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Malaria - ?worse in the monsoon season in Bangkok. Worried.

Travel Forums Asia Malaria - ?worse in the monsoon season in Bangkok. Worried.

1. Posted by Molly Muld (Budding Member 9 posts) 8y

Molly Muld has indicated that this thread is about Thailand

Lots of chemothrapy a few years ago has left my immune system a bit compromised. Worried about having Hep B injections and the rest - any advice anyone? Also don't want to take malaria tablets unless I absolutely must - we will be in Bangkok for 4 days and maybe up to one of the Islands or Chiang Mai for a few days and then flying out. What should I do?

2. Posted by wildfk (Respected Member 459 posts) 8y

Firstly that is really the sort of advice you should get from a doctor.

however, I can say that most people consider the risk of catching malaria in anywhere but the jungle and fringes of Thailand as very low.

I would suggest that most people should be immunised against hep "A" and "B" though. In you particular circumstancces I have no idea though.

[ Edit: Edited on Aug 3, 2008, at 6:47 PM by wildfk ]

3. Posted by Sander (Moderator 4810 posts) 8y

I agree completely with wildfk: go see a doctor. This is not the sort of advice you want to get from random people with varying levels of knowledge on the internet.

I can say that when I went to the local vaccination clinic, they asked how long I would spend in Thailand (just shy of 2 weeks) and where I'd go (I said I had no idea, but probably only places on the main tourist route: bangkok, chiang mai and one of the islands), and they said that malaria medicines would not be necessary for me.

I suspect it'll be the same for you. But maybe your chemotherapy has left you more at risk for catching the disease than from the side-effects? Only a doctor can tell you. Go see one.

[ Edit: Edited on Aug 3, 2008, at 7:29 PM by Sander ]

4. Posted by bex76 (Moderator 3713 posts) 8y

Hi Molly

I would agree with the others - definitely go to a doctor/travel clinic but malaria prophylactics are not normally needed for the areas you mentioned. I was advised that it's only the border areas with Myanmar that are malarial, but that can change as malaria can move around.

In terms of injections I was advised to have Hep A and Typhoid, and I also needed a tetanus booster. I didn't have Hep B.

Not sure whether they have these in Scotland, but my sister has just been to a Nomad Travel clinic (in Manchester) for travel advice, rather then seeing her GP, and said that the doctor she saw was really good.

5. Posted by Isadora (Travel Guru 13926 posts) 8y

Hi Molly!

As everyone has mentioned, definitely speak with your physician - more specifically, the specialist who oversaw your chemo (rheumatologist, oncologist, urologist, etc.). They will be better suited to advise you than will a general practitioner due to their "hands-on relationship" with the type of therapy you received.

With that said, people with immunosuppression can receive certain preparations of both the Hep A&B vaccines. The vaccines made from live (attenuated) virus should NOT be given to immune-suppressed patients. In most cases, the killed virus vaccine can be administered but it's effectiveness is diminished in those who have received chemotherapy. There are guidelines on how long after the last chemo treatment a patient must wait before getting the Hep A&B vaccinations. You docs will have those guidelines. Each patient's timeline will vary dependent on the type of treatment they received, their general health and how suppressed their immune system is currently.

Hep A is a virus contracted mainly through contaminated food and/or water consumption. As you would at home, be vigilant about what and where you eat. Definitely avoid street vendors and quaint little places where cleanliness is questionable. Drink bottled water and avoid ice cubes.

Hep B is usually contracted through contact with infected blood and/or bodily fluids. Most often medical facilities are responsible for the spread of Hep B. Unprotected sex is second in line for infection though something tells me that will not be an issue for you.

Typhoid is more common in small towns and rural areas in Thailand. It is also (most often) transmitted through food/water. Take the same precautions you would at home (and as mentioned for Hep A).

Malaria should not be too much of a concern. The CDC states the following for Thailand:

Malaria risk area in Thailand: Risk in rural areas that border Cambodia, Laos, and Myanmar (Burma). Very limited risk in Phang Nga and Phuket therefore prophylaxis is not recommended for these two areas. No risk in cities and in major tourist resorts. No risk in Bangkok, Chiang Mai, Chiang Rai, Pattaya, Koh Samui, and Koh Phangan.

If you are really concerned with the malaria issue, ask your physician about the use of doxycycline, which is an antibiotic used as an anti-malarial. For the short period you will be there, I think you should be find without prophylaxis. Doxy does require continued treatment for 3-4 weeks after you leave the area. That's a long time for just a few days of protection.

Again, speak with you doctors about the best route to take on these issues. Since you already have to be more careful than the average person about exposures, using the same precautions away as you would at home will benefit you well.

The CDC link lists information about all of the above diseases. The page also contains links to more in-depth information for each.

Hope this helps.

6. Posted by lodesafun (Budding Member 56 posts) 8y

I might add, Dengue fever is on the rise as of late.
The only prevention is a mossy repellant with DEET. The same would deter malaria mosquitoes and In My opinion is the best and safest over all prevention.
Many have problems with the malaria pills, besides some side effects you also have to remember to take them, something I've seen forgotten by many on their travels

These mosquitoes are worse at dawn and dusk so more care should be taken at these times.
(Did you know it's only the female mosquitoes that carry the virus?)
Enjoy,
Lodes

7. Posted by Isadora (Travel Guru 13926 posts) 8y

Quoting lodesafun

I might add, Dengue fever is on the rise as of late.
The only prevention is a mossy repellant with DEET. The same would deter malaria mosquitoes and In My opinion is the best and safest over all prevention.
Many have problems with the malaria pills, besides some side effects you also have to remember to take them, something I've seen forgotten by many on their travels

These mosquitoes are worse at dawn and dusk so more care should be taken at these times.
(Did you know it's only the female mosquitoes that carry the virus?)
Enjoy,
Lodes

Lodes' advice is great, BUT because of your suppressed immune system, it may not be the best option. This (again) is definitely something to discuss with your physician as well. DEET is not a naturally occurring insecticide, unlike some of the pyrethrum-based (pyrethrin) products. It works wonderfully but considering the situation, I (personally) would be concerned about it's (known) mild toxicity and my immune responses. Follow up on this with your doc.

Sorry Molly, I know I sound like a curmudgeony old lady... I spent a lot of years in the health care field and believe everyone should be pro-active for their own benefit. The fact that you posted your questions shows me you are on the same page. I also have a friend with severe rheumatoid arthritis and has developed other complications because of her immuno-suppression. Again, my apologies if I am overstating my case, but I see what she has had to deal with and it's not easy. ;)

8. Posted by wildfk (Respected Member 459 posts) 8y

This on Dengue in Thailand -

Avoidance is the only thing to do. Dress in light long sleeved/legged clothing at appropriate times, clear the room with coils or spray, use a DEET rellent.

Read this......

Dengue - Thailand – 2008 - http://www.irinnews.org/Report.aspx?ReportId=78586

THAILAND: Dengue fever "crisis" looms

The 'Aedes aegypti' mosquito which is the carrier of dengue fever
BANGKOK, 5 June 2008 (IRIN) - Rising temperatures, longer rainy seasons and increased urbanisation are leading to an explosion of dengue fever cases in Thailand in what health officials are calling a near-crisis situation.