Medication Abroad - Malaria etc

Jonny_H

Jonny_H

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Just been to the local travel clinic to discuss vacinations and prescription medications (antibiotics, pain killers etc) to take with us on our travels to Australia commencing next year.

The one area which they seemed vague on was Malaria - we will be going in and out of various Malaria prone areas, but as the tablets are designed to be taken for 4 weeks after leaving an area the chances are we will be in a new area by then and therefore need to continue taking them.

So, question to the panel - what do you do re Malaria tablets - take them all the time, not bother with them, take them when needed?

Thanks

Jonny
 
We don't bother with them although we have been in malaria areas and areas with the dreaded dengue fever.

We do take some precautions though. Cover up and/or mosquito repellant when going out. Spray the boat with mosquito spray regularly. mesh over all hatches.

I think there is a maximum time you can take medication.
 
Yeah - we had the mosquito chat! We've got fly nets for all portlights and hatches and are quite good at using the strong DEET stuff (also have repellant candles for the cockpit when at anchor) - so think we're clear in that respect!

Just wondered about the Malaria stuff? The doctor seemed to suggest some areas would be widly infections (Panama for instance).

That said, he was quite over the top in some other areas (suggested Australia was high risk!) so perhaps just overkill? Maybe we'll take some tablets and just take them in the key places.

The other thing that was said is that there were two types of tablet, one cost around £30 per person per week but had little side effects and only had to be taken for a week after leaving an infected area, the others were £2 per person per week (more our budget), but may cause an aversion to sunlight and need to be taken for 4 weeks after leaving an area.

The second ones don't sound as convenient, but for two of us £60 per week is lots of food / beers!

Jonny
 
We know a number of boats who have spent time in Panama, it's a great cruising area. None of them took malaria tablets but there is a small risk. I think you'll find that those at highest risk are the backpackers who go off into the boonies.

One thing you must have for S Ameica is a yellow fever jab. It's really nasty and if you go to a yellow fever area without a jab and then to country that doesn't have yellow fever you will be refused entry if you don't have the jab on the spot. That's not a good idea because you have no control on cleanliness etc.
 
Thanks for that - the jab list for us before we leave is:

Yellow Fever
Hep B (3 stage dosage!)
Rabies (3 stage dosage again - told we needed this due to "rats in those smelly habours you'll have to visit!)
Tyhpoid booster
Hep A booster

Ouch - feel sore just looking at that lot!!

Jonny
 
I think it very much depends exactly where you are . In Panama there are many areas that are free of mosquito's, but if you enter the country at the eastern border, Obaldia, I would recommend that you take the tablets prior to arrival. particularly if you are going to spend any time ashore walking or in the villages.

We started taking AVLOCAR, the cheaper option, when we left the ABC's heading for Colombia.We have continued taking them as we cruised Colombia, Panama,Costa Rica and through Honduras to Guatemala where we are currently.

Despite taking these medications I caught Dengue fever when we were in the Bay Islands, Honduras. There have been 3 notified cases of malaria on the Rio Dulce Guatemala in the last year.

We met a handful of cruisers in Panama who had caught malaria.

We have suffered no side effects by the medication and have been told by our medical advisers that we can safely take AVLOCLOR for up to three years continuously.

We also shut our companionway between dusk and dawn, have netting fitted on all hatches, spray both the boat and ourselves.

What I would maybe recommend is carrying the treatment drug, sorry can't remember the name, just in case of infection.

My understanding is that there are some serious dengue problems on some of the Pacific Islands but you probably need to check with the World Health Organization who will give you the latest info.
 
Thanks - we were warned about Dengue - apparently there is no treatment for it? As I understand it this is a mosquito carried infection (is that correct?).

We are getting a list of medication together to get prescriptions for - think malaria treatment may be one of them!

Jonny
 
I travel extensively in Africa, I never have nor will I take anti malaria drugs, they are not good for ones body, if taken a lot. I used to carry Halfran, which is not a preventative, but a treatment for malairia which is very effective. Have had malaria twice and it stops it dead. Talk to a medic.
 
There are three main kinds of malaria tablet, Chloroquine, Lariuim (Mefloquine) and Malarone. They are suitable for different parts of the world, and are available at different costs. You need to discuss with your doctor what would be suitable for the different areas you will visit.

Lariuim, which it sounds like you have been prescribed, is perhaps the cheapest and most widely effective, but everyone I know who has taken it (including myself) has suffered depression after several doses. The day after taking it is particularly bad, so if there will be more than one in your crew, take it on different days. You will not want to take for longer than strictly necessary. This is why many people say they will never use anti-malarials again.

Get your tablets before you go. Fake medications for malaria are common in third-world countries.

The coastal areas of many affected countries, such as Brazil, are malaria free, so those who do not take medication are reasonably safe as long as they dont venture inland.

None of the medications is 100% effective, so always use backup measures such as mosquito nets and Deet.
 
neither in Panama Canal area or the Pacific Islands/Australia did I meet any cruising boats with the crew taking anti malaria tablets... The side effects are dreadful. Much more sensible to use mosquito nets etc... I also never met or heard of anybody contracting it on the circumnavigation route...
Dengue fever is much more common and several boats I know had crew coming down with it... a 6 year old girl and a middle aged man... Normally it is not a killer but does require hospital treatment for re-hydration... Except perhaps Indonesia you will mainly not be that far from an air lift to a hospital...
Far more dangerous are impact injuries and wounds - sutures and local anesthetics are vital... inflatable splints & a catheter... Have a look at the medical page of my web site and consider buying the Ships Captains Medical book....
Michael
 
[ QUOTE ]
Have a look at the medical page of my web site and consider buying the Ships Captains Medical book....
Michael

[/ QUOTE ]

or you can download it for free from here




/forums/images/graemlins/smirk.gif
 
Go with that list, we didn't have Rabies jabs though.

Also we had: polio; tetanus (a definite must); and Diptheria. Can't remember how many of those were boosters.

Also keep an eye on what's going on, in illness terms, wherever you are. For example, while we were in Venezuela we had jabs for a new form of polio that had broken out in Caracas. If you tried to leave Venezuela by air (to fly home say for a visit) without it they jabbed you at the airport.
 
We have Tetanus, Polio, Diptheria, Hep A and Meningitus all up to date already (thankfully!)

The rabies get done at the same time as Hep B (so might as well go all out!).

Doctor said www.fco.gov.uk was essential to check regularly for all the latest issues (also if they say not to travel somewhere and you do your health insurance is likely to be void).

That brings me nicely onto the next query ... health insurance. I've always had it through work before now - what do other people have?

Jonny
 
We lived in Bombay for a couple of years and over that time had several visitors from the UK. Many felt ill almost as soon as they arrived and our advice was to stop taking the maleria tablets and they all became instantly better. Not sure what's in them but they certainly upset a lot of people. We and almost all the couple of hundred expats in Bombay never took pills but sprayed up well in the evenings. The choice is yours and we were in a city and not in the environment that you will find yourself in
 
We had company policies with AXA PPP (volume discount). They were happy to transfer them to personal policies at the same price. We have claimed once for major surgery in Venezuela, no problems except an argument about exchange rates (they backed down after admitting they had 'misled' us).
 
Yes thats correct, dengue is carried by mozzies. Anti- malarial is of no use and there is no treatment. Its bloody painful!
What it did confirm though is that the mozzies we encountered were carrying something!
AVLOCLOR is a chloroquine based drug. Other posters are correct in you need different kinds of drug for different areas of the world.

I agree that there is a low chance certainly here in Central America of contracting the illness but on the other hand we have met a number of people who have been 'unlucky'!
 
"Peacefull Sleep"to spray and "Klippies"for the buzzing /forums/images/graemlins/grin.gif

Cheers Joe
 
I live in Africa and work on protozoal diseases. There is some really dangerous advice above. Do take malaria very seriously, it can kill within 24hrs and the thought of the whole crew going down mid ocean is pretty unpleasant. It is not uncommon for several members of the same family to get symptoms within hours of each other, presumably because the same infected mozzy visited them all as they slept about 10 days before.

Lots of rufty tufty people say they won't take antimalarials. But lots of tourists die of malaria. You rarely hear about it but I can assure you that every year dozens of tourists are shipped home in extremis and several die. Bear in mind that locals and long term residents have invariably acquired a modicum of immunity (or died!) so their advice is not appropriate. As a totally naive visitor you are extremely vulnerable.

If you quickly go to a medic in the area where you were bitten, you will be probably be OK. The worst thing is to show 1st symptoms in UK (or presumably other non malarial areas). There the medics will not treat you until they see parasites and a naive person will be very very sick by the time that happens.

As has been said, the no 1 priority is to avoid being bitten. Just half a mile offshore is probably enough to be perfectly safe. Until recently I would then have said that a short term visitor absolutely should take prophylactic anti malarials. This is especially true of a sailor who might get sick mid ocean.

However, the new artemesin drugs have changed the picture. They are very cheap, very safe and very effective if taken immediately you show any signs that might possibly be malaria. Carry them with you, and don't mess about. If in doubt treat yourself. Also bear in mind that your 1st bout of malaria will rarely show the textbook symptoms, it can look like flu or even a bout of squits. A few hours later, you will be in no doubt!

There are not (yet) any reports of artemesin resistant parasites; but it will happen and WHO et al are understandably worried about the indiscriminate and inconsistent use of this drug. So I am not sure about its availability in UK, speak to a Dr. If you do use it, as with antibiotics, please complete the full curative course. Otherwise you are contributing to the emergence of resistance.

As for Dengue fever, yes it is mosquito borne and yes it is extremely unpleasant. But it is not likely to kill an otherwise healthy person (the first time) and there is nothing you do about it except avoid being bitten and avoid areas with big Dengue outbreaks.
 
Doxy 100 (Doxycycline) is the recommended preventative for malaria in Asia. NO malaria in Australia. We have been around asia for 4 years, took Doxy 100 for the first 6 months only. Don't know of any other cruisers who have malaria.
 
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