Zambia Malaria and Yellow Fever

[TheWall]

Hi,
Going to Zambie (Close to Livingston) Beginning August.
i Dont really want to go on anti-Malaria pills again... Is it recommended there that time of year?
Is there anything else we will need? ie Yellow Fever vaccinations or something?
Thanks

[TheWall]

Ok, here is a post regarding YF. Yes it is required.
http://www.4x4community.co.za/forum/...t=85217&page=2

So now just Malaria...

[Tony Weaver]

Hi,
Going to Zambie (Close to Livingston) Beginning August.
i Dont really want to go on anti-Malaria pills again... Is it recommended there that time of year?
Is there anything else we will need? ie Yellow Fever vaccinations or something?
Thanks

The Zambezi Valley is a year round malaria high risk area. You'd be crazy not to take prophylaxis.

[Louis J]

Drink everything that you have to !!!!! My son is just back from the Congo / had malaria there and is in hospital with kidney failure. We cant at this time blame the malaria but its probably a result of that. Dont take chances its not worth it

[Jean Kotze]

Malaria is not a joke. The normal strains you can still fool around with if you are really stupid. The celebral strain is deadly.

I met a chap from Namibia (Windhoek, I think - forgot his name) in Maun in June last year. They were travelling from Namibia via the Caprivi Strip to Zambia when his 6-year old son fell ill on the second day and went into a coma on the third day. They rushed him to Maun. When I met the dad in Maun, it was the fith day of their tour and the boy was still in a coma in ICU - 50/50 chance. Celebral Malaria. I do not know what happened to the youngster.

Do not fool around with malaria, it is back big time and can ruin you entire holiday. And that is not the worse case scenario.

[Tony Weaver]

Also, if you are taking your water straight from the Zambezi, purify it - it may look clean, but there are many settlements upriver, and the water is full of lurgies.

[TheWall]

mmm, ok, was hoping to not go on it again. Usually when diving i take Doxycycline and just finished my last course after mozam over easter weekend a little while ago...

What other Malaria pills can you guys recommend. Only going for 7 days and don't want something to strong (ie hallucination and stuff)

Maybe i should just stick to what i know? It might be an old malaria pill and you do have to take it for a month after you return but it works...?

This is for honeymoon and was thinking Malaria is a short term problem vs it stuffing around with some of the misses medication.

[MikeAG]

You have three choices of prophylaxis:

Doxy, which you know of
Larium (Lariam) .....which is the trade name for Mefloquine....which is a once-per-week tablet, and occasionally gives some people some mental health issues. I take it, as do the rest of my family, and all we get are occasional vivid dreams.
Malarone.........just about side-effect free, except that it takes half your annual income to buy in the first place.

As far as I know, nothing else is effective in Africa.

Mike

[Tony Weaver]

You have three choices of prophylaxis:
Doxy, which you know of
Larium (Lariam) .....which is the trade name for Mefloquine....which is a once-per-week tablet, and occasionally gives some people some mental health issues. I take it, as do the rest of my family, and all we get are occasional vivid dreams.
Malarone.........just about side-effect free, except that it takes half your annual income to buy in the first place.
As far as I know, nothing else is effective in Africa.
Mike

You're on honeymoon - spend the bucks and take malarone, it isn't THAT expensive. Very few side-effects.

[Gary110]

You're on honeymoon - spend the bucks and take malarone, it isn't THAT expensive. Very few side-effects.

I am a paramedic working in Africa. Malarone is your best bet. Yes, it is expensive, but it is the only prophylaxis that I trust. I have worked in some of the "hottest" malaria spots in Africa, and have not gotten malaria yet. Take the Malarone for 3 days before entering the area, then daily whilst there, and for 7 days after leaving.

Remember to also take the basic barrier precutions, like long trousers and sleeves, closed shoes and mozzie repellant between dusk and dawn. Sleep under the mozzie net (could be romantic!?) and then you will be fine.

Just remember that the initial signs and symptoms are very similar to the flu, headache, congestion, muscle and joint pain, etc. If these symptoms occur up to 3 months after being in a malaria area, go see your doc immediately and tell him you were there. He can do a smear test and have the results very quickly.

Don't mess with malaria. It does kill, and can do so very rapidly.

[dieselfan]

BIL went to Madagascar couple weeks ago, came back with flu like symptoms and went to doc. Was told it's not malaria...few days after that he was in hospital. Stupid doc?

[TheWall]

Yip, lots of people tell me the Malaria meds hides the symptoms...
Still waiting for a Doctor to agree with them and until then i will take my meds but what is up with that?

[Tony Weaver]

Yip, lots of people tell me the Malaria meds hides the symptoms...
Still waiting for a Doctor to agree with them and until then i will take my meds but what is up with that?

People who tell you malaria hides the symptoms don't know what they are talking about - malaria is the symptoms, the prophylaxis keeps it under control.

[Aries]

I am a a Paediatrician and Ihaveseen patients die from malaria.Prophylaxis prevents the sickness or at worst will prevent the fulminating spread, buying time to start effective treatment. It does not hide symptoms. Children seems especially prone to fulminating illness.So take your prophylaxis and if at any time in the "window period afterwards you feel unwell, go to your doctor and INSIST TO BE TESTED. Malaria is not a clinical diagnosis,it may be suspected but needs to be confirmed by blood tests.Rapid diagnosis and treatment is almost certain of 100% cure as opposed to a very horrible death.

[Tony Weaver]

I am a a Paediatrician and Ihaveseen patients die from malaria.Prophylaxis prevents the sickness or at worst will prevent the fulminating spread, buying time to start effective treatment. It does not hide symptoms. Children seems especially prone to fulminating illness.So take your prophylaxis and if at any time in the "window period afterwards you feel unwell, go to your doctor and INSIST TO BE TESTED. Malaria is not a clinical diagnosis,it may be suspected but needs to be confirmed by blood tests.Rapid diagnosis and treatment is almost certain of 100% cure as opposed to a very horrible death.

Excellent post. Thank you.

[pretdave]

I spent some time in Ghana a few years ago. Suffered several bouts of Malaria , despite taking the appropriate drugs.
Without the prophylaxis I have no doubt I would be dead . As it is I have suffered a 90 % loss of vision in one eye , as a side effect of the Malaria.
This loss of vision in one eye naturally affects my driving , as my depth perception is gone . Takes some of the fun out of off road driving

It is a vicious disease - dont mess with it..

Dave

[matthee]

Yes, agree this is a great post. Thanks all for contributing your knowledge and experience. Am saving this one on my PC.

[Tony Weaver]

Yes, agree this is a great post. Thanks all for contributing your knowledge and experience. Am saving this one on my PC.

This is a recurring question that arises on this forum, and every time there are people doubting the necessity of prophylaxis and repeating myths like "prophylaxis hides the symptoms". Mods, can we not post this particular thread, which gets to the nub pretty fast, as a sticky under a new category, "Medical Issues"?

[JohanJvV]

This is a recurring question that arises on this forum, and every time there are people doubting the necessity of prophylaxis and repeating myths like "prophylaxis hides the symptoms". Mods, can we not post this particular thread, which gets to the nub pretty fast, as a sticky under a new category, "Medical Issues"?

Agreed and merge it with the other thread RE Yellow Fever:

http://www.4x4community.co.za/forum/...t=yellow+fever

[Stan Weakley]

Although as a surgeon I am not an expert in the field of tropical diseases, because of my travels I have always taken a keen interest in Malaria prophylaxis. I feel very strongly that any unorthodox views propagated against prophylaxis are unfortunate and irresponsible. If you have these views please do not encourage others to adopt them.
In the medical field there will always be alternate and fringe views. Modern medicine is nowadays entirely evidence based and within the profession there is no tolerance for management that is not based on sound scientific evidence. Outside the medical profession people are entitled to their own opinions, but these alternate opinions should not be accepted as fact. The medical evidence for taking malaria prophylaxis is overwhelming, so please do not be misled. I agree that we all to make up our own minds with regard to this and many other decisions in life, but I would like to plead for common sense. If in doubt obtain advice from a medical expert that you respect. I am sorry but I cannot allow any disinformation on this topic to go unchallenged. If you want to be a "hero", well and good, but please do not try and influence others to take this sort of unnecessary risk.

The objection I have is when the anti-prophylaxis brigade parade their views as orthodox and scientifically sound. Unfortunately these dangerous views influence others to think that they can safely omit prophylaxis where it is clearly indicated. Unfortunately even within the medical profession there are fringe views on this and other topics. These would not be defendable by the doctor in a court of law!

Malanil (Malarone) is the newest and most effective of the malarial prophylactics. Its only disadvantage is its price, over R1000 depending on the length of stay in a malaria area. As far as the side-effects of Malanil are concerned they are rare and minor, uniquely so for this group of medications. If one takes the trouble to read the package insert of any medication you will notice that there is always a long list of side-effects for each and every medication. The pharmaceutical companies are obliged to report each and every side-effect. The reported side-effects such as abdominal pain, nausea, vomiting and headaches would be found in the side-effect profiles of common, very safe household medications such as Asprin and Paracetamol. Thus one needs to keep a perspective about this.

Some of the older prophylactics such as Doxycycline and Larium (Mefliam) more commonly have side-effects and this is probably where most of the antagonism to taking prophylaxis arose. For instance the skin sensitivity to sunburn found with Doxycycline and the vivid dreams, nightmares, insomnia and even psychiatric disturbances found with Larium can ruin the long-awaited trip in the bush. With Larium, the treatment of malaria can be difficult due to the interaction with Quinine causing potential severe heart arrhythmias. However millions have and will use these products quite safely. Malanil has become the gold standard because of its excellent safety profile. If for any reason (e.g. scuba diving, epilepsy, children, pregnancy) one of the other medications is what you need to use, you can do so with an easy mind. If any exceptional medical circumstances exist as in brackets above, prophylaxis will need to be tailored for the individual and I suggest you consult a medical expert in whom you have trust.
General precautions such as insect repellants, long sleeves and trousers are very important but must only be regarded as supplementary precautions.

The medical facts speak for themselves and anyone entering a malaria area for a relatively short time should take some form of effective prophylaxis. The "short time" is not accurately defined, but I would think less than 3 months should be reasonable but this is open to debate. Prophylaxis for those staying for longer periods is another matter altogether and should not be confused with short-term prophylaxis. Obviously if you live permanently in a malaria area it would not be cost or health effective to take prophylaxis. Likewise those staying for longer periods are justified in forgoing prophylaxis.
If you become ill after a trip to a malaria area both you and your doctor need to have a high index of suspicion in order to make a timely diagnosis and avoid fatal and permanently disabling complications. The blood smear to diagnose malaria is a very specific test and the diagnosis will probably not be picked up on general lab Tests. If your first test is negative it is advisable to have the tests repeated. The presenting symptoms of malaria can be very variable especially in the early stages and with partial or incorrectly taken prophylaxis. It must be suspected within a week or even a month or two after a visit to a malaria area. Symptoms may include some or all of the following. Fever, ‘flu, diarrhea, vomiting, headaches, abdominal pain etc.

There you are, off my chest now and I feel much better.
Stan.