malaria protection - indonesia
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jake11
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We have been there 3x and have not taken malaria protection and have had no problems. If you are going to be on a LOB then you should be fine without it. If you are doing land based then that might be a different story. Malorone is usually the drug prescribed for that area! Have a great time! You will love it there!
buiszie
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Take malaria pills, thats my advise....
ocdiver1
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I always take doxyclene for malaria areas..been to West Papua a couple of times..can't remember if I took anything there, but if I did it would have been doxyclene. Doctors here always think I'm crazy when I ask for it malaria, but it's prescribed as an anti-malarial in other countries which is how I found out about it. I like it because it's cheap (generic) and it's a pill you can take daily with limited side effects. Double check with your doctor, but I've taken it many times with no problems.
Shasta_man
Contributor
Malarone. The disease far exceeds any side effects.
Luko
Contributor
I am surprized the physicians at your place do not consider Doxycycline being part of their antimalarial toolbox. In Europe it is one of the two most frequent prescriptions with Malarone (Lariam is less prescribed due to heavy side effects).
The question I have is that DoxyC was supposed to enhance photosensitivity and to carry skin reaction under sun light (something which is hard to avoid spending a week on the equator), have you experienced any of these issues or do you den to the darkest corner of the hold as soon as you're back on the boat?
thanks for all the advice - we are staying on an island so I think it would be safer to take something. I was wondering about the photosensitivity issues with doxycycline - don't really want to sit under a tree all the time. Luka, is it easy to get in France from a medicin traitant?
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Hi belette,
Rather skimpy info thus far. Hopefully you'll find this more appropriate and useful.
Best advice is to get advice from an expert in travel medicine. To set it up, go the International Society of Travel Medicine (ISTM) website (ISTM - Home Page) and enter the Travel Clinic Directory at the top of the menu on the left hand side of the page. Or the International Association for Medical Assistance to Travellers (IAMAT)(IAMAT - Medical Directory of Licensed Doctors Abroad).
First order of business in preventing malaria (and dengue fever, yellow fever, etc.) is to avoid getting bitten by an infected mosquito. This updated and edited version of my "Ask RSD" article on the topic appeared in Rodale's Scuba Diving:
"The danger and 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 (Search Results) 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 (although the mosquito that transmits dengue is most active during the daytime), 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 arguably is full strength DEET. Some divers like things such as Avon's Skin-So-Soft and Cactus Juice, less toxic products than DEET, by the science is solidly behind DEET for long-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% (Scientific Anglers) 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 and worse. Be aware that DEET can dissolve synthetics like plastics, rayon and nylon, so it's best to wear natural fibers and keep it off of your gear.
Relatively recently, picaridin-based repellants have been found to be quite effective and much less irritating to the skin and malodorous than DEET. The line of Cutter's Advanced products is an example (Cutter).
However, based on the published scientific research some of these products contain questionably small amounts of picaridin, e.g., Cutter Advanced Picaridin Repel at 7%, Cutter Advanced Wipes at 5.75%. It is therefore recommended that a product like Cutter Advanced Aerosol with 15% picaridin be used. Some repellants available in foreign venues contain even higher concentrations of the chemical.
(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 regards chemoprophylaxis for malaria, Malarone (atovaquone/proguanil) (Malarone Information from Drugs.com) is likely the best choice if your travel clinic recommends it.
BTW, Lariam (mefloquine) is an effective and often prescribed antimalarial, but it can pose problems, especially for the diver. The following updated article from my "Ask RSD" article on the topic in Rodale's Scuba Diving may prove informative:
"Lariam (mefloquine) is a very effective drug in preventing and treating malaria, but can give rise to unwanted side effects, including vivid and disquieting dreams, hallucinations, anxiety, depression, confusion and forgetfulness.
The US package insert directs 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 simply 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. Similar advice regarding scuba diving is provided by Dr Bridget Farham, B.Sc (hons), Ph.D, MB.ChB., an expert on tropical medicines, and appears in the package insert accompanying mefloquine dispensed in South Africa.
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.
The FDA has come out with the following warning regarding mefloquine:
http://www.fda.gov/bbs/topics/NEWS/2003/NEW00921.html
and
The following is very thorough--The Journal of the American Medical Association (Vol. 297 No. 20, May 23/30, 2007) (This Week in JAMA, May 23/30, 2007, 297 (20): 2167) scroll down to the section on Lariam)
Helpful?
Regards,
DocVikingo
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.
Rather skimpy info thus far. Hopefully you'll find this more appropriate and useful.
Best advice is to get advice from an expert in travel medicine. To set it up, go the International Society of Travel Medicine (ISTM) website (ISTM - Home Page) and enter the Travel Clinic Directory at the top of the menu on the left hand side of the page. Or the International Association for Medical Assistance to Travellers (IAMAT)(IAMAT - Medical Directory of Licensed Doctors Abroad).
First order of business in preventing malaria (and dengue fever, yellow fever, etc.) is to avoid getting bitten by an infected mosquito. This updated and edited version of my "Ask RSD" article on the topic appeared in Rodale's Scuba Diving:
"The danger and 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 (Search Results) 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 (although the mosquito that transmits dengue is most active during the daytime), 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 arguably is full strength DEET. Some divers like things such as Avon's Skin-So-Soft and Cactus Juice, less toxic products than DEET, by the science is solidly behind DEET for long-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% (Scientific Anglers) 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 and worse. Be aware that DEET can dissolve synthetics like plastics, rayon and nylon, so it's best to wear natural fibers and keep it off of your gear.
Relatively recently, picaridin-based repellants have been found to be quite effective and much less irritating to the skin and malodorous than DEET. The line of Cutter's Advanced products is an example (Cutter).
However, based on the published scientific research some of these products contain questionably small amounts of picaridin, e.g., Cutter Advanced Picaridin Repel at 7%, Cutter Advanced Wipes at 5.75%. It is therefore recommended that a product like Cutter Advanced Aerosol with 15% picaridin be used. Some repellants available in foreign venues contain even higher concentrations of the chemical.
(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 regards chemoprophylaxis for malaria, Malarone (atovaquone/proguanil) (Malarone Information from Drugs.com) is likely the best choice if your travel clinic recommends it.
BTW, Lariam (mefloquine) is an effective and often prescribed antimalarial, but it can pose problems, especially for the diver. The following updated article from my "Ask RSD" article on the topic in Rodale's Scuba Diving may prove informative:
"Lariam (mefloquine) is a very effective drug in preventing and treating malaria, but can give rise to unwanted side effects, including vivid and disquieting dreams, hallucinations, anxiety, depression, confusion and forgetfulness.
The US package insert directs 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 simply 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. Similar advice regarding scuba diving is provided by Dr Bridget Farham, B.Sc (hons), Ph.D, MB.ChB., an expert on tropical medicines, and appears in the package insert accompanying mefloquine dispensed in South Africa.
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.
The FDA has come out with the following warning regarding mefloquine:
http://www.fda.gov/bbs/topics/NEWS/2003/NEW00921.html
and
The following is very thorough--The Journal of the American Medical Association (Vol. 297 No. 20, May 23/30, 2007) (This Week in JAMA, May 23/30, 2007, 297 (20): 2167) scroll down to the section on Lariam)
Helpful?
Regards,
DocVikingo
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.
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