Cerebral malaria!!

[Stan Weakley]

Peet, Artemisia is not approved by the American FDA (Food and Drug Administration) for use in malaria at all. Numerous trials throughout the world have failed to prove that it is effective in any way. No self-respecting doctor would prescribe it. The FDA is considered the ultimate authority throughout the world.

[Quack]

Hallelujah! A malaria thread, where I don't have to strip my thread!

[Tony Weaver]

Hallelujah! A malaria thread, where I don't have to strip my thread!

Can we please make this a sticky? I am so sick of beating the prophylaxis drum and having macho denialists and homeopathic advocates dump on me for insisting that chemical prophylaxis be taken even in low risk areas. It gets very tedious. Thanks Stan, Francois, Quack, Henk et al for being persistent on this one.

[hbannink]

Great idea Tony. Done however.........I think there is still a lot of drumming to be done for tomorrow a new unbeliever Rambo surfaces to rattle our cages

[Shemula]

Hi guys Just a quick bit of advice the in Maputaland area Ndumo/Kosi Bay area malaria has shown its face again after quite a few years of nothing. The area is very wet and there are numerous water holes all over the area that have not seen water in many years that are now full and they are all still standing water.
So if you are coming to the area take the nesessary precautions with the emphasis on your children. They often don`t give to much detail why they are not feeling well and the parents if not careful can misdiagnose and not take them to the doc in time.
MY ADVICE BE CAREFUL IN THIS AREA

[FMaartens]

Very good advice Shemul, the late rains in northern KZN will prolong the malaria transmission season this year due to the stagnant water that become mosquito breeding sites. Human movement between Moz and SA and the fact that not much malaria control is taking place in Matatuine districts in southern Mozambique is not helping either.

[FMaartens]

Information, education, communication (IEC) is your first line of defence against malaria infection and it is a good idea to share malaria information on this site as many of us travel to malaria areas. Below please find some useful info.
What is malaria?
Malaria is an infectious disease caused by the parasitic infection of red blood cells by a protozoan which is transmitted by the bite of an infected female malaria vector mosquito.
What does malaria mean?
The name malaria is a Latin word meaning bad air; the early Romans associated the deadly fever with swamps and the bad smell that came from the swamps.
What is a malaria vector?
The epidemiological definition of a malaria vector is “An organism that does not cause disease itself but which spreads infection by conveying pathogens from one host to another”. In terms of malaria, it’s a female mosquito that has the ability to carry the malaria parasite and then spread the parasite to humans.
Are mosquitoes born with malaria?
No, mosquitoes are not born with the malaria parasite; a malaria vector needs to bite a malaria infected person before they can transmit the disease to other humans. The percentage malaria infected people in a population and the density of malaria vectors determines your risk of contracting the disease.
Do all mosquitoes have the ability to transmit malaria?
There are over 3000 different mosquito species in the world and only 40 species are malaria vectors. Mosquito species have diverse behavioural characteristic and it is important to understand their feeding preference and resting patterns so that the most effective and appropriate malaria control intervention can be selected. Some mosquito species feed primarily on animals (zoophilic) and others seek out humans for their blood meal (anthropophilic). Some species live (exophilic) and bite outdoors (exophagic) while others fly into (endophilic) houses and feed indoors (endophagic).

[PeetS]

I have found a few sources that gives information regarding a specific area that one can use to access the risk in that area.

If anybody would care to comment on the accuracy and validity of these sites, please do so.

If there are other sources out there, please list them.

http://www.map.ox.ac.uk/

http://cdc-malaria.ncsa.uiuc.edu/

[Nikki1]

Malaria is a big problem in Mozambique and one need to be very careful as it can be fatal. One important point to note is that cerebral malaria is simply a complicated form of the most common malaria strain found in Africa namely Plasmodium Falciparum. In other words - untreated Plasmodium Falciparum becomes cerebral malaria. Please feel free to contact me if you require any additional information. Regards, Francois Maartens (Integrated Malaria Control Consulting)

Can you help? We are going to Moz (Inhambane) in July & because it was July and south Moz, we thought we didn't need anti-malarials. We are 2 adults & 3 children (13, 11, & 3!) Can you advise on anti-malarials, particularly which one is best forour 3 year old. Also, does camping significantly increase your risks? Thanks. Nikki.

[BlomCo]

I was also wondering, if anyone has any experience and can advise me on my status regarding Malaria and my splenectomy.

I had my spleen removed and doctor told me I can forget about visiting a Malaria area...? Any experience?

[Stan Weakley]

Blomco, I am a surgeon and have removed many spleens in emergencies.

There is no doubt that a splenectomy lowers your immunity and makes you more liable to develop (amongst other infections), malaria. Often the malaria in these patients is more severe than usual.

However this is a poorly studied topic and it is not clearly understood what the risks are if effective modern malaria prophylaxis is diligently taken.

Just to quote from a few relevant articles from medical journals:

“Those lacking a functional spleen are at higher risk of contracting malaria and succumbing to its effects. Travel to malarial areas will carry greater risks and is best avoided. (My underlining). Travellers should take the most appropriate anti-malarial prophylaxis medication and be extra vigilant over measures to prevent mosquito bites.”

“Asplenic travellers should be advised to avoid travel to high risk malarial areas. People who travel should scrupulously adhere to measures to avoid bites and take appropriate antimalarial prophylaxis. Immediate referral for medical advice is essential should a fever develop.”

“The increased malaria risk after splenectomy is difficult to quantify, as controlled trials are not readily available.” (My comment) For instance the Australian Defence force will deploy members who have undergone a splenectomy to a malaria area, as long as the member is aware of the risk, adheres rigidly to the best prophylactic schedule and diligently takes all available measures to avoid mosquito bites. It is also a requirement that they carry a Medic Alert type bracelet advising that their spleen has been removed and that they are at increased risk for malaria and its worst forms.

Therefore it seems that you are at you are at increased risk and standard advise is to avoid malaria areas if at all possible. If you do decide to go, please take the above precautions and visit a travel clinic and discuss your particular situation with the doctor.

[BlomCo]

Stan Weakley, I appreciate your comment and value the feedback. Thank you very much!! I thought I would start and ask here on the forum, so thank you as a professional to reply! I would've and still will read up on it before I decide finally to go to a Malaria area.

May I ask your personal opinion - If your spleen was gone...would you have considered (with all the above mentioned) to go to a Malaria area like Moz...

[Stan Weakley]

Blomco, please don't ask me to give my personal blessing to a medical risk that only you can decide on.

Besides that, I really do not know enough about your medical background to offer a rational medical opinion. The internet is a dangerous place for medical consultations. Sorry bud, the ball is in your court. I am happy to provide you with a little background information.

The best advice I can give you is to see a doctor you trust with knowledge on this topic. There should not be shortcuts when it comes to your health.

[Pietsweis]

Blomco, please don't ask me to give my personal blessing to a medical risk that only you can decide on.

Besides that, I really do not know enough about your medical background to offer a rational medical opinion. The internet is a dangerous place for medical consultations. Sorry bud, the ball is in your court. I am happy to provide you with a little background information.

The best advice I can give you is to see a doctor you trust with knowledge on this topic. There should not be shortcuts when it comes to your health.

On that topic. There are a whole bunch of malaria treads doing the rounds. Who knows of a doctor who is well experienced in this field? It seems like there is a lot of advice being asked for given on the topic and no disrespect meant to anyone but this is a highly specialised topic and all gp's is not always familiar enough with malaria simply because very few doctors have to deal with this on a daily basis.
Maybe someone who is working with this every day?
I know netcare travel clinics have some well experienced people out there.

There must be doctors who specialise in malaria who can be consulted for these types of questions.

[cilt]

Maybe this is a stupid question, but is it possible to have had malaria without knowing it, perhaps thinking it was a really bad case of flu? Would a test show if you have previously had malaria?
Thanks for a really interesting topic and all the advice.

[Zapiture]

Vaccine for Malaria? Read and comment. http://fortune.com/2014/07/24/glaxos...alaria-vaccine

Regulatory submission is a first step toward launching the vaccine in malaria-infected regions.

GlaxoSmithKline GSK is getting closer to its launch of a first-ever malaria vaccine that could change the lives of billions of people around the world.

Glaxo has submitted a regulatory application to the European Medicines Agency (EMA) for its malaria vaccine RTS,S, the company announced Thursday. The regulatory submission is a first step toward launching the vaccine in malaria-infected regions across Africa and parts of South Asia.

“This is a key moment in GSK’s 30-year journey to develop RTS,S,” Sophie Biernaux, head of Glaxo’s malaria vaccine program, said. “And brings us a step closer to making available the world’s first vaccine that can help protect children in Africa from malaria.”

In 2012, 207 million people were infected and 627,000 died as a result of the disease. Of those deaths, 91% were in sub-Saharan Africa and 77% were children under the age of 5.

Malaria is prevalent across 106 countries, impacting nearly 3.4 billion people, according to the Centers for Disease Control. The CDC calls it “one of the most severe public health problems worldwide.” The center estimates that direct costs from illness, treatments and premature death amounts to around $12 billion per year.

A vaccine to combat the disease, which is spread by mosquitos, has been difficult to develop because malaria parasites have a complex life cycle and there is poor understanding of the body’s immune response.

Glaxo’s RTS,S vaccine is intended for use against the Pasmodium falciparum malaria parasite, which is the most common in sub-Saharan Africa. The vaccine is designed to prevent the parasite from infecting, maturing and multiplying in the liver, which would allow the parasite to re-enter the bloodstream and infect red blood cells, leading to disease symptoms.

Approval by the EMA is required for all vaccines and medications manufactured in a European Union member state, though the RTS,S vaccine is intended for use exclusively outside the EU. The EMA’s blessing is required by the World Health Organization, which will issue a policy recommendation on its use as soon as the end of 2015, pending regulatory approval.

A go-ahead from EMA is also required for marketing authorization by the National Regulatory Authorities in sub-Saharan Africa countries, which would pave the way for large-scale implementation of the vaccine through African national immunization programs.

Glaxo has invested more than $350 million to date and expects to spend an additional $260 million through final development.

To ensure the vaccine is affordable, especially to communities in lower-income areas, Glaxo promised that the price will cover the cost of manufacturing plus a small return of about 5% that the company plans to reinvest in research and development for second-generation malaria vaccines, or vaccines against other neglected tropical diseases.

The Bill & Melinda Gates Foundation, which has been a major advocate for malaria eradication across the globe, invested $200 million towards a malaria vaccine through the PATH Malaria Vaccine Initiative, which contributes financial, scientific and managerial expertise to the development of Glaxo’s RTS,S.

J

[Quack]

On that topic. There are a whole bunch of malaria treads doing the rounds. Who knows of a doctor who is well experienced in this field? It seems like there is a lot of advice being asked for given on the topic and no disrespect meant to anyone but this is a highly specialised topic and all gp's is not always familiar enough with malaria simply because very few doctors have to deal with this on a daily basis.
Maybe someone who is working with this every day?
I know netcare travel clinics have some well experienced people out there.

There must be doctors who specialise in malaria who can be consulted for these types of questions.

I'm a registered travel physician, Stan has a passion for over landing, and though I gather that he is retired, his knowledge of tropical diseases far surpass that of the average surgeon! On top of that you have Francois that works with this regularly.

[TonyP]

I farmed in Moz in the Macuba area and contracted Malaria 4 times in a year. I was a damn fool and tried to ignore symtoms (I was in the middle of getting a crop in the ground) on the last go around with a near fatal result. It ended up with me in ICU for 2 weeks in Westville Hospital after being evacuated by air. It had got to the cerebral stage and the doctors said I made it by a day.
I can honestly say I have never been the same since.
This is not something to play with and if anybody thinks they are so tough that they don't need to take precautions, forget it. These tiny little parasites haven't heard about how tough you are and don't care. They will turn you into a snivveling, shivering wimp. Get the pill before you go and finish the course, don't play with this thing.
As an aside, I get very nervous when I hear of people taking very young kids into maleria areas.

[Spliffcat]

When/If the vaccine comes out I'm first in the queue.

[BigRed]

.....I had my spleen removed and doctor told me I can forget about visiting a Malaria area...? Any experience?

Mine was taken out following a cycling accident in 1986.... In those days I was told the opposite. Dont take malaria prophylaxis, as these would be more susceptible to changing / confusing the symptoms, should I contract Malaria.

....There is no doubt that a splenectomy lowers your immunity and makes you more liable to develop (amongst other infections), malaria. Often the malaria in these patients is more severe than usual......

This I've only hear recently, some 15 years later.

I still go into Malaria areas, but now with prophylaxis and extra precautions.