Madagascar and malaria

Please register or login

Welcome to ScubaBoard, the world's largest scuba diving community. Registration is not required to read the forums, but we encourage you to join. Joining has its benefits and enables you to participate in the discussions.

Benefits of registering include

  • Ability to post and comment on topics and discussions.
  • A Free photo gallery to share your dive photos with the world.
  • You can make this box go away

Joining is quick and easy. Log in or Register now!

waterfall

Registered
Scuba Instructor
Messages
11
Reaction score
0
Location
Europe
Hi I'm off to Madagascar to work on a reef conservation project for one year.What on earth can I do about malaria prophylaxis for that length of time?Has anyone taken antimalarials for such extended periods while diving?Any advice welcome.
 
Not while diving but I have taken both Larium and Malarone for periods of up to a year without having time to stop either as I was out of the malaria effected areas only a short time and could not stop taking the prophylaxis. I was doing offshore survey work in West Africa. I had less side effects with the Malarone but I still preferred the Larium. I could afford to have crazy colorful dreams 1 day a week. Good luck and remember to take your meds while there.
An interesting fact that I learned from visiting Angola many times was that 90% of the mosquitos I saw where in the airport. Anyway, good luck.
 
Hi waterfall,

Madagascar is loaded with insects of a wide variety, including malaria carrying mosquitos. The first step in prevention is to minimize bites. In this regard, you may find the following informative:

Avoiding Mosquitoes and Other Bothersome and Disease Carrying Insects
http://www.awoosh.com/Doc Vikingo's Resource Page/Avoiding_ Insect_Bites.htm

The next step is chemoprophylaxis. Be aware that when necessary it is possible to take certain antimalarials over very long periods of time without undue concern.

There are serious concerns regarding taking Lariam while diving. You may become acquainted with these by reading the following article which I wrote for my column in Scuba Diving magazine:

"Lariam (mefloquine) is an effective drug used to prevent and treat malaria, but can give rise to unwanted side effects, including hallucinations, anxiety, depression, confusion and forgetfulness.

The US package insert indicates that "...caution should be exercised with regard to driving, piloting an airplane, and operating machinery as dizziness, a disturbed sense of balance, neurological or psychiatric reaction have been reported during and following the use of Lariam," and states that "dizziness, sensory & motor abnormalities, headache and fatigue have been recorded in patient's taking the drug." These cautions are consistent with suggestions by some in the medical and dive communities that mefloquine may produce side effects which mimic DCS.

Interestingly, the German package insert adds it should not be used for "certain activities which have a need for full attention and undisturbed motor activity," with a specific direction that pilots should not use Lariam for the prevention of malaria during their work.

Of most concern to the diver are the positions of some medical professionals that the drug should not be taken for malaria prophylaxis by those who are actively diving. These sources include "Rodale's Diving Doc," Dr. Samuel Shelanski, and the German Society for Tropical Diseases. This later group, whose policies can be used as a basis for professional and legal action in cases of harm resulting from a physician's failure to follow them, states that people with a special need for three-dimensional orientation, for example pilots, scuba divers and others, should not take mefloquine as prophylaxis.

The above information suggests it would be prudent to take this drug only after detailed discussion with a physician who is fully aware of its current status, and to closely monitor for any adverse reaction."

Also, in mid-'03 the FDA issued the following warning and Medication Guide for Lariam http://www.fda.gov/bbs/topics/NEWS/2003/NEW00921.html

Fortunately, drugs like Malarone http://www.malarone.com/ are equally or more effective for the Madagascar region and have more benign adverse reaction profiles.

The traveler/diver will want professional advice on this important issue. Such may be obtained by contacting:

International Society of Travel Medicine
http://www.istm.org/

Travel Clinic Directory
http://www.astmh.org/scripts/clinindex.asp

Helpful?

Regards,

DocVikingo
 
Thanks to one and all for your speedy and helpful replies.Sorry it took me a while to get back to you but I've been running around like a headless chicken sorting tickets and visas etc!!
I've had a good think about it all and I'm definitley not happy with the idea of Lariam long term so I'm giving the Malarone a go.Yes its expensive but perhaps cheaper to buy once I'm out there.Anyway,its my health in the end isn't it,so I don't really want to gamble with that!Thanks again everybody!
 
You won't be able to buy Malarone in Madagascar, as far as I know the only African countries where it is available are South Africa and Kenya, and there pretty much at the same price as in Europe.
Besides Lariam and Malarone there is doxycycline, an antibiotic, which is as effective in preventing Malaria in East Africa than the other two. The advantage is that it is VERY cheap, even in Europe, and widely available otc in many countries, including all African countries I have visited.
Some people have side effects like stomach upsets and heart burn, which can usually be avoided by not taking it on an empty stomach and by not lying down for an hour or so after taking it.
One disadvantage is that a common side effect is increased photosensitivity, which has some people burn very easily in the sun when on doxy, but mostly a good sun protection lotion can handle it. I personally and many others I met didn't have any problems with getting burnt.
Doxy has been used long-term for up to a year or more both as Malaria prophylaxis (e.g. Australian army on missions abroad) as well as for other things (treatment of severe acne in teenagers), so I would assume you would be safe to take it for a year.

I don't know where in Europe you are, but in Germany even though doxy is not licensed as a Malaria prophylaxis (while it is commonly used to treat many other things), any knowledgable doctor will know about it and give you the prescription if you ask.
 
Great tips,thanks.I've been taking the Malarone for a few days now and have a month's supply from my doctor.
He said he wasn't sure about supply issues once I'm out in Madagascar,but reckons I can switch to doxy when I'm out there if needs be without any ill effects.
Thanks again all,I'm off soon so might not be checking in here again for a while.Happy diving one and all.
 
Better bring all the meds that you will need with you. I wouldnt chance that it will be available locally.
 
Hey Waterfall,

You're welcome.

Since you're talking about taking doxycycline for a period of about 11 months, you'll want to keep an eye out for possible fungal infections (e.g., mouth, GI tract) and liver dysfunction (also in this regard, never use doxycyline that is past its expiration date). As has been noted, it can be hard on the stomach and be very careful about u/v exposure.

You will be able to locate doxycyline in the capital city, Antananarivo, but it could be hard or impossible to find in other locations. It comes in many trade names around the world, but in Madagascar likely will be labeled Radox, Doxylag or Medomycin.

What a great opportunity--do enjoy.

Regards,

DocVikingo
 
I was reading through a number of web based articles on malaria prophy and a drug called atovaquone-proguanil came up. Has anyone experience or knowledge of this?
 

Back
Top Bottom