycline - this is basically an antibiotic and I think needs to be taken every day before you go fo a week, then while you are out there then I think for a month when you get back, not only is this a real ball ache but also being an antibiotic if you need any in the few months after you get back for an illness there effect will be minimal. On the pluss front it is free on the NHS.

Larium is another one they may suggest you take, my advice would be to STAY WELL CLEAR. On the plus side you can get it on the NHS but the side effects can be HORRENDUS, nausia, insomnia and very vivid halucinations.

My recomendation would be something called MALARONE now, the doctor may be reluctant to prescribe on the NHS as it's hugely expensive, somewhere in the region of £3.00 per pill, however the side effects are minimal, you take it for two days before you enter a malarial area and a week after you leave. You may need to pay for it on a private prescription, but well worth it, the side effects are minimal and does a great job. This is the stuff they treat you with if you catch the disease.

I last took it about two years ago while in africa for three months and had no problems.

hope this helps

PC

[Marmot]

Well, im really glad i spoke to people here cause it stood me in good stead when facing the nurse and my local clinic - she knew nothing.
She recomended chloroquine to me but i said i believed that the area i was going to the malaria had become resistant to this, she just said that the website she was looking at said that choloquine was the stuff to get - despite me pointing out the chart on the wall beside me that showed the malarial regions and said that the Sabah region i was going to contained chloquine resistant mosquitoes.
She claimed that the chart was out of date - it was dated April 2004, and that her website wasnt.

Which is a good point how do you know what information to trust?

When we went to the pharmacy to see what they said the famacist pulled out a sheet with Borneo on it and said that i was right, sabah did contain chloroquine resistant malaria.
So she recomended doxycyline - thanks Chamberlain - and i hear what your saying about any future anti biotics having a little effect after the trip, any idea how long this effect lasts?
And malarone she also said was one of the best, but yer, it will be £111 for the four weeks out there, the week i come back, and two days before i leave.
Plus the triple shot of rabies is £30

- this travelling lark is expensive!

[Survivaldon]

Ken wrote
Your mosquito net works? Mosquitos in the more forested areas(military training areas) here are able to bite thru soldiers wearing BDUs. There are campsites near these training areas and those mozzies bite thru my cargo pants unless I apply bug goop.
Yeah my bug suit really works. They are made of a tight weave netting the doesn't allow the mosquitoes proboscus to penetrate through it. You have to buy them one or two sizes bigger than the size of the clothes you normally wear.

They do protect against black flies, ticks, chiggers, etc. too. You can wear shorts and a short sleeve shirt under the suit so that they are much cooler and the best line of defense against those pesky little creatures.

The thing that I don't like about chemical repellents like "deet", etc. is that they can contribute to things like skin cancer (melanoma) and when you have to wash it off it leaches into and contaminates the ground water.

The other thing you can do is to eat garlic. Mosquitos and other insects are attracted to the carbon dioxide that we ommit. By eating garlic it mixes with the carbon dioxide and makes it extremely pungant to the insects. They in turn will stay away from you. Yes garlic does actually work!

[jbgraham]

I agree with Survivaldon about the risks of long term exposure to DEET and other insect repellants, but I think Marmots time of exposure is short enough, and the possible diseases to which he could be exposed to severe enough to warrant liberal use of insect repellants. There are far more nasties out there than just Malaria. I would try and minimize the exposure of my skin, shun shorts and sandals when in the bush, there are leeches and even nastier parasites that will attach themselves to any exposed skin. I myself have had many cases of Tick borne diseases, Lyme disease and others and have learned the hard way the lesson about needless exposure. Not only that, but if you so much as brush against the bush with exposed skin, the chances are good that even if you don't come away with some bloodsucker attached, you will have scratches or a rash, and these kind of minor abrasions will be breeding grounds for infections in those humid environs. I would be very careful what water I drink, I know people who use bottled water, but use ice made from infected water and got sick. I like to carry my own personal anti-viral water filter.

I have to laugh about Survivaldons heavy garlic dosing for insect repellance. I know people who use garlic and Vitamin B12 in massive doses, and you can smell them ten meters away, of course the same can be said of DEET, but at least DEET can be washed off. By the way, pay particular care to hand washing before eating , and try and ensure that any porters who prepare your food follow similar precautions.

[Marmot]

Chloroquine





Chloroquine is the antimalarial drug of choice for travellers to malarious areas where there is no resistance to chloroquine. You should start taking chloroquine one week before entering the malarious area, continue during your stay and continue for 4 weeks after leaving.

UK trade names
Avloclor, Nivaquine

Dose (adults)
300mg of chloroquine base weekly. In the UK chloroquine is supplied as tablets containing 150mg of base so two tablets are taken weekly.

Common side effects
Chloroquine commonly causes minor symptoms of gastrointestinal upset usually on the day the drug is taken. These can be minimised by taking the drug after the last meal at night. Chloroquine sometimes causes headaches and may cause itching (particularly in dark skinned people). Occasionally the drug causes hair loss which is usually reversible and may cause temporary blurring of vision (often on the day after taking the drug).

Who should not take chloroquine?
Chloroquine should not be used by people who have epilepsy if they have had a seizure within the last 2 years or are taking anti-epileptic drugs. Chloroquine may worsen psoriasis. A reduced dose may be needed in people with renal failure.

Proguanil



Proguanil may be used as an alternative to chloroquine in malarious areas where there is no resistance to chloroquine. You should start taking proguanil one week before entering the malarious area, continue during your stay and continue for 4 weeks after leaving.

UK trade names
Paludrine

Dose (adults)
200mg of proguanil should be taken daily. In the UK proguanil is supplied as 100mg tablets so two tablets are taken daily.

Common side effects
Mild gastrointestinal upset may occur. The drug may cause mouth ulcers but this is more common when it is taken in combination with chloroquine (see below).

Who should not take proguanil?
The dose of the drug may need to be reduced in severe renal failure. Proguanil may affect the dose of anticoagulants needed for those on long term treatment. Proguanil is safe in pregnancy but a folate supplement should be used (such as folic acid 5mg daily).

Chloroquine plus proguanil



This combination is used to provide protection in areas where there is limited to moderate chloroquine resistant malaria. You should start taking chloroquine and proguanil one week before entering the malarious area, continue during your stay and continue for 4 weeks after leaving.

UK trade names
Chloroquine - Avloclor, Nivaquine
Proguanil – Paludrine

Dose (adults)
300mg of chloroquine base should be taken weekly plus 200mg of proguanil should be taken daily. In the UK this means taking two tablets of chloroquine weekly and two tablets of proguanil daily.

Common side effects
See above for individual side effects. Mouth ulcers are more common with this combination than when proguanil is taken alone.

Who should not take this combination?
See above for individual contraindications.

Doxycycline



Doxycycline is a useful alternative to mefloquine or Malarone for travellers going to areas where there are high levels of chloroquine resistance (e.g. much of Sub-Saharan Africa). You should start taking doxycycline a couple of days before entering the malarious area, continue during your stay and continue for 4 weeks after leaving.

UK trade names
Vibramycin

Dose (adults)
100mg taken once daily.

Common side effects
If the contents of the capsule/tablet come into contact with the oesophagus (the tube from the mouth to the stomach) they may irritate it leading to unpleasant "heartburn" symptoms. To prevent this it is important to wash down the capsule/tablet with plenty of water. It is also wise not to lie down immediately after taking the drug (to avoid reflux).

As doxycycline is an antibiotic it may cause diarrhoea (paradoxically it will treat some causes of travellers diarrhoea) and may increase the incidence of vaginal thrush especially in those prone to this problem.

Rarely, doxycycline may sensitise the skin to the sun (approximately 3% of people taking this dose of doxycycline will be affected) leading to an unpleasant rash or increased risk of sunburn. It is wise to use high factor sun screens covering both UVA and UVB. Travellers taking the combined oral contraceptive pill should take extra contraceptive precautions for the first month of taking doxycycline.

Who should not take doxycycline?
Pregnant women and children under 12 years of age should not take this drug.

Malarone



Malarone is a combination drug containing 250mg of atovaquone and 100mg of proguanil. A paediatric tablet is also now available containing 1/4 of the adult dose. Malarone has recently been licensed for the prevention of malaria by the UK authorities after large trials demonstrated that it was very effective and well tolerated. The drug is a suitable alternative to mefloquine and doxycycline for areas where there is significant chloroquine resistance (e.g. much of Sub-Saharan Africa). At present Malarone is not licensed for trips lasting longer than 28 days. However, we have seen safety studies on longer term use and current UK guidelines suggest 3 months use is acceptable.

You should start Malarone 24 - 48 hrs before entering the malarious area, continue during your stay and for 7 days after leaving.

UK trade names
Malarone

Dose (adults)
1 tablet taken once daily. Malarone should be taken with food or a milky drink at the same time each day.

Dose (children)
Each paediatric Malarone tablet is a quarter of the adult tablet. Dosage is weight related and licensed for children weighing 11-39kg.

Common side effects
Side effects appear to be uncommon and are generally mild. In trials the most common side effects reported were headache, abdominal pain and diarrhoea. These side effects were also reported in people who were taking a placebo drug so it is difficult to decide if they were directly attributable to Malarone.

Who should not take Malarone?
There is insufficent data to recommend the use of Malarone in pregnancy or when breast-feeding. Malarone is not licensed for children under 11kgs.

Mefloquine



Mefloquine is an effective antimalarial for those at high risk of highly chloroquine resistant malaria. You should start taking mefloquine at least one week (ideally two or three weeks) before entering the malarious area, continue during your stay and continue for 4 weeks after leaving.



UK trade names
Lariam

Dose (adults)
250mg of mefloquine taken weekly. In the UK this equates to one tablet of mefloquine weekly.

Common side effects
Mefloquine is a prescription only drug and is not suitable for everybody. Its use should be discussed with your travel health adviser.

A study by MASTA and The London School of Hygiene and Tropical Medicine, published in the British Medical Journal (BMJ) shows that about 1 in 140 people taking mefloquine will experience temporarily disabling neuropsychiatric side effects. A previous study showed that very serious side effects can be expected in 1 in 10,000 people taking this drug.

Most people who get side effects will develop them after the first few doses. We recommend that you start taking mefloquine 2 or 3 weeks before you are due to leave, so that if you develop early side effects an alternative can be found. For most countries (but not all) where mefloquine is advised a suitable alternative is either doxycycline or Malarone.

The most common side effects with mefloquine include dizziness, headache, gastrointestinal disturbances and sleep disorders.

Who should not take mefloquine?
It is particularly important to discuss the use of mefloquine with your travel health advisor if:

You have had fits or seizures in the past or any member of your immediate family suffers from fits or seizures.
You have a history of psychiatric illness. Depression should be included as a psychiatric illness but only if it was bad enough to require treatment.
You are in the first 3 months of pregnancy or you are planning to become pregnant within 3 months of stopping mefloquine.
<LI>You will be undertaking activities which require precision (for example piloting a plane, scuba diving etc.) as mefloquine can cause dizziness.

Maloprim



Maloprim is sometimes recommended when other drugs are not suitable for a particular traveller. It is particularly useful as an alternative for travellers with epilepsy. There is a relative paucity of data on the efficacy of this drug but the overall impression is that it is reasonably effective. In combination with chloroquine it remains a suitable alternative for Oceania.

UK trade names
Maloprim - Maloprim, Deltaprim (unlicenced)

Dose (adults)
One tablet of Maloprim should be taken weekly.

Common side effects
If taken at the correct dose, side effects from Maloprim are rare. It is important that no more than one tablet weekly is taken as higher doses may lead to bone marrow depression. Who should not take Maloprim?
Maloprim should not be used by people with an allergy to sulpha drugs. Maloprim may be used in pregnancy but a folate supplement (folic acid 5mgs daily) should be given.

this info was ripped from http://www.masta.org/ which is an incredibly useful travel drugs company and has lots of other little odds and sods like a jetlag calculator

[Marmot]

on that note http://www.fitfortravel.scot.nhs.uk/ is also very useful and does suggest which drugs to be used where and in what situations - an NHS servise which for once have found useful

[Marmot]

an interestng article on bug repellants
http://channels.netscape.com/ns/homerealestate/feature.jsp?story=AP_mosquitorepellent&floc=LAWN-1_T

[Marmot]

This being malarial Awareness week i thought id keep you up to date with soem info i read in an article inthe paper.
2,000 UK travellers a year contract the malaria overseas. 16 britains died from it, doubel the figures of last year - the writer also otes that those who contracted the diseas were on prescrived prophylactics - the anti malarial pill.
She notes that this is because alot of people take the wrong medication for the area they are visiting - or that they dont follow the full course.

It should also be noted that the quinine levels in tonic water are not nearly a shigh as they used to be.
It also only the female moquitos that pass on the disease.

She recomends Afresco as a repellant which uses botanical extracts instead of DEET.
And if your interested today is the last day to see a mosquito with a 6ft wing span at the national history museum.

www.malarialhotspots.co.uk (http://www.malarialhotspots.co.uk) is quoted along with www.afresco.uk.com (http://www.afresco.uk.com)

[Marmot]

hello there, its your resident malarial learner.
What ive learnt to date is that malarone can be taken for a maximum of 28 days
And if taking doxycyclone you should take it standing up and remain standing for the next half hour, as if th pill gets stuck on the lining of your oesophagus - food pipe - it can cause some damaged

[Marmot]

http://www.hpb.gov.sg/hpb/default.asp?pg_id=865&aid=194

is also another useful travel health website