Preventing Malaria: To Pill or Not to Pill

When traveling to less developed portions of the world, mosquitos are definitely something to keep an eye out for, particularly as they can carry two pretty nasty illnesses: Dengue Fever and Malaria, the later of which kills 1-3 million people each year. While Dengue Fever is not preventable using modern medicine, Malaria is…mostly.

Let me preface this by saying that I am not a doctor. The information contained here is my experience and you should make your own decisions by discussing with your doctor.

Anti-Malarial drugs are a fairly contentious issue. While they certainly increase your odds of evading the disease, there is no guarantee. Many drugs come with a whole host of potentially nasty side effects (some of which I’ve heard people say are worse than getting the disease itself). Some argue that you shouldn’t bother with Anti-Malarials because if you get Malaria, you’ll be taking the exact same medication (just in a considerably higher dose).

On the other hand, many people take Anti-Malarials with no issues. The key is to do your own research. Do note that all Anti-Malarials do not work everywhere in the world. Mosquitos in different parts of the world have developed resistance to one or another Anti-Malarial. The World Health Organization maintains a great interactive map for travelers, telling you of the Malaria risk and drug resistance in the regions you will visit. A good guide book should also advise you as to specific areas of risk in a country. (For example, WHO says all of China’s Yunnan province is at risk, while Lonely Planet specifies that its actually just the border region with Laos and Vietnam).

As for me, on my last trip to Southeast Asia, I did use Anti-Malarials, though only for my initial time in Laos. I did a lot of research and chose Malarone (the brand name for Atovaquone & Proguanil), which is a newer drug that has the least side effects in comparison with the alternatives.It was fine for me and I had no reaction to it.

This time around, I did get myself some Malarone, again for my time in Laos. After my previous positive experience, I figured I didn’t have anything to lose and it was covered by my U.S. health insurance (which was nice, especially since they wouldn’t cover my Typhoid Fever vaccine).

Of course, the only 100% way to prevent Malaria is not get bitten! Wear light colors, keep exposed skin to a minimum (so wear long sleeves, pants and closed-toed shoes), and use an insect repellent with DEET. Note that mosquitos like to come out at night. (And yes, I realize that Southeast Asia can be extremely hot, so use an insect repellent liberally!)

Some people will advise you to bring along a mosquito net to sleep under that you’ve soaked in a repellent called Permethrin. I did for my last two trip to Southeast Asia, though I don’t think I will in the future as in a collective six months in Malaria and Dengue-prone areas, I only used the net once. Easier solution would be to spend a bit more and stay in a place where it wasn’t necessary!

Considering the lack of side effects I think I will continue to use Malarone on my travels to Malaria-prone areas, especially if it is covered by my health insurance! After all, what do I have to lose?

What are your thoughts? When you travel to Malaria-prone areas, do you take anti-malarials?

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3 Responses to Preventing Malaria: To Pill or Not to Pill

  1. Phil August 7, 2011 at 2:02 am #

    Hey Aaron,
    good post about a tricky subject. It’s hard to take a stance and you’re right to point out that people should talk to a doctor.

    “Some argue that you shouldn’t bother with Anti-Malarials because if you get Malaria, you’ll be taking the exact same medication (just in a considerably higher dose).”

    This depends on the prophylactic you are taking. If you are taking doxy, for example, you need to use doxy in conjuction with something else for treatment, like quinine which is the standard for treatment.

    I have had malaria twice and both times I was taking a prophylactic (doxy once and mefloquine once). Malarone is indeed the best and you are fortunate to have it covered by your US insurance.

    I mostly travel in W. Africa and I currently do not take prophylactics, but I always carry coartem with me (strongest emergency stand by available right now) and I’ve used it for treatment twice to great effect. Malaria is scary anywhere, but in Africa the primary strain is p. falciparum which is responsible for severe and cerebral malaria. Very important to get rapid treatment!!! And yes, crucial, as you say, to minimize bites in the first place!

    • Aaron August 7, 2011 at 2:16 am #

      Thanks for sharing your experience and your post Phil! I don’t think a lot of people realize that a) no prophylactic is guaranteed to prevent malaria and b) not all mosquitos in different parts of the world carry the same strain of malaria, making your anti-malarial choice vary depending on destination. I also feel like this is a topic that travelers are often faced with that is little discussed.

      Cheers, and thanks again!

  2. Phil August 7, 2011 at 2:03 am #

    Also wrote a similar article for one of the sites I work on if you’d like to check it out, it’s here: http://sickontheroad.com/2010/11/28/should-you-take-malaria-prophylactics/

    Take care,
    Phil

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