I'm planning a dive trip to the Togian Islands in Central Sulawesi, Indonesia. The area has malaria, and I'm researching on the appropriate prophylaxis to take. Is there any advice on this? Is there any concern about diving while on such medication? Thanks very much.
Malaria prophylaxis and diving
- Thread starter rgo
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cdiver2
Contributor
rgo:
Do a search lots of stuff on it
Indonesia
CHLOROQUINE RESISTANT AREAS
(Doctor's Interpretation)
MEFLOQUINE
or DOXYCYCLINE
or CHLOROQUINE AND PALUDRINE
or MALARONE
Any of the above medications might be considered for the region you have selected. Details on whether the medication is suitable for you, when to start and finish, dosing and potential side effects must be discussed with a medical practitioner. It is also important to consider that while a country may have areas endemic for malaria you may not be visiting a high risk area. An assessment must be made whether the risk of the disease outweighs any potential side effects of medication.
Check out the following site for medical travel advice: www.tmvc.com.au
regards
Dennis
CHLOROQUINE RESISTANT AREAS
(Doctor's Interpretation)
MEFLOQUINE
or DOXYCYCLINE
or CHLOROQUINE AND PALUDRINE
or MALARONE
Any of the above medications might be considered for the region you have selected. Details on whether the medication is suitable for you, when to start and finish, dosing and potential side effects must be discussed with a medical practitioner. It is also important to consider that while a country may have areas endemic for malaria you may not be visiting a high risk area. An assessment must be made whether the risk of the disease outweighs any potential side effects of medication.
Check out the following site for medical travel advice: www.tmvc.com.au
regards
Dennis
My personal preference is for doxycycline. I have been living in Malaria areas for the last five years. Its side effects are the least obnoxious, from my perspective. I suggest you do some Internet research and then talk to your doctor. Most doctors don't really know much about this topic.
Greg
Greg
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Indeed there are concerns. You can improve your awareness of them by reading the multiple previous malaria threads posted on this board.
For example, below is reposted reply #5 from a thread of earlier this month on malaria prophylaxis (http://www.scubaboard.com/t51629.html). Although it adressess malaria prevention in the Honduras, the principles are exactly the same. BTW, the CDC URL in that post is for Central America. Here's the one for Indonesia---->http://www.cdc.gov/travel/seasia.htm :
"You might find this helpful. It's an updated edited version of my "Ask RSD" column in the Oct '99 issue of "Rodale's Scuba Diving."
Sand fleas & mosquitoes can be a real bother, not to mention that they are sources of some serious tropical diseases.
The danger & bother of insects can be substantially reduced by these precautions: (1) Wear long sleeves and pants, avoiding dark or bright colors, especially at dawn and dusk. Protective clothing such as the "Buzz Off" brand can be useful. As an extra precaution, you may treat clothing with permethrin (As in the easy to use Sawyer Products http://www.permethrin-repellent.com ) ; (2) Try to stay indoors at dawn and dusk when many flying insects are most active, and avoid sandy areas as much as possible at any time of day, especially when there is no breeze. When making reservations, make sure the resort has screened windows; (3) Wear insect repellent. The best protection against these and other insects is full strength DEET. Some divers like things such as Avon's Skin-So-Soft & Cactus Juice, less toxic products than DEET, by the science is solidly behind DEET for lasting effectiveness. Most DEET containing repellents are the 15-30% range of concentration. The testing of various strengths of DEET has shown that after about 30% little additional effectiveness is to be had by upping the strength, and even less after about 50%. As such, there is simply no point in exposing oneself to more potent brews. UltraThon at 32% http://www.3m.com/us/home_leisure/ultrathon/ appears to be a good product. Used as directed over relatively brief periods of time, say a week, DEET has been shown to pose no significant risk when applied to exposed skin. If you wear lightweight, loose fitting clothes, it generally is safe to use DEET underneath. Doing so with heavy, snug fitting clothes can result in dermatological problems & worse. Be aware that DEET can dissolve synthetics like plastics, rayon & nylon, so it's best to wear natural fibers & keep it off of your gear; (4) Avoid scented toiletries and perfumes; (5) Upon arrival, treat your room with a bug bomb such as Shelltox or Fish (stay outside while this is being done). Touch up with spray after that as needed."
As for malaria, there are reported cases of malaria on Roatan, although to the best of my knowledge not at a high incidence rate. The majority of divers I know who frequent Roatan do not take malaria medication prophylactically if they are not planning to go over to the mainland for touring.
As with many things in scuba & foreign travel, the level of risk one is willing assume is a personal decision. However, malaria is a nasty disease, and the conservative CDC guidelines would be appropriate for those wishing to reduce risks to a very low level. These can be found by clicking here----> CDC Travelers' Health--Health Information for Travelers to Mexico and Central America http://www.cdc.gov/travel/camerica.htm .
If one decides to take an anti-malarial prophylactically, care must be taken in choosing the drug as some may not mix well with scuba, e.g.,----> Concerns About Lariam http://dive.scubadiving.com/talk/re...204092&t=203844 . At present, chloroquine (e.g., Aralen) is largely recommended for the Honduras, and it tends to be tolerated well & to pose little threat to scuba.
If you decide that malaria chemoprophylaxis may be for you, contact your nearest tropical diseases/travel medicine clinic. They'll get you squared away. And, don't wait until the last minute. The following websites may be of assistance in locating such a facility:
International Society of Travel Medicine http://www.istm.org
American Society of Tropical Medicine and Hygiene (ASTMH)
http://www.astmh.org/scripts/clinindex.asp "
This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual, and should not be construed as such.
Helpful?
DocVikingo
For example, below is reposted reply #5 from a thread of earlier this month on malaria prophylaxis (http://www.scubaboard.com/t51629.html). Although it adressess malaria prevention in the Honduras, the principles are exactly the same. BTW, the CDC URL in that post is for Central America. Here's the one for Indonesia---->http://www.cdc.gov/travel/seasia.htm :
"You might find this helpful. It's an updated edited version of my "Ask RSD" column in the Oct '99 issue of "Rodale's Scuba Diving."
Sand fleas & mosquitoes can be a real bother, not to mention that they are sources of some serious tropical diseases.
The danger & bother of insects can be substantially reduced by these precautions: (1) Wear long sleeves and pants, avoiding dark or bright colors, especially at dawn and dusk. Protective clothing such as the "Buzz Off" brand can be useful. As an extra precaution, you may treat clothing with permethrin (As in the easy to use Sawyer Products http://www.permethrin-repellent.com ) ; (2) Try to stay indoors at dawn and dusk when many flying insects are most active, and avoid sandy areas as much as possible at any time of day, especially when there is no breeze. When making reservations, make sure the resort has screened windows; (3) Wear insect repellent. The best protection against these and other insects is full strength DEET. Some divers like things such as Avon's Skin-So-Soft & Cactus Juice, less toxic products than DEET, by the science is solidly behind DEET for lasting effectiveness. Most DEET containing repellents are the 15-30% range of concentration. The testing of various strengths of DEET has shown that after about 30% little additional effectiveness is to be had by upping the strength, and even less after about 50%. As such, there is simply no point in exposing oneself to more potent brews. UltraThon at 32% http://www.3m.com/us/home_leisure/ultrathon/ appears to be a good product. Used as directed over relatively brief periods of time, say a week, DEET has been shown to pose no significant risk when applied to exposed skin. If you wear lightweight, loose fitting clothes, it generally is safe to use DEET underneath. Doing so with heavy, snug fitting clothes can result in dermatological problems & worse. Be aware that DEET can dissolve synthetics like plastics, rayon & nylon, so it's best to wear natural fibers & keep it off of your gear; (4) Avoid scented toiletries and perfumes; (5) Upon arrival, treat your room with a bug bomb such as Shelltox or Fish (stay outside while this is being done). Touch up with spray after that as needed."
As for malaria, there are reported cases of malaria on Roatan, although to the best of my knowledge not at a high incidence rate. The majority of divers I know who frequent Roatan do not take malaria medication prophylactically if they are not planning to go over to the mainland for touring.
As with many things in scuba & foreign travel, the level of risk one is willing assume is a personal decision. However, malaria is a nasty disease, and the conservative CDC guidelines would be appropriate for those wishing to reduce risks to a very low level. These can be found by clicking here----> CDC Travelers' Health--Health Information for Travelers to Mexico and Central America http://www.cdc.gov/travel/camerica.htm .
If one decides to take an anti-malarial prophylactically, care must be taken in choosing the drug as some may not mix well with scuba, e.g.,----> Concerns About Lariam http://dive.scubadiving.com/talk/re...204092&t=203844 . At present, chloroquine (e.g., Aralen) is largely recommended for the Honduras, and it tends to be tolerated well & to pose little threat to scuba.
If you decide that malaria chemoprophylaxis may be for you, contact your nearest tropical diseases/travel medicine clinic. They'll get you squared away. And, don't wait until the last minute. The following websites may be of assistance in locating such a facility:
International Society of Travel Medicine http://www.istm.org
American Society of Tropical Medicine and Hygiene (ASTMH)
http://www.astmh.org/scripts/clinindex.asp "
This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual, and should not be construed as such.
Helpful?
DocVikingo
beche de mer
Contributor
rgo:
There are various web resources on this topic, but the short answer is, yes, anti-malarials would probably be recommended for this region, and, for practical purposes, the choice is between doxycycline and Malarone.
The combination of Chloroquine and Paludrine does not give adequate protection against falciparum malaria, which is prevalent in this region.
Lariam (mefloquine) has the potential for neuropsychiatric side effects and should not be used while scuba diving.
Malarone is effective and generally free of side of effects, but is somewhat expensive, costing ~ $A12/day in this part of the world. (Which would be ~ US$7/day.)
Doxycycline is effective and has a good side effect profile. Possible adverse effects are a predisposition to sunburn, dyspepsia, gastric irritation and, for females, the possibility of candidal vaginitis. Doxy costs ~ $5 per week.
The preferred anti-malarial for you personally would depend on a number of specific factors including gender, age, drug sensititivies, other medication you might be taking, and what you might have used in the past. It would be advisable to consult a travel physician.
Be aware that no anti-malarial is totally effective. Equally important is judicious avoidance of mosquito bites.
Allison Finch
Contributor
Another concern involves Dengue (spelling?) fever which is really traveling around Indonesia right now. The CDC mentions that Doxy is probably the best antimalarial in that area, for now, due to its reliable help with both of these diseases.
Something to consider.
Something to consider.
Allison Finch:
Very good point! Dengue is a significant problem in Indonesia. But, taking prophylaxis and prevention of getting bit will make the chances of getting one of these not nice diseases very small. Just spend as much time in the water as you can!
Greg
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