I'm going to South East Asia for about 8 months leaving in just over a week (27th April)!
Has anyone else gone to SE Asia for this length of time (8+ months)? What did you do for anti-malarials?
I'm going to Malaysia, Indonesia, Timor-Leste, Philippines, Vietnam, Cambodia, Laos, Thailand.
I was told by the Travel Nurse at my doctor's that I could just get my anti-malarials from a pharmacy. However, went to the pharmacy today and they said that for where I'm going I will need a prescription so they couldn't sell me any.
Unfortunately I don't have time to go back to my doctor's, but you can buy anti-malarials online from Superdrug or Lloyds Pharmacy.
I need to make sure I get the right tablets though; I don't want to get malaria (obviously) but I don't my trip ruined by malaria tablets side effects either.
I have done some research and doxycycline is the cheapest option (and therefore I'm leaning towards this one), but the side effects do not sound nice. Also, are there any risks of taking anti-malarials for such a long time? Will doxycycline protect me for all of the countries I'm visiting?
I'm going to speak to another pharmacist for some more advice, but any advice on here would be great especially from those who have done the same thing or are planning the same thing.
Check out this Web site before you go: http://wwwnc.cdc.gov/travel/destinations/list.
I've taken generic Malarone, also known as atovaquone/proguanil, for 90 days without side effects. That included travel last year to Indonesia, Timor-Leste, Papua New Guinea; and Guinea-Bissau in West Africa.
The antimalarials don't guarantee that you won't contract malaria and other mosquito-born diseases, such as dengue and chikungunya. An Australian friend was taking doxycycline in Tanzania (Zanzibar) and still contracted malaria. I was traveling with him at the time.
The best way to protect yourself is to cover your arms and legs, particularly at dawn and dusk when mosquitos are most active; and in shaded areas. Use mosquito netting, if provided. Many people use insect repellent. I sometimes do, but often do not. I used it in Timor-Leste after spending time there with a family whose children had contracted malaria several times. When I was visiting, one of the kids was suspected of suffering from chikungunya, for which there is no test available.
You're doing the right thing in consulting your doctor and pharmacist. In the U.S., Malarone (atovaquone/proguanil) is available in generic form. I purchase it through my former employer's prescription drug plan, which makes it more affordable.
Prevention is key; and much of that has to do with protecting yourself against bites. So cover up. It also helps to wear light-colored clothing; and to avoid heavily scented products. Lactic acid, used in many skin-care lotions, also appear to attract mosquitos and other insects. After bitten, use an antihistamine or steroidal ointment to calm the itching and swelling. Ask your doctor about them.
If you are flying to Dili from Denpasar or Singapore, flights will be cheaper if booked through the Air Timor Web site. Air Timor uses Silk Air flights from Singapore; and Garuda flights from Denpasar. I purchased my ticket -- from Denpasar to Dili -- online with a U.S. credit card. From Dili, I flew Airnorth to Darwin, Australia. Make sure you read the Travellerspoint guide to East Timor before you go, particularly the section on getting around. Early birds are likely get out of Dili on a more timely basis than others.
For twenty years or so traveling in SE Asia, India, South and Central America, I never used anti-malarial tablets because I didn't want the side effects. I did use strong Bushman's insect repellant (80% deet - banned from sale in Europe) and found that perfectly adequate.
For the first time while traveling through Eastern and Southern Africa six months ago, I got a prescription for doxycycline because of the region I was going through and, despite the fact that I had to continue taking them for 28 days after leaving the affected area, I had no side effects. I still used the Bushman's as well though!
Whether I'd take the tablets again for other trips, I'm not so sure - it's a personal thing that only you can decide with the advice from your GP.
Enjoy your travels
Thankyou both berner256 and Borisborough for your responses
I'm definitely going to get some more professional advice and decide from there, I'm just very aware that I don't have a lot of time to decide!
As far as preventing bites goes I do have mosquito repellent, a mosquito net and some long trousers and long-sleeved tops to take with me so hopefully they will help too
I don't usually use DEET products, as it can affect clothing, particularly those made with synthetic materials. But I'll use insect repellent on my legs, especially when wearing shorts on beaches or sand dunes known to have sand flies, also known as midges.
Mosquitos aren't as prevalent during dry seasons than in wet seasons, as such monsoons. So that might be a consideration as you travel from country to country.
The choice really is yours whether to use an antimalarial or not. Some people don't; and they come away unscathed. Many hotels in malaria-prone countries supply mosquito nets, so it might not be necessary to bring one of your own. Locals also use mosquito nets, particularly to protect children since they haven't built immunity.
As mentioned before, the best protection is to avoid bites by covering up. But you'll find that mosquitos and other biting insects are persistent; and you will be bitten. That's virtually guaranteed. Some even bite through clothing. Mosquitos don't like windy conditions. It inhibits flight. So one rationale is to sit by a fan. I did so in a restaurant in Bagan, Myanmar, sitting in front of a fan that I thought would protect me. I got mosquito bites on the back of one arm, near the elbow. A sneak attack, from the back!
With atovaquone/proguanil, the regimen is to take one tablet for two days before entering a malaria zone; a tablet daily while there; and a tablet for seven days after leaving.
Protection from mosquito bites is gaining importance with the spread of a variety of diseases. The latest is the zika virus that is now of concern in Central and South America; and the Caribbean.
[ Edit: Edited on 18-Apr-2016, at 12:46 by berner256 ]
We haven't done such a long time in Asia, but have on a few occasions used anti malarials for a two or three months at a time, and were advised that doxycycline is good for extended use. We've had no bad effects from them. We've used Malarone previously, years ago, but only for short trips, and before my husband was taking another medication that makes it less suitable.
I absolutely agree that bite avoidance is best, given the other diseases you can get, but have found it impossible to guarantee no bites, so still take the anti malarials.
I admit, I've become a total wimp and (with very few exceptions now and then) simply don't travel to malaria areas anymore. I've had dengue a couple of times. I never want malaria...