Malaria prevention during pregnancy
Replies: 6 - Last Post: Aug 21, 2012 2:13 PM Last Post By: nutraxfornerves
Aug 7, 2012 6:15 AM
Malaria prevention during pregnancyI will be in Joburg in September and we wanted to take a side trip to Victoria Falls. I am wondering how much of a malaria risk is there at this time of year in the developed part of the falls, and also in the surrounding national parks (Zambezei, Chobe, etc.). The thing is, I am pregnant (first trimester) and so I have been advised not to take Malarone (Atovaquone/Proguanil). I think that Lariam (Mefloquine) is okay for pregnancy, but I have heard bad things about the side effects. What is the real risk in these semi-developed areas of these countries (Zambia, Zimbabwe) that are designated as malaria zones? Does the season make a difference? If I stay inside after dark and wear lots of DEET, is that sufficient to minimize the risk? Is it even okay to wear DEET? Is it advisable to take Mefloquine? Just trying to figure out the real deal and what information should I use in making the decision whether to go or just skip the trip.
Aug 7, 2012 7:22 AM
1All of Zambia and Zimbabwe are considered ot have risk of malaria. Although it is seasonal in some areas, it is present year round in the Zambesi Valley (which includes Victoria Falls). I see from another thread that you are also considering Kruger. The South African Department of Health recommends chemoprophylaxis for all travelers visiting from September through May and mosquito-avoidance measures for the rest of the year. CDC recommends chemoprophylaxis at all times of the year.
Malaria in these areas is primarily the species that is most likely to be fatal.
Because you are pregnant, things are different, and you have to take even low risk very seriously. Malaria in a pregnant woman is a medical emergency. For assorted reasons having to do with a pregnant woman's immune system, she is more likely to have a serious case of malaria. In addition, there is an increased risk of miscarriage, still birth, or premature birth. The US CDC says:
If you go to Kruger, where risk is low enough that many people do not take antimalarials, you should consider yourself at high risk and take something.
You are correct that mefloquine (Lariam, Mefliam, Mephaquin & others) is the only antimalarial that a pregnant woman can take for travel in Southern Africa. People sometime start taking it 2-3 weeks before travel to a malaria area
You should discuss this both wit your OB/GYN and with your regular provider or even a travel medicine specialist. Your OB knows how how your pregnancy is going, and what kinds of issues there are for you, but may be unfamiliar with travel medicine. A specialist needs information about your pregnancy in order to make the best recommendation.
A side note: South Africa is being particularly nasty about enforcing yellow fever requirements. They require a certificate of every0one who has been in a risk area--even if only an airport layover. They also require a certificate of anyone who has been in Zambia, which is not on the WHO risk list.
YF immunization is not recommended in pregnancy. If you do not already have a certificate, you will need to get a medical waiver--South Africa will honor that. The waiver needs to come from an official YF vaccination center, with an official stamp.
Aug 7, 2012 2:42 PM
Sorry to hear of your dilemma with your up and coming trip - it must be very confusing for you! The above poster has provided some excellent advice, hopefully this has cleared up some of your questions. In relation to your concern about whether DEET is safe to use whilst you are pregnant - this is unclear. According to the babycentre.co.uk, they advise the following:
Your doctor will probably advise you against travel to these areas. But if you really do need to go, then the benefits of using Deet outweigh any possible harm. This is because contracting mosquito-borne diseases such as malaria and West Nile virus during pregnancy can be harmful to your growing baby. The HPA recommends you use Deet if you’re pregnant and travelling to a malarial area. Just make sure you use them according to the manufacturers’ guidelines. A certain amount of Deet can be absorbed through your skin and into your bloodstream, and in large doses it can make you seriously ill.
However, note that it is still uncertain about whether DEET is 100% safe for use whilst pregnant, indeed, according to this same source:
We don't know much about the possible harmful effects on your baby if you use Deet during pregnancy. A study in 2010 found evidence of a link between using insect repellents in the first trimester and a birth defect in boys called hypospadias.
If you are particularly concerned about the use of DEET then search for alternative natural insect repellents, and be EXTRA cautious about putting all the preventative measures into place to avoid getting bitten in the first place. Follow the "ABC's" of malaria prevention, outlined here: How To Prevent Malaria When Travelling.
Best of luck,
Aug 9, 2012 12:13 AM
Aug 10, 2012 12:56 AM
Aug 21, 2012 11:39 AM
Thanks for telling me about the yellow fever requirements. My husband will be getting vaccinated and getting a certificate from an official yellow fever clinic. For myself, do you mean that a letter from my OB saying that I am pregnant and can't take the vaccine is not good enough? The letter needs to come from the YF clinic as well? That makes no sense. The OB has verified that I am pregnant; all the travel clinic would do is ask if I am pregnant and then take my word for it. An OB letter should be much better.
Aug 21, 2012 2:13 PM
6It's not just that you OB knows you better. It's that an Official Vaccination Center has officially proclaimed that you can't get the shot.
Sort of like the difference between Professor Whosit writing a letter saying that you have a PhD in Physics, and an official letter from the university, complete with university seal. Officialdom wants the latter.
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