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One of the most commonly asked questions by first-time travellers to Southeast Asia is "Should I take malarials?". It's a simple question, with a complicated answer, best summed up as "it depends". Here's ten pointers that we hope will help you make a more informed decision regarding malarials and travel to Southeast Asia.
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- the client's own compliance with mosquito avoidance measures - the client's own wishes regarding what level of risk is acceptable -- some want to be "covered for everything" whilst some others don't want tablets even if they're going to a high risk area. It's a moveable feast and not cast in stone. For example: - Previous blanket recommendations for needing prophylaxis for anywhere in India were recently relaxed about one to two years ago. However a recent increase in cases amongst tourists in Goa forced a rethink. - there is good evidence that due to climate change, malaria in Kenya is now occurring at higher altitudes (incl. Nairobi!) at areas and elevations previously considered malaria free. I think the main message is that the decision to take or not take malaria prevention needs to be made by the client after consultation with a travel medicine provider." Now here's some other points about the disease you should consider.
a) Use a permethrin impregnated mosquito net b) Use mosquito repellent containing DEET c) Dress sensibly -- wear long pants and sleeves at dawn and dusk. d) Use mosquito coils or other anti-mosquito devices (e.g.., citronella) as a secondary control. e) If you are prone to being bitten, lean towards accommodation that can be sealed up -- air-con with no slatted windows nor open eaves. f) Watch out for rooms with bucket showers/toilets. These tend to have buckets ofstagnant water -- a mozzie's beach resort -- in the bathroom. g) Don't sleep naked in a swamp.
Laos: Throughout the year in the whole country except in Vientiane. Thailand: Throughout the year in rural, especially forested and hilly, areas of the whole country, mainly towards the international borders. There is no risk in cities (e.g. Bangkok, Chiang Mai, Pattaya), Samui island and the main tourist resorts of Phuket island. However, there is a risk in some other areas and islands. Vietnam: Malaria risk exists in the whole country, excluding urban centres, the Red River delta, and the coastal plain areas of central Vietnam. High-risk areas are the highland areas below 1 500 m. south of 18?N, notably in the 4 central highlands provinces Dak Lak, Dak Nong, Gia Lai and Kon Tum, Binh Phuoc province, and the western parts of the coastal provinces, Quang Tri, Quang Nam, Ninh Thuan and Khanh Hoa.
Primaquine Stomach cramps, nausea, and vomiting. Primaquine can also cause an hemolysis (bursting of the red blood cells) in G6PD deficient persons, which can be fatal. That all sounds pretty terrible, but then there's the effects of catching malariawhich you need to weight these against: Shaking chills, headaches, muscle aches, tiredness, nausea, vomiting, and diarrhoea. May also cause anaemia and jaundice. Infection with one type of malaria,Plasmodium falciparum, if not promptly treated, may cause kidney failure, seizures, mental confusion, coma, and death.
Vietnam The southern and central part of Vietnam, including rural areas of the provinces of Tay Ninh, Song Be, Lam Dong, Ninh Thuan, Khanh Hoa, Dak Lak, Gia Lai, and Kon Tum are all mefloquine resistant -- use only atovaquone/proguanil or doxycycline. All other areas you can use atovaquone/proguanil, doxycycline, mefloquine or primaquine. No risk in Hanoi, Ho Chi Minh City, Da Nang, Nha Trang, Qui Nhon, and Haiphong. To boil all that down, if you are going to take malarials, don't take mefloquine as it doesn't cover the entirety of any one of the above countries.
Have known not a single person who has contracted malaria Have seen two people (including a Travelfish staffer) totally freak out as a result of taking mefloquine. In conclusion, if you're planning on stopping by just the main tourist hotspots, using repellent and a mosquito net, dressing sensibly and never sleeping naked in a swamp, then chances are you probably don't need to take malarials. On the other hand, if you're planning on spending a lot of time trekking in remote areas and hanging out in border zones, don't plan to use a mosquito net or repellent and almost certainly plan to sleep in a swamp in your birthday suit once or twice, then availing yourself of a course of malarials would be a prudent decision. One last point -- if you do decide to take malarials, make sure you take the full course of pills. If you cut it short you're contributing to drug resistant strains of malaria and also endangering yourself.