Malaria prevention

I'll be in New Delhi and the Golden Triangle area, Goa, and south into Kerala, ending up in Mysore and Bangalore.

My Indian friends have told me to not bother with Malaria pills. My Canadian friends are aghast that I am not going to take them.

I took them when I went to KunaYala in Panama. They are a nuisance.

I need to decide in the next day or so as I am leaving next Friday.

I know that medical advice received on the ThornTree is risky -- but my inclination is to not bother with them. Just wondering how many people travel in India without taking them.

Thanks for this last piece of help.

More than Malaria, it is dengue that you need to be concerned about. Delhi had quite a few incidents of dengue a month or so ago.

Having said that, the monsoon season is over in the Northern Parts of India and the cold weather will start to knock the mossies off. In the South however, you will still have mosquitoes - dengue is not as rife there but chikungunya was a year or so ago.

In my view more than malaria pills, you should rather wear long sleeved clothing esp in the evenings and when on the backwaters (if you are going there , remember that the backwaters are die hard mosquito territory) and use mossie repellents both on your body (e.g Odomos) and in your room (e.g. Good night)

Not sure what the basis of the classification is. From what I know, Goa is a low risk area reg Malaria. Delhi is high risk - and shown as low risk on the map.

I would suggest that you don't pump your body with medication if you can take other precautions.

Have a look at this map by the British National Health Service:

http://www.fitfortravel.scot.nhs.uk/destinations/asia-(east)/india/india-malaria-map.aspx

(You have to copy the whole address, as there seems to be a problem with the link.)

Tommi

Edited by: Tommi1

My Indian friends have stressed using insect repellent and not to bother with the Malarone. I am now wondering -- according to the map - if it would be worth it to just treat Goa as the "malaria risk" and take the pills which are bloody expensive, on the proper regime over that part of the trip.

ARe you in India Gemcap? Do we in North America just worry too much about these things? I do have a stash of antibiotics and one friend said that if I think I have malaria (how would I know????) I should just fill myself full of them and get to a hospital asap.

:-) am an Indian and yes, I do think most travellers from the West tend to worry a bit too much about illnesses which are not endemic to that part of the world. Partly justified, but its when someone goes overboard that things which seem normal to an Indian start assuming gargantuan proportions. There was a post on this forum about a bat some time ago which is a good example of this. I still remember meeting a a tourist who was panicking because she had seen a mosquito near her (not sure if she had been bitten) and was convinced she would come down with Malaria.

When travelling, there are things to take basic precautions about as a tourist as the residents of the place also do. Avoid raw food, water etc, use insect repellents, but don't over medicate yourself as a precaution against something which may or may not happen. In Kerala for example, personally we never use chemical mosquito repellents and always sleep under mosquito nets.

How would you know if you have malaria ? Temperature fluctuations ie fever which comes and goes as opposed to a steady high temperature and chills /

Edited by: gemcap

siemprepatty : I would definitely advise that you take basic antibiotics along with you esp tablets when travelling.

"have a stash of antibiotics and one friend said that if I think I have malaria (how would I know????) I should just fill myself full of them and get to a hospital asap"

I would recommend the latter unless you carry a microscope for blood tests with you. Indian doctors are good and can distinguish which variety if at all malarial it is. Can't help you with the symptoms. I was in no shape to tell much less treat myself.

"which is a good example of this" Chuckle..

Dengue fever...
http://www.medicinenet.com/dengue_fever/article.htm

To worry about yellow fever precautions, you need to go to Africa.

Cholera is certainly existent in India but in the less cleaner parts of the country where water is contaminated (and treated on a war footing when it does break out) - and of course in Haiti now.

Its sad that an illness which has not been there for close to a century has been most likely reintroduced by people who went to help the residents - and ended up being more trouble than help.

Reminds one of many islanders a few centuries ago who were killed in thousands because of illness introduced by Sailors.

But for some reason, it doesn't worry me for there

Its all in the mind...travel in peace.

One obviously also has a fever with Dengue. Is that a steady fever as opposed to a fluctuating fever with Malaria?

I KNOW I won't get Yellow Fever or Cholera - although the Dukoral I took was my friend's leftover dose and a bit outdated :-)

The very funny thing about this is that I am going to Guatemala in February - and according to that posted map site, Guatemala if rife with Malaria. But for some reason, it doesn't worry me for there, even though I do agree with the above comment about good doctors in India and maybe not so good in Guatemala.

I had to have the Yellow Fever shot because I was re-entering Costa Rica from areas of Panama that have Yellow Fever. As it turned out, they didn't ask to see the proof of vaccination, but they could have, and they could have denied me entry.

I am going to India next month and I will be taking Doxcylline against malaria.

Previously, I have had Dengue Fever. There is no medicine against it, but I will use a rollon repellent.

I took anti-malarials on my first trip to India. On the next four trips (now almost three years in India) I didn't. Most of my time has been spent in the Ganges Valley and further north, so the risk was less; though I did spend six months in Varanasi on my last trip - during monsoon, with no adverse effects of not taking them. And though I realize that it only takes one mosquito to get you, in general, mosquitoes don't like me, and the feeling is mutual :)

"I KNOW I won't get Yellow Fever or Cholera - although the Dukoral I took "

You have no serious risk from either in India at this time. However, the Cholera vaccines are far from perfect coverage. Its like Japanese E which only offers partial protection. Other vaccines are far more effective.

"Previously, I have had Dengue Fever"

Please take all possible precautions Gary. With Dengue its the second time that is a bear..

I would never go to india without having all my shots (hep A and B, tetanus, typhoid, polio booster,) and I would also take doxycycline for Malaria prophylaxis. I also use deet and cover exposed areas with light clothing and take a regimen of cipro for TD that persists for 2 days. Despite the incredible sights, sounds, color and variety of everything, India is just too filthy.

Other than the latter regimine of broadscale use of antibiotics I would be completely on board..

OK - so this is interesting.

I went to the Travel Clinic - one has to pay, but this is the best travel advice I have ever had. She thought I should have a typhoid shot but did not really see the need for Malarone in the areas I am going too. Even Goa was just a step up from "totally clear." The main bad area was Rajastan. Rural pockets around Mysore (not Mysore itself) were the same as Goa. I did not look at the rest of the country, but it was a bit different form the one posted above.

So I have a prescription for starting in Goa -- she felt that anything else was a waste.

Explained about day time mosquitos being the source of Dengue and night time mosquitos being the cause of Malaria. Has anyone else heard this?

Anyway, she seemed far more concerned about Dengue than anything else, and it appears that one of the Canadian athletes who returned from the Commonwealth Games develped Dengue. One out of several hundred - them's pretty good odds.

No problem with anything but paragraph #4. Mosquito behavior is evolving (bloody smart critters) so malarial mosquitoes are hunting in the daytime now as well..

Explained about day time mosquitos being the source of Dengue and night time mosquitos being the cause of Malaria

Ah...my zoology lessons in school come back to me. Malaria is caused by the anopheles mosquito (with a black and white striped body if you ever let it get close enough to see it), which is a largely nocturnal and dengue by the Aedes mosquito (all gray body) which is largely diurnal. Of course, you do know that only the female mosquito bites.

I love the animal kingdom :-) The men are pretty, titivate to attract the opposite sex, and the women fight and bite.

@ 17 I would never go to india without (hep A and B, tetanus, typhoid, polio booster,)...doxycycline..deet..a regimen of cipro for TD+ +Despite ..everything, India is just too filthy

I am not being facetious but need to ask, did you also carry Prozac with you as a pick me up from all the depressing sights which India also presents and the sheer difficulty of travelling around?

MY doctor said Cipro is not as good for India as Azithromycin. She didn't explain, just said it was the "drug of choice" now.

Anyway, I guess I'm going with a zillion pills. What I don't use in India will serve me well in Guatemala in February.

This thread has links to recent research re malaria in India.

Gemcap, you are being facetious, but also showing a sense of humor. No, I didn't need any prozac in India. I was too busy figuring out all the madcap activity, bargaining with vendors who smile because even they know their first offers are usually ridiculous, making up silly songs about riding in buses and driving on India's roads, fighting with obnoxious French tourists, chatting with storekeepers over cups of chai, fantasizing about the beef dishes I would like to make with the two cows who head butted me in Jaisalmer, getting lost in the alleys of Varanasi, exploring castles, markets, forts, deserts, beaches, mountains and crazy cities; leaving various cities either one day before, or one day after terrorist attacks, and not worrying as much as others might because I did take basic health precautions in a very dirty country. The depressing sights are there - yes - but I could not dwell on them, and I did not have the resources, money or governmental support to do much about them.

Great response :-). You seem to have really had a great time during your travels.

I leave today - although it will take me a week to get to Delhi. Thank you everyone for your insightful help on this thread.

I'm armed with 25 Malarone pills - to start the day before I got to Goa and a week after I leave India. Insurance. I have all sorts of anti-diarrhea stuff, including having taken a dose of Dukoral. I can't do anything more, and probably have already done too much.

One thing I did read about the Malarone, and this is something else I am thinking of doing perhaps instead of taking them preventatively -- it says if you get Malaria -- to take 4 pills a day for two days as "treatment" while you get yourself to a hospital. I am not ever going to be too far from a major centre, so that's a possibility. I'll discuss it with my Inidian friends.

This trip is a little outside my comfort zone, but I'm as ready as anyone could be --- i hope :-)

Thanks again.

Patty

Patty, good luck with your trip, stay healthy and safe. Look forward to reports on the trip.

buen viaje.

Janet

I've lived in India a total of 5 years over the past 30 (started off as a hippie, ended up a professor of Indian religions); sometimes I took anti-malarials (chloroquine in the old days) and sometimes I didn't. I'm currently spending 3 months in a village in S. Karnataka, and have been taking Mefloquine (my wife is not). Something to be aware of with this is that a side effect (in rare [?] cases) is that one can become depressed and even suicidal (I'm not making this up--read the fine print). About ten years ago I was living in Nepal, and a girl I met actually became pretty psychotic, and indeed suicidal, on the stuff. I had a bout of some pretty wierd ideation a couple of weeks ago, but it has passed--not sure if it was the drug or just the craziness of the environment bringing out my innate looniness. Anyway, my feeling is that it is a crapshoot whether you take it or not. (The alternative, antibiotics, is fine as long as you don't go out in the sun--good luck!)

I agree with previous writers who are averse to taking meds unnecessarily (count me among them), but I read the local papers, and a lot of people contract and die from malaria in South Asia. The WHO just came out with a study that estimates the number is three times previous estimates, which were already pretty horrific. My strategy on this trip was better safe than sorry, but next time I might go the other way.

A question for others out there: How is that a country that is booming in IT can't get it together to install screens on hotel room windows? (I'm talking Rs 800-1000/night, not the dives I stayed in back in the day.) Next time I come to India I'm bringing my own mosquito net.

Here's a new twist. I have the Malarone pills. In the instructions, it says for "treatment" as opposed to prevention, to take 4 pills a day for two days, and I assume get yourself to a hospital asap. Perhaps this is a better thing to do, particularly as the travel doctor told me not to even bother with them, and the areas I am in are pretty low-risk according to the map....

is that a side effect (in rare [?] cases) is that one can become depressed and even suicidal

Interesting you say that...This (or the problems from the side-effects of the pills) is what the book "Undress Me in the Temple of Heaven" is based on. The author's friend's psychotic behaviour was said to be a result of the anti malarial pills she took.

On an aside, I bought the book to read on a flight and the risque sounding title, with an uber-glam lady complete with daddy-long-legs kind of legs on the cover, posing behind a strategically placed rucksack, had my neighbour rubbernecking to see what the book was all about.

siemprepatty - how's the trip going so far?

Yes, Mefloquine (Larium) is too scary for me..

Next time I come to India I'm bringing my own mosquito net.

johnrn - can't you buy one now in the place you are in ? Or else, tell a local shopkeeper to get one for you (he'll get it via the bus driver who goes to the nearest town)

You can get mosquito "netting" (called by the Hindi "macchar dhani") in most fabric stores in India, but in my experience ready-made (Indian English:) "bed-nets" (also called "macchar dhani") are scarcer than hens' teeth. But even if you have a "bed-net" it is often a big hassle to fix it over your bed properly.

I'm not familiar with the drug previous writers have mentioned, but I don't think you want to contract and then treat malaria. It is a very nasty organism; the first bout with it is often pretty bad; and my understanding is that the treatment is no fun either.

I don't like being bitten by mosqers in any case (forget malaria, dengue fever is no picnic either), so my current strategy is that I have bought some lengths of net and fabricated some make-shift screens that I can hang over hotel room windows. But again, at Rs 1000 plus a night you would think the hoteliers would put up screens!

but in my experience ready-made (Indian English:) "bed-nets" (also called "macchar dhani") are scarcer than hens' teeth

Not quite so.. you're not looking in the right place. Mosquito nets (meant for beds) are common in India. Window screens are not.

Quite so. I had so many I bought in India and stored away that I finally gave them away to all and sundry. However, when I brought screening and installed it I rose immeasurably in my mother in laws esteem..

when I brought screening and installed it I rose immeasurably in my mother in laws esteem

Point 1 in the manual "How to win and influence your in laws though practical household tips" :-)

Travel mossie nets are still pretty hard to source Gemcap, but some petticoat liner and a good tailor can do wonders (pink is nice)

"The WHO just came out with a study that estimates the number is three times previous estimates"

Actually you are as guilty as me of not reading articles properly ;-) the WHO actually repudiated said assertions, they did not make them!

Not having a dig, I made the same mistake myself a few days back.........................Whoops

The mosquito which bites is female...think she'll be attracted to pink?

This is the kind of mosquito net I had in mind - - it's by no means a travelling net.

Note : no idea what this hotel is all about. Took it for the photo op.

Ha you may have a point about the pink petticoat liner Gemcap..............back to the drawing board.

I returned from India yesterday.

I did not see readymade mosquito nets for sale in the shops or markets in India.

Unless they have gone out of style I bought several in Pune even in the 1980s. I prefer to bring mine though..

I did not see readymade mosquito nets for sale in the shops or markets in India.

I know for a fact that you can buy them easily in Delhi / Bombay / Chennai / Kerala. Mosquito nets are not on display like ready made clothes - you need to ask for them in shops selling textiles or / and clothes. You not going to get them in shops in large malls.

Yeah even the tacky beach markets in Goa sell them now, made out of a bit of plastic conduit and said petticoat liner.