Malaria Prevention

[Keith1010]

My wife and I will be visiting two ports of India for a World Cruise; Mumbai (Bombay) and Cochin, Inida. We will go on local excursions but will not travel to other places in India. We have been receiving conflicting opinions as to whether or not we should take any pills just prior to reaching these ports for Malaria prevention. Any thoughts on this would be appreciated.

 

Earlier this year we went on a world cruise so we did see a medical professional specializing in travel and the vaccinations that we received will also address our upcoming trip. But, India was not part of the itinerary earlier this year so would appreciate any advice from those who have traveled to these locations in India.

 

I do have a copy of the CDC Book and have also used their web site but this one is confusing. If need be we will go see the health travel professional again for clarification.

 

Keith

[Spikesgirl]

Usually the cruise line will advise you as to what sort of precautions you need. We went to our doctor and asked his opinion. Since he travels in the Orient frequently, he was up on all the requirements for the regions.

 

We've had friend who have done India on land tours and used DEET (mosquito spray). They didn't have any problems, but I would urge you to check with the cruise line, your TA or/and your doctor to see what they advise.

 

Charlie

[gr8lakes]

We just finished our visit to our travel medicine clinic for our vaccines and also malarone for Cambodia for our cruise to SE Asia.

 

Here is a website with excellent information:

www.travmed.com

 

 

Click on the area of the world you want to visit and then the individual country.

 

For India, here is what it says about malaria:

 

Current Advisories & Health Risks

 

"

Malaria: The risk of malaria is present countrywide year-round, excluding high altitude areas (above 2,000 meters elevation) of the states of Himachal Pradesh, Jammu and Kashmir, and Sikkim. Malaria risk occurs year-round in the tropical cities of Mumbai (Bombay), Calcutta, and Madras. Malaria risk in the more temperate Delhi is seasonal, with the major risk being from July to November, peaking in September. The incidence of malaria has increased recently in Delhi, Tamil Nadu State, and Haryana State. The most intense malaria transmission in India occurs in the eastern and northeastern states. • Prophylaxis with atovaquone/proguanil (Malarone), mefloquine (Lariam), doxycycline, or primaquine is recommended.

• All travelers should take measures to prevent evening and nighttime mosquito bites. Insect-bite prevention measures include a DEET-containing repellent applied to exposed skin, insecticide (permethrin) spray applied to clothing and gear, and use of a permthrin-treated bednet at night while sleeping."

 

You can check out any vaccines, medications or precautions needed by country, and also get info on the Health Care available in the area, should it be needed.

Of course, I'd always consult with my doctor before doing anything.

Have a great trip.

[SarasMommy]

We took malaria pills when we cruised to Africa, and here's how it worked:

 

Take first pill 1 week before departure.

 

Then take 1 pill a week for the duration of the trip.

 

Then continue taking 1 pill a week for three weeks after arriving home.

 

We took 8 pills in total, over an 8-week period. Make sure to take the pills on the same day of the week.

[greatam]

We just finished our visit to our travel medicine clinic for our vaccines and also malarone for Cambodia for our cruise to SE Asia.

 

 

As a frequent Cambodia business traveler, UNLESS you plan on spending a LOT of time in the jungle, malaria prevention is probably not needed in Cambodia. Around Siem Reap, they spray for mosquitos, the hotels are well prepared to deal with mosquitos and a good strong DEET spray will ward off any that might be missed.

 

I have never taken malaria precautions and have taken 7 trips to Cambodia since October 2005. And I have taken 4 trips up the Mekong/Tonle Sap rivers from Saigon/Chau Doc to Phnom Phen where the bugs are thick. DEET for me.

[gr8lakes]

Thanks for the info on Cambodia. We're not going on the cruise ship, we're going on a separate trip. Based on where we're going, we've consulted our doctor and decided to take malarone.

By the way, the dosage of the malaria medication varies with which one you take. Malarone is taken one a day for 2 days before, one each day during your visit and 7 days after. Different medicines have different dosages. Best to check with your doctor.

[Keith1010]

Usually the cruise line will advise you as to what sort of precautions you need. We went to our doctor and asked his opinion. Since he travels in the Orient frequently, he was up on all the requirements for the regions.

 

We've had friend who have done India on land tours and used DEET (mosquito spray). They didn't have any problems, but I would urge you to check with the cruise line, your TA or/and your doctor to see what they advise.

 

Charlie

 

Charlie, the cruise line will only advise on anything that is required. And nothing is required this year. Last year we were required to get a yellow fever vaccination. Our TA is not up on this. We know we can go back to the travel medical folks we used last year but I just wanted to see if I could get feedback from those who have been to India on a cruise.

 

Keith

[Keith1010]

Folks, this seems to happen whenever I ask for input about prevention/vaccination but I figured I'd give it the college try.

 

I am not interested in Africa or Cambodia as I just need to know about India. The advice about the insect repellent is great and I've already purchased that.

 

What I need advice on is from folks, if there are any out there, who cruised to India and what they were advised either by their doctor or by the shipboard doctor.

 

I do appreciate all of the comments but I really am looking for input on these two ports in India.

 

gr8Lakes thanks for the web site. I have read similar information on the CDC web site and sarasMommy thanks for your input on the Malaria pills. What I'm trying to figure out is if we need the pills in the first place.

 

Keith

[Keith1010]

We just finished our visit to our travel medicine clinic for our vaccines and also malarone for Cambodia for our cruise to SE Asia.

 

Here is a website with excellent information:

www.travmed.com

 

 

 

I just went to this web site and wanted to let you know that I think it is a great web site for general information on each country. Thank you very much for sharing it and I will be sure to bookmark it for future reference.

 

Keith

[AdventureSeeker]

Hi Keith...I'm a fellow traveler, and also happen to be an epidemiologist. It looks like you found the information you were looking for, but I'll sum up the precautions to take for anyone else traveling to India or Southeast Asia.

 

If you are traveling to an area where malaria is even a slight risk, you should take it seriously. If not treated promptly, certain species of malaria parasites may also cause kidney failure, seizures, mental confusion, coma and death.

 

For most people, symptoms begin 10 days to 4 weeks after being bitten by a malaria-infected mosquito.

Malaria often produces flu-like symptoms including:

• fever
  
• shaking chills
  
• headache
  
• muscle aches
  
• tiredness
  
• Travelers may also experience nausea, vomiting, diarrhea, anemia and jaundice.

Malaria prophylaxis:

Doxycycline or Atovaquone/proguanil is recommended in places where there is resistance to chloroquinine. (Malarone is the brand name for atovaquone/proguanil) Your physician can prescribe this for you...the dosing schedule usually begins one week before you leave and continues for several weeks after you come home.

(If you are of Mediterranean descent, ask your doctor to give you a day's worth of doxycycline to try ahead of time...in some people it can cause a reaction where your red blood cells lyses...not fatal, but can make you feel very tired and ill)

 

Also, treat your clothes with permitrin, wear a deet repellent with at least 50% deet, and sleep under a permetrin net if not staying in a air-conditioned, mosquito-free room. These steps are crucial, even if you are taking malaria medication, because some travelers will develop malaria even with prophylaxis. Plus, in areas where malaria is a problem, dengue is also likely to be a risk...so preventing mosquito bites is extra important.

 

Btw, Keith, you mentioned you received your vaccinations before knowing that India was part of the trip. I'd assume that means you received both the Hep A and B shot...but you should also make sure you received the typhoid vaccine.

 

Have a great trip!

-Gisselle

[Keith1010]

Hi Keith...I'm a fellow traveler, and also happen to be an epidemiologist. It looks like you found the information you were looking for, but I'll sum up the precautions to take for anyone else traveling to India or Southeast Asia.

 

If you are traveling to an area where malaria is even a slight risk, you should take it seriously. If not treated promptly, certain species of malaria parasites may also cause kidney failure, seizures, mental confusion, coma and death.

 

For most people, symptoms begin 10 days to 4 weeks after being bitten by a malaria-infected mosquito.

Malaria often produces flu-like symptoms including:

• fever
  
• shaking chills
  
• headache
  
• muscle aches
  
• tiredness
  
• Travelers may also experience nausea, vomiting, diarrhea, anemia and jaundice.

Malaria prophylaxis:

Doxycycline or Atovaquone/proguanil is recommended in places where there is resistance to chloroquinine. (Malarone is the brand name for atovaquone/proguanil) Your physician can prescribe this for you...the dosing schedule usually begins one week before you leave and continues for several weeks after you come home.

(If you are of Mediterranean descent, ask your doctor to give you a day's worth of doxycycline to try ahead of time...in some people it can cause a reaction where your red blood cells lyses...not fatal, but can make you feel very tired and ill)

 

Also, treat your clothes with permitrin, wear a deet repellent with at least 50% deet, and sleep under a permetrin net if not staying in a air-conditioned, mosquito-free room. These steps are crucial, even if you are taking malaria medication, because some travelers will develop malaria even with prophylaxis. Plus, in areas where malaria is a problem, dengue is also likely to be a risk...so preventing mosquito bites is extra important.

 

Btw, Keith, you mentioned you received your vaccinations before knowing that India was part of the trip. I'd assume that means you received both the Hep A and B shot...but you should also make sure you received the typhoid vaccine.

 

Have a great trip!

-Gisselle

 

Gisselle, thank you very much for the excellent and thorough input. It is greatly appreciated.

 

Yes, we did recieve the Typhoid Vaccine (we chose the tablets since they last longer) for the World Cruise we did earlier this year so we are already covered for this years travel.

 

Thanks again for all of your input on this.

 

Keith

[broberts]

If there is a risk of exposure to Malaria carrying mosquitoes I would suggest that you take appropriate preventative medication.

 

You'll have to discuss which medication is most appropriate with a qualified doctor. If your family physician has little experience in this area you might want to ask for a referral to someone who does have current experience in tropical medicine.

 

There are a number of different medications for Malaria prevention. To the best of my knowledge they all involve taking doses before, during and well after the exposure period. It is important to carefully follow the prescribed dosing to gain the maximum amount of protection.

 

I suffered this disease several times while growing up, despite using available medication at the time. It is most definitely not a pleasant experience. Further, it is possible for the disease to re-occur well after the initial episode and without re-exposure.

 

I'll second AdventureSeekers recommendation. Seek qualified medical advice on getting a Typhoid vaccination. You might also want to check with your doctor regarding the currency of your Tetanus vaccination.

[Keith1010]

If there is a risk of exposure to Malaria carrying mosquitoes I would suggest that you take appropriate preventative medication.

 

You'll have to discuss which medication is most appropriate with a qualified doctor. If your family physician has little experience in this area you might want to ask for a referral to someone who does have current experience in tropical medicine.

 

There are a number of different medications for Malaria prevention. To the best of my knowledge they all involve taking doses before, during and well after the exposure period. It is important to carefully follow the prescribed dosing to gain the maximum amount of protection.

 

I suffered this disease several times while growing up, despite using available medication at the time. It is most definitely not a pleasant experience. Further, it is possible for the disease to re-occur well after the initial episode and without re-exposure.

 

I'll second AdventureSeekers recommendation. Seek qualified medical advice on getting a Typhoid vaccination. You might also want to check with your doctor regarding the currency of your Tetanus vaccination.

 

We did meet with a travel medical expert when we went on a World Criuse earier this year and, yes, we have already gotten our typhoid vaccination (tablets) and our hepatitis shots, and we also verified that our tetanus vaccinations are up to date. The only issue for our upcoming cruise is to verify the Malaria. I was trying to avoid the need to go back to the Travel Medical Doctor if I could if I could get input from those who have visited these two ports. Worst case we will go back to seek the guidance of the medical experts.

 

Keith

[A J Theodore]

Keith--

Please check with your travel medical professional. Your need for malaria medication and the associated risks will depend on a number of factors, not just the locations to which you are travelling and the likelihood of exposure, but also your age, general health, prior health history, etc. Giselle's cautions should be taken very seriously; malaria is a very serious matter.

That being said, one of the easy courses of treatment/prevention involves taking doxycycline (or another antibiotic) starting several days before first arriving at a port with mailarial possibilities and continuing for (I believe) forty days after that, if this is a course of treatment that you can medically tolerate. While slightly inconvenient, this certainly beats treatment of malaria itself. But, as the cliche says, "an ounce of prevention . . . ."

While you are at it, please also ask about other conditions and whether you need any kind of medication or vaccine - I am thinking now particularly of Hepatitis C and Yellow Fever.

[AdventureSeeker]

Although Doxycycline is cheaper, Malarone is more convenient because you start the treatment 2 days before heading to your destination, and only have to continue it for one week after returning. It is also a once a day dose. (You can't take Malorone if you have any kidney disease)

 

For treatment to be effective, you need to follow the dosing regimen exactly as prescribed. You can't just take the meds for a few days. Keith, as there is definitely some risk in Mumbai...you will need take malaria prophylaxis during your entire trip.

 

-Gisselle

[Keith1010]

I did get with my physician and he has prescribed us Malorone.

 

We have gotten all of the other vaccinations that have also been recommended for the other areas we will be visiting during this trip.

 

Thanks to everyone for their input.

 

Keith