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by mortsgah on Mon Nov 11, 2019 4:33 pm
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I have a trip to the Okavango Delta in Botswana planned for March 2020. I'll be in country about 10 days traveling both on land and by boat. As I make plans for the trip, I am torn on the whole chemoprophylaxis for malaria topic. I suspect some of you out there might have thoughts/opinions on the "take malarone versus follow practical preventative measures" discussion. Currently the CDC recommends Malarone if traveling in that part of Botswana. But I have heard stories of very unpleasant side effects from taking the drug. I can't find any statistics on the actual chances for contracting the disease due to the lack of numbers being reported. I will of course be speaking with my physician and perhaps a travel medicine doc, but thought I would see what experiences any of you might have so I can be somewhat prepared for that discussion.
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by Anthony Medici on Mon Nov 11, 2019 4:53 pm
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Malarone isn't nearly as bad as Larium which is taken once a week rather than once a day. I've heard many interesting stories about people on Larium. I've really not heard of any on Malarone. If using Malarone, I'd recommend taking it in the morning while there rather than in the evening.
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by savagetom on Mon Nov 11, 2019 5:10 pm
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My wife and I have been to Tanzania 4 times and Tanzania 4 times and took Malarone every time with zero adverse effects.  I have a friend that has been to Africa something like 30 times and took Malarone every time with no adverse effects.
 

by PullmanPhotographer on Mon Nov 11, 2019 10:02 pm
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I spent almost two weeks in Tanzania and took Malarone before, during, and after the trip with no noticeable side effects. The 3 other choices I had were to chance it, take the stuff that causes one to hallucinate, or the antibiotic that causes sun sensitivity. I'm happy with my choice.
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by photoman4343 on Tue Nov 12, 2019 10:40 am
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My wife and I took malarone when we were in Tanzania with no side effects. When we were in Botswana and the Okavanga Delta, we do not think we took any anti-malaria drug.
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by mortsgah on Tue Nov 12, 2019 2:03 pm
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Upon a bit deeper dive in to the subject, it looks like the Okavango Delta area is considered both a "high risk" and a "low risk" area for malaria especially during the wet season. It seems to depend on whose data you choose to look at. The CDC calls it simply a risk area (neither high or low). Since I will be going at the end of the wet season, I guess it makes most sense to take Malarone as prophylaxis. Or as my doc said "if you get malaria, you will have to take a higher dose of Malarone than you will as a preventative". :-)

Appreciate you all sharing the experiences you have had with the drug.
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by keithkennedy on Tue Nov 12, 2019 4:55 pm
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About 5 years ago on a trip to Tanzania, I had a very significant side effect from taking Malarone. Within 3 days of taking a daily dose of Malarone, I developed a severve case of mouth sores. At first I did not realize that this is one of the possible side effects of this drug. The condition became so bad, even water burned my throat. After ruling out food and other consumables, I re-read the Malarone label and noted that a small percentage of people (<10%) reported mouth sores. I stopped taking the medication and within 48 hours, I was almost back to normal.  On subsequent trips to malaria areas (including Botswana), I have not taken antimalarial drugs but rather relied on personal repellents and repellent clothing (Insect Shield) as my main strategy. I have found that the mosquito populations in many of the wildlife areas are not that significant vs. populations in some of the urban/suburban areas. For example, during a two week Tanzania trip, the first time I endured a mosquito bite was at the end of the trip in the Kilimanjaro airport waiting in line to check in for the flight home. I also spent two weeks in Botswana/Okavango and was not bitten once. So it is possible to avoid malaria without relying on antimalaria drugs that can have signicant negative side effects.

If you do take a repellent, do not rely on one of the 'organic' products that utilize a cocktail of essential oils such as geraniol, citronella, etc--these simply do not provide protection. Deet still works well and repellents containing picaridin are especially good against some of the main malarial vectors. Moreover, pircaridan is not a plasticiser--i.e. it will not damage your polycarbonate camera body. BTW, I am a retired entomologist and have spent quite a few years testing personal and space repellents in the lab and in the field.
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by mortsgah on Tue Nov 12, 2019 7:48 pm
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keithkennedy wrote:About 5 years ago on a trip to Tanzania, I had a very significant side effect from taking Malarone. Within 3 days of taking a daily dose of Malarone, I developed a severve case of mouth sores. At first I did not realize that this is one of the possible side effects of this drug. The condition became so bad, even water burned my throat. After ruling out food and other consumables, I re-read the Malarone label and noted that a small percentage of people (<10%) reported mouth sores. I stopped taking the medication and within 48 hours, I was almost back to normal.  On subsequent trips to malaria areas (including Botswana), I have not taken antimalarial drugs but rather relied on personal repellents and repellent clothing (Insect Shield) as my main strategy. I have found that the mosquito populations in many of the wildlife areas are not that significant vs. populations in some of the urban/suburban areas. For example, during a two week Tanzania trip, the first time I endured a mosquito bite was at the end of the trip in the Kilimanjaro airport waiting in line to check in for the flight home. I also spent two weeks in Botswana/Okavango and was not bitten once. So it is possible to avoid malaria without relying on antimalaria drugs that can have signicant negative side effects.

If you do take a repellent, do not rely on one of the 'organic' products that utilize a cocktail of essential oils such as geraniol, citronella, etc--these simply do not provide protection. Deet still works well and repellents containing picaridin are especially good against some of the main malarial vectors. Moreover, pircaridan is not a plasticiser--i.e. it will not damage your polycarbonate camera body. BTW, I am a retired entomologist and have spent quite a few years testing personal and space repellents in the lab and in the field.
Keith, this is one of the reasons I have been hesitant about taking it. My challenge is finding published data on the frequency of the drugs side effects. My next step would be to go through the FDA website's clinical trial database and see if I can obtain the adverse events reported during the clinical trial or in subsequent post market reports. That will take some effort on my part.

As a photographer, I learned some time ago the hazards of using DEET and have switched over to Picardian. I am also fortunate to not be one of those that attracts mosquitoes in high numbers. I still attract them, but not like some folks I have been in the field with. So glad to NOT be one of them! Good to have some validation from an entomologist on my 'N' of one trial on the effectiveness of Picardian.
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by SantaFeJoe on Tue Nov 12, 2019 9:37 pm
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If you simply google “side effects of Malarone”, you can get a general idea, e.g.:

https://www.drugs.com/cdi/malarone.html

https://www.drugs.com/sfx/malarone-side-effects.html

https://www.rxlist.com/malarone-side-ef ... center.htm

https://www.webmd.com/drugs/2/drug-1979 ... al/details

https://www.webmd.com/drugs/2/drug-1979 ... ideeffects

https://www.mayoclinic.org/drugs-supple ... g-20061484

https://www.medicines.org.uk/emc/product/947/pil

The last link has some of the numbers regarding chances of having certain side effects.

Joe
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by E.J. Peiker on Wed Nov 13, 2019 7:59 am
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When I take Malarone I just don't feel myself - it's almost like I'm an other person - a bit out of body. I don't like it but it's tolerable. Larium should not be taken, period! It's potential side effects are pretty severe in some people and can ruin your whole trip. My personal practice, note this is my PERSONAL practice and a risk I am willing to take, I am not prescribing this on anyone, is to not take anything but have Malarone on standby. Malarone is what is used to treat malaria so I don't take it unless I received a mosquito bite. I opt for good protection. Long sleeves and pants and everything that is exposed to the outside (socks, pants, shirt, hat) is treated with Permethrin. Any bare skin is treated with Picaridin. I do not use DEET, ever!
 

by mortsgah on Wed Nov 13, 2019 11:11 am
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E.J. Peiker wrote:When I take Malarone I just don't feel myself - it's almost like I'm an other person - a bit out of body.  I don't like it but it's tolerable.  Larium should not be taken, period!  It's potential side effects are pretty severe in some people and can ruin your whole trip.  My personal practice, note this is my PERSONAL practice and a risk I am willing to take, I am not prescribing this on anyone, is to not take anything but have Malarone on standby.  Malarone is what is used to treat malaria so I don't take it unless I received a mosquito bite.  I opt for good protection.  Long sleeves and pants and everything that is exposed to the outside (socks, pants, shirt, hat) is treated with Permethrin.  Any bare skin is treated with Picaridin.  I do not use DEET, ever!

E.J., This is along the lines of where my investigation is taking me as well. Its all about risk mitigation, but being prepared.
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by MikeBinOK on Wed Nov 13, 2019 9:19 pm
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Sounds like you’re headed for a decision, but for another data point I’ve taken Malarone on several trips with no negative effects at all. Of course I even took Lariam back in the 90s and had no trouble. But based on reports from people I know and trust, I think there’s no doubt that both Malarone and Lariam do have adverse effects on some people.
Mike B. in OKlahoma
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Last edited by MikeBinOK on Wed Nov 13, 2019 10:38 pm, edited 1 time in total.
 

by ChrisRoss on Wed Nov 13, 2019 9:24 pm
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I took Malarone when I went to Indonesia recently, stopped after a few days as the side effects were not tolerable. I think the response is very individual and if you take it for the first time while travelling could well spoil at least part of your vacation till you work out hat is happening. We spoke to others at the dive resort and they all said no way would they use Malarone. Out of body experiences while diving are nt a good thing! You can go ahead and get a prescription for Malarone as it is also suitable for treatment if by some chance you contract malaria, Make no mistake - malaria is a nasty disease, but chances of contracting it can be greatly reducedy other means.

Regarding mosquitos in the Okavango, we went there in May 20 years ago and my experience was the mosquitos were only active for quite a short time around sunset as the nights were very cold. We used no anti malarial drugs and used mosito repellant and long sleeves/pants once the sun started to go down. Picardin is good as is the repellant based on oil of lemon eucalytpus - you need to get the right formulation for that not just eucalyptus oil I beieve the actual active changes when it is steam distilled or something like that.
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by P.W.Post on Wed Nov 13, 2019 10:13 pm
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On a general note, if you have any questions of this type that you can't find the answers to, you can try calling the CDC directly. Back in 1984, before going to India and Nepal, it was recommended that I get a shot of gamma globulin as a preventative for hepatitis. I was concerned that being a blood product it could give me AIDS. I called the CDC and left a message. Their expert on vaccines actually called me back. I was told as long as I got the shot in the US or Canada, where it was treated with glycol to kill any viruses, it was safe. Whatever I did I shouldn't get it anywhere else.

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by Primus on Fri Nov 15, 2019 10:22 am
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Any medication can have serious side effects as people have already said. My experience may not mirror yours and so on. 

All I can say is that I cannot take any of these meds due to potential interaction with some other meds I have to be on. So I never take them. In the past 35 yrs have traveled to India numerous times, have also traveled to Africa, including Botswana (Chobe river) and the Delta. 

In all my trips to India I have never worn any protective clothing or used sprays, since we spend very little time outdoors after dark. Most mosquitos are indoor pests and every home has a variety of repellants already in place. 

My wife often accompanies me and she always takes mefloquine. This works well for her and has not caused any problems. Only thing is you have to start a week before your trip and continue for four weeks afterwards, however, since it is only one tablet a week it is not too big a deal. Mefloquine is also one of the recommended drugs for Botswana. 

My own strategy (for Africa or in a malaria zone where I am likely to be outdoors a lot) is to wear protective clothing - anything that is not pre-treated (insect shield) I spray with permethrin a week before leaving. Also use wipes or sprays in the field on my head and hands in the evenings and early mornings.

There is no one size fits all. You have to pick what you think you will be able to do and most importantly see it through. If you find something that works without any significant problems then just stick with it every time. 

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by Wildflower-nut on Fri Nov 15, 2019 4:16 pm
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from the cdc
"Malaria is a mosquito-borne disease caused by a parasite. People with malaria often experience fever, chills, and flu-like illness. Left untreated, they may develop severe complications and die. In 2017 an estimated 219 million cases of malaria occurred worldwide and 435,000 people died, mostly children in the African Region. About 1,700 cases of malaria are diagnosed in the United States each year. The vast majority of cases in the United States are in travelers and immigrants returning from countries where malaria transmission occurs, many from sub-Saharan Africa and South Asia."

I am not an expert by any stretch of the imagination but here is what I would do and have done in the past. I would get expert medical advice from someone like the CDC for what i am doing and where I am going. I would follow their recommendations. I would only go counter to that if a reaction to the medication developed that forced its discontinuance and not ignore their advice on the basis a reaction "might" occur. If I had a medical condition or concerns which prevented me from following their advice, I'd go somewhere else. There are a lot of wonderful places to go that don't have these issues.
 

by Primus on Fri Nov 15, 2019 5:31 pm
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Wildflower-nut wrote:from the cdc
"Malaria is a mosquito-borne disease caused by a parasite. People with malaria often experience fever, chills, and flu-like illness. Left untreated, they may develop severe complications and die. In 2017 an estimated 219 million cases of malaria occurred worldwide and 435,000 people died, mostly children in the African Region. About 1,700 cases of malaria are diagnosed in the United States each year. The vast majority of cases in the United States are in travelers and immigrants returning from countries where malaria transmission occurs, many from sub-Saharan Africa and South Asia."

I am not an expert by any stretch of the imagination but here is what I would do and have done in the past.  I would get expert medical advice from someone like the CDC for what i am doing and where I am going.  I would follow their recommendations.  I would only go counter to that if a reaction to the medication developed that forced its discontinuance and not ignore their advice on the basis a reaction "might" occur.  If I had a medical condition or concerns which prevented me from following their advice, I'd go somewhere else.  There are a lot of wonderful places to go that don't have these issues.

It is a good idea to talk to somebody knowledgeable. CDC has excellent online resources too.  Only problem is, they will not tell you what you SHOULD do, only what you CAN do, i.e. what your options are. Very much like seeing a doctor for a condition which may have several ways to treat it. The doctor may not be able to tell you must take, only what works and what side effects it may have. Until one has tried a remedy there is no way to find out if it will have any adverse effects. Which is why the first time is a leap of faith. 

There are many options for anti-malarial prophylaxis based on the travel destination, all quite effective and yet with widely different dosing protocols, costs, availability and adverse effects. 

If you are in the US, one other thing, from my experience none of these meds are covered by health insurance plans. Things may be different for some people.

My recommendation is to see somebody in a travel clinic at a local teaching hospital, most major metros will have one. Malaria prophylaxis is one of the commonest questions they get asked so they are quite well versed with all the options and can make a recommendation based on your preferences. They can also provide or order the medications since these are not easily obtained from a local pharmacy. 

Pradeep
 

by E.J. Peiker on Fri Nov 15, 2019 8:56 pm
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Never had a problem getting Malarone covered by my insurance (Cigna) in the USA, nor Larium before that..
 

by Ed Cordes on Fri Nov 15, 2019 9:37 pm
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I used to use Larium and never had a problem. The last two years or so my Doc and I decided the reported side effects at my age presented too much risk so we switched to Malarone. Still no side effects at all. I am very cautious in that if I am even close to a risk area I take the med. My dad had Maria from his tours in the South Pacific in WW II. Not pretty, so I try my best to reduce the risk as much as possible. I have used Deep Woods Off (yes, has a lot of DEET) with out issues with camera gear as long as I am careful. Next trip I will switch to Picardian as I have read it is just as good.
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by ChrisRoss on Fri Nov 15, 2019 9:38 pm
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My experience with doctors is they will say you need to take your medication and not be all that concerned about the side effects unless you have well documented contra-indications, telling you that malaria is worse than the side effects, which it no doubt is. The advice is all about consequence not risk which is the combination of consequence and liklihood. You really need to to form this view for yourself.

You do need to be careful where you go for advice, my doctor for example looked up the online resources and said yep take malarone. Travel clinics are probably the worst places to go as they want to sell up all the jabs etc even for very unlikely conditions. The resources are by no means complete, for example where I travelled to Indonesia has a very effective anti malaria program and it is now quite rare, but this was not reflected in CDC advice. Having said that this CDC advice is sound:

"Prevention of malaria involves a balance between ensuring that all people who will be at risk of infection use the appropriate prevention measures, while preventing adverse effects of those interventions among people using them unnecessarily. An individual risk assessment should be conducted for every traveler, taking into account not only the destination country, but also the detailed itinerary, including specific cities, types of accommodation, season, and style of travel. In addition, conditions such as pregnancy or the presence of antimalarial drug resistance at the destination may modify the risk assessment."

If you have not taken the recommended drugs before, by all means try them out if you don't have contraindications. For myself I will adopt EJ's approach in the future and have the drugs with me and take all anti mosquito precautions.

Back to the OP's questions if you are going in May nights are likely to be quite cold (5-10 deg C) so mosquito activity much supressed - but by all means confirm that.
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