Anti-malarials in India

HelenR

Is Larium really that bad? A doctor friend recommended that to us as the best option. I am very prone to mood swings, went through depression for about a year, maybe I shouldn't take Larium?

As a side note, I came from Rio a week ago. I used Ultrathon with 34.4% deet and Cutter Advanced with 15% picardin, applied one or the other once a day (sometimes twice), as the directions say. I got bit 4 times. Does this mean these insect repellents won't work in India?

zoltan

Hi Helen,

I was going to say (having read the first part of your sentence), don't take it if you have any depression or mood swings. Then I read the 2nd part of your first line.

My recommendation is that you avoid this like the plague. Your GP recommending this (if (s)he knows you have bouts of depression should know better.

Anyway, depends on when and where you are going. If it is during the peak season (when chances of contracting malaria are higher), find an alternative deterrent - roll-on's; nets for night use. Avoid the use of perfumes and bright clothing (they attract mosquitoes).

Consider alternative medicines (doxycycline (cheap but has other side-effects) or malarone (works well but expen$ive)).

Cheers
Zoltan

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Nick-H

And probably many people reading your post would have said exactly the same thing. Is it that bad? Many people take it with no ill effects, but if it is bad for you, then it can be very bad. I see no justification at all for taking that risk when there is a choice of several other anti-malarials. Depending on where you are travelling in India, the risk may not be high anyway.

"Repellent" is a great misnomer, and it would be great if someone invented one! They do not actively repel mosquitoes, they mask your smell, or confuse the senses of the mossie (it is mostly be smell that they find you) so that they find it harder to find you. If they do find you, they'll bite if they feel hungry; the 'repellent' does not stop them.

DEET still holds number-one place in the effectiveness table, and it will work as well in India as it does anywhere in the world. The percentage determines how long the effect lasts; if you want it to work all night you probably need 50%. You can find these numbers somewhere on the internet.

In the end, whether any particular repellent, combined with your specific odours, works, is an entirely personal thing. I find DEET fairly effective, but I only use it occasionally anyway, but one other compound I tried a few years ago for a trip was markedly useless!

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HelenR

Thanks for the advice Nick-H and Zoltan. I will definitely bring up my mental health concerns with the doctor before getting the meds.

I am allergic to a lot of antiobiotics so I'm not sure if I can take doxy. I'll look into malarone.

We will be traveling in the North. Our route consists of: Mumbai, Ahmadabad, Udaipur, Jodhpur, Jaisalmer, Jaipur, Delhi, Amritzar, Agra, Varanasi. We will be there September 7 or 8 through October 5. Is this the peak malaria/mossie ( ) season?

All this time I actually thought mossies would be repelled by these "repellents," since I sure am! Sigh...

Nick-H

Sometimes you can see the mossie looking as if it is being repelled. It flies close, does a couple of, "but... but... I was sure!" confused circles and flies off again.

If you were bitten four times using the stuff, you probably would have had countless bites without it!

Groovemeister

I'm moving to Delhi/Gurgaon in August and was told that it's not high risk so needn't take anti-malarials - just do what we can to avoid getting bitten and be aware of any malaria-like symptoms.

brownboy66

I'm always wary of advice that relies on some commonly held yet unquantifiable statistic to give you piece of mind (i.e - the chances of catching such and such are low). Friends of ours were told the chances in Delhi were low and sure enough, last wet season the husband got malaria (thankfully - it wasn't severe). The way he thinks of it now is that the risk in Delhi is low, right up till the time to catch it!

Having said that - being here for a few years means popping pills daily isn't really an option - so as you've said a rigorous regime based around not getting bitten is what we follow (deet on the skin when going out - coils around the entrances if visitors are coming - electric repellants in the house).

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Groovemeister

It's all about the balance of accepted risk - which in the end is a personal decision. Of course - low risk doesn't mean no risk - but you get as much info/advice as you can and then decide for yourself what course of action you think is best.

If I was coming for 3 or 4 months then I'd probably take anti-malarials. For 2 years, the balance of risk shifts towards the possible side effects (not to mention the incovenience and expense)of taking medication for that length of time.

Deet, nets, coils, repellants and vigilance against symptoms is good enough for me.

Nick-H

Nets and symptom watching is as far as I go here. DEET occasionally. I get bitten pretty regularly, but if it were not for those nets I'd be a pin cushion.Do you often get bitten by your visitors? And do the coils prevent it?

brownboy66

oh, absolutely. At the end of the day any decision about your personal health is your own decision. Its something that each individual has to weigh up for themselves.

Don't misunderstand - my comment wasn't directed at your decision - which is totally your decision to make. It was more about the statements you sometimes here which seem to be nothing more than conjecture dressed up as maths - which says the chances, likelyhood, statistical probability, etc - are low. I'm just a bit sceptical of that sort of thing in general. Don't get me wrong - if I were sitting in front of a one arm bandit in Las Vegas then wooohooo - give me the odds and I'll have a go. When it comes to dealing with sometimes fatal, often debilitating diseases with reoccurring symptoms that can continue to inflict suffering for decades - mmmmmmmm.....no. That's the type of gambling I'm not into - but as you said its a personal decision.

and a very balanced perspective to take.

I don't know that the risk of long term use is just a possibility is it? I don't know of any literature that highlights a safe "long term" malaria medication? In any case I've had previous ailments that simply rule out long term use (irreversible damage to vital organs - that sort of thing). So prevention is all I've got.

Not as often as I'd like to.....

for the tiny flying visitors with ultra sonic wing actions - yes. Its just something we do when we have a lot of visitors coming in and out of the house....

Groovemeister

Don't worry, I hadn't misunderstood! The statistics for a given region should be considered, but that shouldn't be your only consideration I guess.


I don't know, my understanding is that some are worse/more risky than others - though I think chloroquine is supposed to be the safest for long term use and it's also the least effective now that there are resistant strains!

brownboy66

sorry....my mistake for not making it clearer - and believe me, I'm definitely not worried!

The "conjecture dressed up as maths" was a round about way of saying I don't trust the validity of general statements/ statistics regarding the possibility/probability/likelyhood of catching a disease - so my position would be to assign little or no consideration to the stats and just get the medication anyway - if it were an option and it was my decision.

But as you said - completely a personal choice thing.

Nick-H

I know I've met people within the past twenty years who said that they had reoccurring attacks of malaria, and the general view always used to be that (assuming you didn't die in the first week) once you caught malaria you had it for life.

If it was true, it seems it is not now. This from the Myths section of my favourite malaria-info source book:
I think, though, that key words here are If the patient has received a full course of treatment with modern antimalarial drugs and has not been re-exposed to malaria

edwardseco

Very well put, IMHO..

pundabee

In a moment of acute boredom I have calculated the risk of contracting malaria if staying in any of the Indian states.

The columns labelled "1994" through "2003" show the number of malaria cases (all types) in the respective states each year from 1994 till 2003. The column "2001 population" show the population in the states in the year 2001. The final column shows the number of malaria cases per 1000 people living in the state.

The poplution numbers were taken from http://finance.indiamart.com/india_b...opulation.html

The malaria numbers were taken from a report called "Burden of Disease in India" published by the National Commission on Macroeconomics and Health.

Due to time constraints, I used the 2001 population numbers with the 2003 malaria cases. Though not ideal, all it means is that the malaria risk in the table is slightly overestimated due to the population in 2003 being slightly higher than the population in 2001. I could of course have used the malaria numbers from 2001, but using the most recent malaria data is of much greater importance than accuracy in the population numbers (due to the downward trend in the number of malaria cases).

The table should be read in the following way: The highest risk of contracting malaria is in Arunachal Pradesh where for every 1000 people almost 32 contract malaria every year. So, if you were to stay for one year in Arunachal Pradesh, you would have a 3.2% risk of contracting malaria. If you were to go there for a week the risk would be 3.2 divided by 52 (the number of weeks in a year), which equals 0.06%. The lowest risk is in Himachal Pradesh and Punjab states.

See attached pdf document.

Attached Files

malaria.pdf (12.3 KB, 63 views)