Malaria

Hi Guys, I've been hanging out on the South Pacific Branch for some years, this is my first post here - so be gentle with me if this is a dumb question. We're heading to Cambodia in early November & have been advised by our doctor (who is very cautious) that we should take Malaria tablets - we are concerned that the possible side effects will compromise our vaction & need advice from those in the know, as to whether this is overkill or if general opinion/experience is that a generous application of deet at dusk will do the trick.

The decision is yours but I would not take Malaria tablets if you are only visiting Siem Reap, Phnom Penh and Sihanoukville as the risk of Malaria is low.

If you are going in to the countryside or out of major towns then I would consider using them.

Protecting yourself against mosquitoes would be the best advice as Dengue fever victims are quite high this year which is also transmitted by the mosquito.

Siem Reap General information

In terms of side effects which may affect travel, I suffered from no side effects when I took Larium but I agree with sydneyangkor, you probably don't need anti-malarials if you stick in the main centers.

Check online updates for recent malaria break outs.

Have fun!

One persons account of side-effects doesn't mean much, as everyone will react differently. By far the most common drug taken is doxycycline (it is also the only one available locally) and it can give you stomache aches and increased sensitivity to the sun. I hated taking it (stomache so messed up it really made me unhappy) and in 10 years visiting SEA have only taken it once (the 1st/last time). I took Larium once and it made me go psycho (more than normal). Bite avoidance is the best strategy in main areas. Meds only needed if you intend to sleep nightly in a bush hammock or join the forestry police.

Try obtaining the drugs early and trying them out before you go! That way you will know what to expect and if you suffer any side effects.

I'm in a similar situation, altho we'll be in Cambodia and Laos in October. Have traveled in SEA for the past ten years and never took antimalarials, but because of the warnings about outbreaks of dengue this year we're being more cautious this trip. It sounds to me that the rainy season will be over, or at least on its final leg in October, and we will only be in PP, and SR in Cambodia. Will be in Pakse and surrounding areas as well as LP and Vetienne in Laos. CDC recommends Deet 30-50% for Cambodia and Laos this year and I got 40%. There is no evidence that Deet in concentrations greater than 50% is any more effective according to the CDC. we'll be using the pretreat stuff for our clothes for the first time this trip too. Don't plan on taking antimalarials, but will deet up, wear approprite clothes and use coils at night and netting if provided in hotels. I feel pretty safe doing it this way, and based on what I have read from people who live in Cambodia and Laos it sounds unlikely we will get Malaria or Dengue. we will also have medical evacuation insurance, but we always do anyway.

For Doxy it is critical that the directions be followed as to how its taken. Its quite detailed. Reading is fundamental..

I could not resist sharing my unfortunate tale with Doxy.

On return from cambodia after taking it in total for three weeks, I began to get uncomfortable heartburn/indigestion (one of the side-effects).

Without thinking I took some Mylanta (antacid) and within hours I had broken out in hives over my entire body.
After a sleepless night of itching and scratching I purchased antihistamine and problem solved.
Doxy went in the bin and I continued on.

For the record - spent a week in Mondulkiri, where despite taking precautions suffered many bites from various insects including mozzies and leeches.

Oh well no fever yet.

PS... been told by a Dr that Larium is no longer effective as prophylaxis in SE Asia. Malarone is now the drug of choice.

Again, prevention is better than cure. Stop yourself getting bitten and vastly reduce your chances of getting Malaria.

I spent june surfing in java and sumbawa then july in laos and cambodia and did not worry about the tablets. Haven't got anything yet so fingers crossed. Just use spray and cover up in the evenings and you should be sweet. I hear that alot of the strains in SE Asia are becoming drug resistant anyway.

If you can get it and are happy to pay a bit more than other options then I recommend Malarone. Much shorter course and most unlikely to cause side effects. That way you are likely to finish the course which is important.

I didnt have any worries with Malarone but maybe it cost me £60/70 or so, better than psychosis and hives though. Larium was mad.

Will I need them for Vietnam? maybe not if I stick to Nha Trang and Saigin? maybe I do for higher regions such as Dalat?

mmm..Malarone is quite expensive... but then I guess hospitalisation for malaria wouldnt be cheap either!

As a woman, I have to say that Doxycycline will make you very (and I mean VERY) susceptible to stubborn vaginal yeast infections. I was also constipated for weeks after coming back from SEA, but that could have had other reasons. Can't comment on the sun-sensitivity, as I burn very easily anyway.

I wish I could have the "use-Deet-and-hope-for-the-best attitude", but I have seen first hand what malaria can do to a strong, fit and formerly healthy man. So I will use Malarone.
(Besides being not recommended for Cambodia these days, Lariam caused some interesting psychotic side effects: I was in Vietnam and suddenly remembered that I had to send my sister a postcard. So I started to write one, and I couldn't remember her address. And then I remembered I didn't have a sister. That was Lariam. But the dreams were great. No nightmares, just extremely vivid.)

Just quick comment to dispell an old wives' tale that you don't need to worry abour malaria in major cities. It is just that, myth. Mosquitos love urban environments where humans kindly provide standing water. Now in my area of Secunderabad they put oil on the nearby lake for a very good reason. Wish they had always done so..

14# I think the chances of getting Malaria in Siem Reap and Phnom Phnom are very low. I know number of expats who have lived in Siem Reap and in Phnom Penh for a number of years and I have heard only 1 person get Malaria and that was probably because he went out into the outbacks for a few weeks.

Chances to get malaria is very low. Wouldn't bother with anti malarial if I were you.

Hi Vozzer,

I did the central highlands (Kontum and Playku) and Dalat in 2005 and was told by the 2 guides I had not to bother. I didn't and all was o.k. but of course that was only me !! Did see a lot of mozzies in Kontum but with the usual precautions like DEET spray, long sleeves etc. didn't get bitten. But once again perhaps my blood is too old for 'em.

Good luck