Much Ado about Malaria

I hate tablets. Pills. Vaccines. Drugs. They are expensive, have bad side effects, are full of crap I really don’t want in my body (both chemical and animal derived), almost certainly tested on animals, treat symptoms rather than the cause, and in many cases are simply ineffective!

On my first big RTW trip, I had a couple of injections, like Yellow Fever. This was by LAW, as if you venture to Brazil, Australian immigration won’t let you back into the country without that little yellow slip.

I avoid all types of medicine when possible. Hell even cold & flu tablets are a joke. Got the sniffles? Dose up on Vitamin C, get some rest and HTFU! But what about Malaria? There is so much hype over the Mozzie-spread disease that its hard to work out the facts.

What is Malaria?
Am I likely to catch it in South East Asia?
What can I do to prevent catching malaria?
Drugs
Side Effects
Verdict

If you’re heading to South East Asia, Marlia and Rabies are two things people may warn you about. Rabies is a no-brainer to simply ignore, as the vaccination is ridiculous. You need 4 injections on specific days over a 4 week period, and even then all it does is give you a few extra hours should you get bitten by a hyper-active, frothing-at-the-mouth monkey. It’s also expensive and full of crap there is no way I’m letting someone inject into me. And even with my tendency to get close to animals, what are the chances? And any main town known to have rabies in the area will be able to deal with it near by.

What is Malaria?

Malaria is an infectious disease where parasites multiply within the red blood cells and cause symptoms such as fever, chills, anemia, nausea and, rarely, coma and death.

Am I likely to catch it in South East Asia?

Malaria is spread by Anopheles mosquitoes and they can only carry it from biting an infected person. There is questionable information about what areas are high and low risk in South East Asia. The worst areas include many of the border areas, rural Vietnam (not in the cities), Laos and parts of Cambodia. There is very low risk in Thailand and most of the main cities etc. Areas like the Mekong, Vang Vieng and jungle areas are of risk because of the increased number of mosquitoes around rivers and wetlands, and also their remote location.

Malaria has been hyped up the wazoo. Reports about super malaria in Cambodia for example; Well the truth is that it was simply taking an extra day or two to be removed from the system. So while it is showing a sign of resistance to the drugs, it still leaves the body within 5 days and all the drugs recommend you take them at least 2-4 weeks after leaving infected areas. So it’s nothing to fret over yet.

If you are only visiting main cities like Bangkok, Hanoi, Saigon and Phnom Penh, you are very unlikely to even get bitten by a mosquito, even less likely to catch Malaria. In the areas suggested above, and also the Angkor Wat area (apparently many mozzies, but I was never bitten there) you have to decide what precautions you want to take.

What can I do to prevent catching malaria?

You could hide indoors in a chrio-suit and cower in fear, or you could just be sensible about it. Use a high quality insect repellent (I’m not going to suggest DEET because it is highly toxic. Hell, use it for a day and watch it work on anything you rub against. It’s like paint thinner!), preferably bought in the local area. In Malaysia for example, I bought an entirely natural repellent sold near Taman Negara rain forest. It was the only one they sold, cheap, and worked a treat. Also wear long pants, long sleeve shirt, closed shoes and a hat in risk areas (although for me it was too hot to follow this!).

DRUGS

There are 3 common Anti-Malaria tablets and all have their downsides. Malarone is considered the best in terms of effectiveness and is least likely to cause side effects, but they can and do occur, usually affecting sleep and dream patterns. It is also the most expensive and requires a daily tablet.

Mefloquine, or Lariam, is much cheaper than Malarone, and is taken once a week. Because of the dosage, the tablets are much stronger on the system and have noticeable side effects: From wikipedia “It is known to cause severe depression, anxiety, paranoia, aggression, nightmares, insomnia, seizures, birth defects, peripheral motor-sensory neuropathy,[2] vestibular (balance) damage and central nervous system problems. For a complete list of adverse physical and psychological effects — including suicidal ideation..”. Pretty messed up. Your also not supposed to drink Alcohol within 24hrs of taking it, which sucks!

Doxycycline is essentially a very strong antibiotic, developed by Pfizer in the 60’s and is semi-synthetic. It is a daily tablet cheaper than malarone, but more than mefloquine (over time). It has numerous side effects which I’ll write about below!

So should I take one, and which one?

If you decide to take one, I would pick either Malarone or Doxycycline, and only take it for the areas you really need it. You can also try purchasing it in the country your visiting as it will likely be a lot cheaper, just make sure you buy real-brand tablets from a respectable pharmacy and you have at least 2 days before leaving the city to risk areas.

Side Effects

In the end, I decided to buy Doxycycline hyclate (Vibramycin tablet) as a last minute purchase before heading to Vang Vieng where I would be on the river, and for later in Cambodia. I was very reluctant to take them for all the reasons mentioned above, and didn’t really research enough before hand. I picked them because of price, they weren’t in gelatin based capsules, and the origin isn’t as bad. I took them while in Laos for 1 week, and continued for the first week in Vietnam.

I began to notice various symptoms, the worst being skin sensitivity. Under the sun, my arms felt like they were on fire even in meagre temperatures. I began getting stomach pains and cramps. Then after kayaking in Halong Bay, I had the worst muscle cramps I have ever had, so bad that I could not sleep and they lasted through to the next day. I immediately stopped taking the tablets and within 2 days all symptoms disapeared. I researched the symptoms and they were listed as direct possible side effects to Doxycycline, so once again my self diagnosis was accurate.

I did, however take them again for Cambodia, about 3 weeks later, and the symptoms were barely noticeable this time. I guess my body had recovered from it and my immune system learned to deal with them. I stopped taking them shortly after leaving Cambodia however and certainly didn’t continue them for the 2-4 weeks suggested.

So, what’s the verdict?

If When I go back to South East Asia, I will NOT be taking any form of anti malaria tablets. The side effects alone are often a big enough reason for people not to take them, as they can ruin a holiday and sometimes cause more damage than good. So everyone has their own experiences.

The actual chances of infection VS what you have to go through with these tablets means, in my opinion, they simply aren’t worth it. I met many people who weren’t taking any anti-malarial drugs, those who were paranoid about it, and some who did and didn’t get side effects from taking them.

You are not supposed to drink alcohol while on any of these, but we all know that’s simply not going to happen. This means your body is under even more stress, and the effectiveness of the tablets may be limited.

Of course, if you DO decide to go drug free and happen to catch Malaria, swine flu, cooties, or any other media-hyped disease, don’t blame me! I’m no doctor, self diagnosis only.

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