Have you ever caught Malaria?

I'm sure malaria has been covered here time and time again but I need some advice! I'm going to be in malaria areas in and out for about two months. I am being told the only medication that is suitable for me that doesn't have weird side effects is doxycycline which is an antibiotic. Now I don't really like the thoughjt of taking an antibiotic for such a long period of time. Do most people still bother with medication or just cover them selves in deet and hope for the best?!

How many people actually catch it?????????????????

how high risk is the area? where are you going?

you DON'T want to catch malaria. i think you're best taking your doctors advice.

I would venture to say that less than 0.001% of foreigners visiting Thailand have ever caught malaria - probably less.

I know several people who have gotten malaria in Indonesia, but, so far, none in Thailand. The Dengue in Thailand is pretty bad, though. With Dengue, you sometimes bleed to death, but usually you just become sick and weak for a very long time. I'd wear plenty deet anywhere you see mosquitos if I were you. There's no antibiotic you can take against Dengue.

Get new doctor. I can't see how an antibiotic is going to do anything about malaria.

I lived in Thailand full time for two years, half-time now for 2.5 years - and have never taken anything for malaria. Thousands of expats live in Thailand and take nothing. I don't know anyone who has caught malaria.

Dengue - you do sometimes hear about - but quite infrequently. It is more of a problem the second time you catch it.

<blockquote>Quote
<hr>Get new doctor. I can't see how an antibiotic is going to do anything about malaria.<hr></blockquote>

Stuff and nonsense. Doxycycline is indeed an antimalarial with proven effectiveness. What's more, it's also effective for treatment of malaria. Note that children should not take it.

I did my senior thesis on malaria in college. My understanding is that the Anopheles mosquito that carries the malaria parasite lives almost exclusively in rural areas. That may be why "Thousands of expats live in Thailand and take nothing." Expats are concentrated in BKK, Pattaya, Phuket, and other big cities. If you're going trekking or to other rural areas, maybe you should consider doxycycline. Lariam- aka mefloquine- can cause "vivid dreams" and in a VERY VERY SMALL % temporary psychosis (often in those with underlying mental illness). Most of Southeast Asia is chloroquine resistant. Note that malaria is more common in some neighboring countries, such as Laos (still in rural areas, though).

I'm going to Thailand, Laos, and Cambodia this summer. (More mosquitoes during the rainy season, too.) I'll be taking doxycycline, but I'll buy it in Bangkok when I get there, as it's cheaper there.

Domitian,
Do you know of a place where I can get Doxycycline in Bangkok once I'm there.

Thanks.
Marie

What "malarial areas" in Thailand are you talking about? Unless you're planning on camping or trekking in the remote border districts you do not need to take malarials in Thailand. If you're doctor says you do, get a second opinion (off a doctor,not this board!)

The best sure is prevention - dress sensibly, use repellent and don't sleep naked in a swamp.

I have lived in Thailand for 3 years, and been here a lot over the last 10. The only person I know who went to hospital for malaria in Thailand had just come from Africa. In some parts of rural Cambodia it is widespread, and in some border regions. I haven't heard of anyone getting infected with malaria in Thailand.
5. There are also a consideable number of expats living well away from main centres of population.

I have been in Southeast Asia since 1997. I have two residences - one in Bangkok, one in Siem Reap.

While someone can come on here and tell you about their friend that picked up malaria on Koh Chang or wherever, and no one denies that it's a nasty nasty illness, your chances of getting malaria are extremely remote. In eight years the only cases of malaria on foreigners that I know of is one expat who had spent considerable time on the Thai/Cambodia border in very rural locations. And those of us that have lived here a year, five years, twenty years - never take malaria meds and none of us are catching malaria. And even if we live in urban areas, where it was correctly pointed out malaria is far less common to non-existent, we still travel through the same areas as tourists and are exposed to the same mozzies.

I'll make the obligatory "Don't listen to me because I am not a doctor" qualifier, but personally, unless you plan to spend a bit of time deep in the jungle, naked even - I would not bother with malarial meds. Of course a GP back in the UK will recommend the meds, you asked him, he looked it up in reference manual, saw that the region is listed as malarial and figures you better take the meds because if he doesn't make the recommendation and you do catch malaria you'll come back and sue him. Works in the States, anyway.

Anyway again, the decision is yours, but several hundred thousand westerners are living in SE Asia, we are not taking malaria meds and we're not dropping dead from the disease.

Now someone brought up dengue - some regions, such as Siem Reap, Cambodia are heavily infected with dengue and if you were to live here you would probably catch dengue within two years. Almost every westerner living here has caught it (self included). However, while there is the chance of bleeding to death (something less than 0.1% of cases - I looked it up recently and I think it was about 0.05, or one in two thousand), most cases of dengue though uncomfortable, are not serious. In its mildest form you may not even know you have it until the rash shows up and then you wonder why you've had a bad headache for three days. Most likely, you'll feel really crappy for a week (fever of 38 to 39, nasty headaches, pain in your joints and horrid pain in the back of your eyes) and have a four to six week recovery period (lethargy and psychological depression) but you've probably been sicker before. On the plus side, your chances of getting DHF are very remote.

Dengue you cannot yet do anything about though vaccines are in the trial stages. Personally, once the vaccine is on the market, though I will continue to question the need for malarial meds here, I certainly don't question the need for a dengue vaccine both for visitors and residents.

Agree with Gorshar.

The few people I met who had contracted Malaria got it whilst in Koh Chang or Koh Samet. I have met many, many people who contracted Dengue, with symptoms described as above.

I use deet if mosquitoes are around, mostly on my feet. Don't blame you for not wanting to take doxy.

A good recourse to read is the US Center for Disease Control.
Probably in the FAQ above.

A few thoughts.
There is malaria in Trat province and Ko Chang (if you are going there).
Not all doctors know that Doxy is effective. Our doctor in France refused to believe it until we produced confirming evidence (in French).
We went to Palawan in the Philippines which is malarial. We talked to a doctor resident there who himself took no medication. But he advised us as visitors to take our Doxy.
We have met Wigman (who posts on the Africa branch). He lives in Johannesburg but travels frequently to lowland areas in the north of the country and to Mozambique. He has caught malaria twice. He goes immediately he develops flu-like symptoms to a hospital for treatment. Of course to do this you have to be in an area of good medical facilities.

How to catch malaria twice? Once you have caught malaria, it is with you for a lifetime, although the attacks are unpredictable.

Dengue is currently a problem throughout SE Asia. Here in Singapore we have an epidemic for more than a year already. So is Malaysia. Whereas malaria is only in rural areas, dengue is also existent in cities, so there is more risk to it to catch it.

Funny thing is that most travellers take the malaria profylaxis from their GP or doctors at home in Europe or USA, whereas there is much more up to date knowledge on this tropical disease here in Asia itself. Any GP here is more knowledgeable than most doctors in USA or Europe, simply because it is a local disease here.

It is far better to just go to a GP or a good hospital (Bumrungrad in BKK) and ask for the current status of malaria infected areas and then decide what to take or do.

Eric

Thanks for all the replys!!! I'm not only travelling in Thailand I should have made that clear. I start in Hanoi and will venture into the 'jungle' for a few days at the start so I need cover for that. I will then mainly be on the coast as I make my way down to Ho Chi Minh taking a couple of weeks. Most of the coastal areas are low risk but with doxycycline you have to take it for two weeks after being in high risk areas so I have to take it then anyway. Then I travel through cambodia for a couple of weeks which is nearly all high risk? Then when in Thailand I go up to the north east quite close to the border which is high risk again. Like I sai in and out of high risk areas for two months which will mean ten weeks taking this drug!!!!! I also have quite fair skin and doxycycline is supposed to make your skin more sensitive to the sun. How annoying!!!!!!!! I have no choice but to take it cos I don't want to catch Malaria!!!!!!!

thanks all

Another vote for Gorshar's post. It is unbelievable to me how many people are destroying their bodies by taking this antimalarial poison. Regardless of those like Steve252 (who is otherwise a brilliant source of info) who say "see your doctor" (who most likely is a westerner untrained and unknowledgeable about tropical diseases) or "take the meds", I have never met anyone who has contracted malaria in Thailand, and I've been travelling/living in SEAsia since 1991.

Dengue is a danger, and you need to use bug juice to prevent bites.

Unless you're sleeping naked in the jungle, forget the antimalarial crap.

re reply #6:-

Do you know of a place where I can get Doxycycline in Bangkok once I'm there.

see this malaria pills in Bangkok thread

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re reply #16:-

... people are destroying their bodies by taking this antimalarial poison.<blockquote>Quote
<hr>doxycycline ...   ... is a tried and tested medication with a good safety record and is usually well tolerated. It can sometimes cause increased sensitivity to sunlight, but this is usually not a problem with common sense use of sunscreens.

source: www.talesofasia.com/cambodia-faq-health.htm</a> - "Q: Any advice on anti-malarials?"<hr></blockquote>see also reply #11 on this Doxycycline thread

 
... those like Steve252 ...   ... who say "see your doctor" (who most likely is a westerner untrained and unknowledgeable about tropical diseases) or "take the meds" ...

to clarify - re malaria chemoprophylaxis:

there are plenty of circumstances where I'd suggest that someone consult a qualified medical/travel/tropical disease expert; however I've never simply said "see your doctor (ie GP)"

I have very definitely never ever said "take the meds", nor anything even remotely close to that effect

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lots of blatant misinformation in numerous other replies on this thread

for accurate non-anecdotal information on topics such as this, best place to try on the Thorn Tree is the Health branch

Thank you GorShar and khunjimbo for pointing out the true reality of this topic. Perhaps the fact that you guys live there will carry some weight. I have banged my head for many years trying to figure out this obsession people have with malaria.

Just a quick word.

Took doxy a few years ago. Was in Indonesia, lake Toba. Went out on the lake for 2 hours with sunscreen factor 20. No Problem. A few hours later, in a bar I could not move. I felt My skin streching and tightening to breaking point. My whole body became redder and redder. What did I have.....the wrost sunburn of my life. It took 6 weeks . I could not move. My skin was so red it looked like blood. In the
4th week I developed bags of skin all over my body, which were full whith fluid, which then fell off. People thought I had had a motorcycle accident. Now I have skin cancer. Thats Doxy.

Just a quick word.

Took doxy a few years ago. Was in Indonesia, lake Toba. Went out on the lake for 2 hours with sunscreen factor 20. No Problem. A few hours later, in a bar I could not move. I felt My skin streching and tightening to breaking point. My whole body became redder and redder. What did I have.....the wrost sunburn of my life. It took 6 weeks . I could not move. My skin was so red it looked like blood. In the
4th week I developed bags of skin all over my body, which were full whith fluid, which then fell off. People thought I had had a motorcycle accident. Now I have skin cancer. Thats Doxy.

Both the Tourist Authority of Thailand and the British National Health Service recommend NOT to take any anti-malarials when visiting Thailand unless you are planning jungle trecking on the Northern borders in excess of three weeks.

Mozzie and bug repellents should be worn all the time and refreshed periodically depending on their strength and type - knock 25% minimum off the effective period mentioned on the label. This avoids nasty bites, Dengue fever and Malaria effectively.

In seven years of visiting Thailand and five living here I have not met anyone who had Malaria but several have had Dengue fever which can be very nasty indeed. If you have persistent flu like symptoms get to a hospital quickly.

<blockquote>Quote
<hr>lots of blatant misinformation in numerous other replies on this thread<hr></blockquote> Which would be what? Rather than sending already confused readers into a vast swamp of malaria posts which may or may not contain the correct or desired info wouldn't it be more helpful to elaborate on that which you say is wrong?

But whatever...

A few hundred thousand western residents in SE Asia are not taking malaria meds and are not getting the disease. And that's good enough for me. ...Unless there is some selectivity where malarial mozzies identify tourists from expats and lay prey to their tender arms and feet?

Therefore... in final summation:

1.) Don't worry about malaria.

2.) Worry more about dengue.

Which would be what? Rather than sending already confused readers into a vast swamp of malaria posts which may or may not contain the correct or desired info wouldn't it be more helpful to elaborate on that which you say is wrong?

yes, it would be more helpful - unfortunately there are not always enough hours in the day (I'd've posted nothing at all on this thread, except then my name was mentioned and I was grossly misquoted in reply #16)

for accurate non-anecdotal information on topics such as this, best place to try on the Thorn Tree is the Health branch

Steve...you're correct. I should not have put quotes around those comments, which give the impression that those were your words. I SHOULD HAVE said that those quoted phrases have often been the gist of your message regarding antimalaria meds. And if you disagree with that, then I'm confused about your stance.

... if you disagree with that ...

I most certainly do

... then I'm confused about your stance.

just guessing wildly, but maybe you're confused because you yourself have a personal stance on this, and that's predisposing you to expect that everyone else does too

can you give an example of one of my posts that is contributing to your confusion?

Steve, stop dodging the issue... Just tell us why half a million expats are wrong, why tourists need to take malaria pills. ...And link us directly to non-anecdotal information explaining why tourists should take malarial meds (and apparently leaving the expats to die...).

Steve asked me to provice this information on current recommendations for travel to Thailand.

UK Dept. of HealthMalaria - no risk in cities nor in the main tourist resorts (such as Bangkok, Chiangmai, Pattaya, Phuket, Samui). Elsewhere there is malaria risk throughout the year. The risk is very low in the central plain, greater in forested and hilly areas of the country, especially in the areas bordering Myanmar, Laos and Cambodia. P.falciparum is highly resistant to chloroquine and sulphadoxine-pyrimethamine, and at the Myanmar and Cambodian borders also shows resistance to mefloquine and quinine.
While the city of Chiangmai is malaria-free, tourists commonly visit forested areas near the Myanmar border where there is a risk if they are there for an evening or night; some tourist hotels in NW Thailand are also very close to the forest. However, the combination of limited risk and resistance to several antimalarials means that most tourists will be advised not to take chemoprophylaxis; they must be made aware of the risk and that they must urgently seek prompt diagnosis and treatment in the event of fever during or up to a year after their visit.
Recommended prophylaxis: Bangkok and main tourist areas, none.Day visits to forested areas, none but be aware of the risk. Longer stays in rural areas with forests, and in border areas with Laos, Myanmar or Cambodia, doxycycline or atovaquone/ proguanil.

MD Travel Health (privately run site fo rtravel merdicine) It is essential for all travelers to take medication to prevent malaria when visiting any area where malaria occurs...
in Thailand: prophylaxis is not recommended for the cities or main tourist destinations, including Bangkok, Chiang Mai, Chiang Rai, Pattaya, Phuket, and Ko Samui. Prophylaxis is recommended for travel to rural areas, especially the forested areas bordering Cambodia, Laos, and Myanmar, including Mae Hong Son. For the areas near Myanmar and Cambodia, either atovaquone/proguanil (Malarone)(PDF) or doxycycline may be given. For travel to the forested areas bordering Laos, either Malarone, doxycycline, or mefloquine (Lariam) may be given.

WHOMalaria risk exists throughout the year in rural, especially forested and hilly, areas of the whole country, mainly towards the international borders. There is no risk in cities and the main tourist resorts (e.g. Bangkok, Chiangmai, Pattaya, Phuket, Samui). P. falciparum resistant to chloroquine and sulfadoxine–pyrimethamine reported. Resistance to mefloquine and to quinine reported from areas near the borders with Cambodia and Myanmar.
Recommended prevention in risk areas near Cambodia and Myanmar borders: Mosquito bite prevention plus either mefloquine, doxycycline or atovaquone/proguanil (take one that no resistance is reported for in the specific areas to be visited

US CDC Thailand: Limited risk in the areas that border Cambodia, Laos, and Burma. No risk in cities and major tourist resorts (Bangkok, Chiang Mai, Chiang Rai, Pattaya, Phuket Island, and Ko Samui.)

The situation for expats can be very complicated. Here are exerpts from a couple of good references--I recommend reading both for the details

Malaria prophylaxis for long-term travellers
C Hughes, R Tucker, B Bannister, DJ Bradley, on behalf of the Health Protection Agency Advisory Committee on Malaria Prevention for UK Travellers (ACMP)

However, this is not to imply that expatriates rarely contract malaria. It has been found that up to 30% of some expatriates develop malaria within two years and that despite their greater experience of overseas travel (or perhaps as a result) many cases can be attributed to poor compliance with
prophylaxis (Schneider and Bradley, unpublished data). Low compliance in this group could be due to a loss of confidence in particular drugs following a febrile episode or suspected adverse effect whilst taking them. Expatriates may also mistakenly follow ill-judged local advice.

From Long-Term Malaria Prophylaxis for Travelers, J Travel Med 11(6):374-378, 2004. © 2004 International Society of Travel Medicine (registraton required to read)

Special Considerations for Expatriates

Expatriates who live where malaria is hyper- or holoendemic should be encouraged to take continuous chemoprophylaxis during the high-transmission periods and to be on standby for the rest of the season. They should rely on local malaria testing and treatment only if there is external quality control of test results.

<blockquote>Quote
<hr>Expatriates may also mistakenly follow ill-judged local advice.<hr></blockquote>

Does doing what other posters suggest on Thorn tree fall under that category??!!

If I had been taking doxy (or god forbid Larium) daily for the last nine years I truly believe malaria would be the least of my concerns LOL.

As I said 20 posts previously, this is a common sense decision:

<blockquote>Quote
<hr>What "malarial areas" in Thailand are you talking about? Unless you're planning on camping or trekking in the remote border districts you do not need to take malarials in Thailand. If you're doctor says you do, get a second opinion (off a doctor, not this board!)

The best sure is prevention - dress sensibly, use repellent and don't sleep naked in a swamp.<hr></blockquote>

I realise larium isn't taken daily -- shouldn't be taken at all

Steve, you are correct that I have a stance, and it's very clear: I believe that antimalaria meds are unnecessary unless you are sleeping naked in the jungle; and prevention of mozzie bites is the best choice.

Why won't you state your exact position on this issue? Maybe that will save a lot of time for people like myself who are apparently too slow on the uptake, or who are not disposed to search thru your thousands of posts.

Why won't you state your exact position on this issue?

some people have one "exact position" that they believe applies to everyone - irrespective of personal circumstances, medical history, previous experience with anti-malarials and bite prevention, and likely propensity to adhere to whatever regimens and/or other preventative strategies might be required; regardless of where they're going (and where they'll be going next) and what facilities exist there; and no matter how they'll get there, how they might be evacuated, how long/where they'll stay and what they'll do while in situ

I believe that any such "exact position" is untenable; I think everyone should make their own informed decision - in other words, I think it's a decision that should (indeed, can only) be made on an individual basis

in many cases it'll be a no-brainer; in some cases it'll be a difficult decision that will require in-depth research

personally, FWIW, I would take anti-malarials in some circumstances, and not in others

again, as per reply #25 I ask: please can you give an example of one of my posts that is contributing to your confusion?

also, just out of curiosity - can anyone please provide a link to anything I've posted on this topic which they find to be in any way inaccurate, misleading, or unhelpful?

<blockquote>Quote
<hr> I would take anti-malarials in some circumstances, and not in others<hr></blockquote>

That's the best advice that can be given, it is a situational decision. Perhaps such a statement can be frustrating for someone looking for a clearcut answer, but the fact is that there is no clear yes or no response. As difficult as it can be for some people, you have to take the information, discard the obviously fruity (no pun intended with regard to Pine Apple's post), and then make your personal decision based on the info remaining (plugged in to your personal situation).

#31, good on you Steve252

fair enough, Steve; thanks.

From the vast majority of inquiries/OPs on this branch over the last few years about taking the meds, or the cost of the meds in Bkk, I would still tell these mostly short-time tourists that they're better off just preventing mozzie bites. This will not only reduce the chance of contracting malaria even further than it's almost nonexistent occurrence rate for tourists in Thailand, but it will also reduce the chance of their contracting Dengue Fever, which is much more prevalent and which has no "cure", and will also reduce sand flea bites, which tend to itch a lot more than mozzie bites and result in infections.

no matter how much sunblock u put on there is a limit to how much time u can spend in the sun. factor 20 is about a nano stronger than factor 12.

two hours sounds like way too long a time to spend in the sun under any circumstances.

not that i'm all for conventional medicines - have a look at blueturtlegroup.com.

Jesus, Eamon2002, that is really awful. Does your doctor directly attribute the skin cancer to the sunburn? And the sunburn to the doxy? Reason enough to stay away from it.

Anyway, I wish you a full recovery.

re reply #36 - have a look at blueturtlegroup.com

for more on the blueturtlegroup scam, see: homeopathic malaria remedies FAQ thread

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re reply #37 - Does your doctor directly attribute the skin cancer to the sunburn? And the sunburn to the doxy? Reason enough to stay away from it.

that's the same as saying: "Does your doctor directly attribute the skin cancer to the sunburn? And you can get sunburn in South-East Asia? Reason enough to stay away from South-East Asia.</b></i>

FWIW / without prejudice: Ayahuasca in Peru

Steve252, he was saying that despite slathering SPF20 over himself he got a horrible sunburn. Which he seemed to be saying was due to the doxy. Then again, I just read the link you provided and I see what you're getting at.

...not to mention the fact that skin cancer would have been caused by a collection of events, both genetic and environmental and chemical, over a long period of time. One sunburn ain't gonna do it. Also, doxycycline is a very widely-prescribed drug and has been in use for many decades, there are no widespread reports of severe side effects.

No disrespect to any posters, but I am more afraid of slipping over in the murky water at the fish market than of Malaria. But I tend to avoid heavily mosquitoed areas in any country.