Malaria in India

Sarah in Bristol

"Travellers told to forget malaria pills for India".
(Independent Newspaper (UK national broadsheet) 3rd July)

Full article here:

http://news.independent.co.uk/uk/hea...cle1155179.ece

Comments? Opinions? Stories?

PeakXV

Everybody has their opinions(including some sectors of the medical community apparently) on this issue cum decision. I have to disagree with them though and say that the average traveller probably does need to take the pills.

IMO, only the mosquito savy, urban and/or business traveller should be exempt from the malarial prophylactics.

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Don't go to India ~ Pre-trip Warnings & Misconceptions?

Sama

The article said the best defense is to avoid bites. However, on my first trip to India I brought DEET with me (i.e, a repellant with more than 25% DEET in it) and I was still bit up. there is no way you can cover 100% of your body with repellant OR clothes.

So until the CDC or WHO says that malaria has been eradicated from India, I'll still take the pills.

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Nick-H

The best protection against being run over is to avoid roads.

No-one, but no-one, except those lucky people who just smell ghastly (to mossies ), can guarantee not being bitten. (and, even if you do cover your body with clothes the mossies will bite through the clothes.)

So really, to suggest it as advice to avoid malaria is silly!

Interesting that they saythat the risks from the drugs are greater than tha risk of catching the disease ---but the Uk Iindependent charges money to read articles, so I guess I'll never find out

So I guess its "As you were" then.

(Moderatorial note: anyone that does read the article, please do not post its contents here! Copyright Issues! of course, a summary in your own words would be fine )

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feralBoy

My indian friend, whose family goes to india every year, never took the pills. Finally, her brother hit the malaria lottery, and it ruined his trip. Now they all take the pills.

For me, I would rather have the side effects, than my entire trip being ruined. Luckily my insurance covered the pills as well. 3 Weeks worth of malarone would have been $150.

Sarah in Bristol

Sorry - I am the original poster, and I didn't realise you had to pay to read the full article (it was available free online on the day of publication, 3 July, which is when I read it.)

The gist, as I recall, is that TropMedEurop's research found the strain of malaria most likely to be encountered by tourists in India is not the really nasty sort. (They say there's the type you die from, and then there's the type that gives you a bit of a fever and is easily treated - the risk to tourists in India is of the second kind).

They also say that the odds of catching that malaria, for the tourist in India, are very very low indeed (the statistic they gave was something like 300,000 people-days chance of receiving one infectious mosquito bite - I can't remember the exact figure this is a wild guess - it was a big number is all I remember).

This low probability of infection, combined with the consequences of the malaria not being particularly serious, led the research group to conclude that it made more sense not to take medication that carries a risk of side effects (a much higher risk than the risk of catching the malaria in the first place).

Overall, then, the research reckoned that the risk/consequence associated with a tourist taking anti-malaria medication is higher than the risk/consequence associated with that tourist not taking it. Obviously there is always a risk, but it's a question of balancing up one risk (and its consequence) with another. TropMedEurop stressed that they do not advocate "taking your chances" but said the best overall response to full knowledge of all the risk options is to use repellant, wear light coloured long clothes, use nets etc. etc. all the stuff we know - and not to take preventative medication.

They emphasised that travel to Africa, for example, would be somewhat different, because the nasy type of malaria is more prevalent.

p.s. I'm just passing on what I remember - I don't have an opinion on any of this as I have no knowledge or experience of India or malaria.

Nick-H

That's very interesting, thank you.

As a completely unqualified person, my understanding of the two type of malaria is that there is the sort that can kill you on the way to the hospital, and there is the sort that gives you a recurrent fever, for the rest of your life, that is much worse than the average does of flu.

Perhaps modern drugs have improved the treatment and control, but it is not something I would like to catch.

Then again, the side effect issue: there is one drug which some people allege has caused serious mental illness, and others which maybe cause a bit of a tummy upset.

So, if I had to balance the possibility of serious mental side effects against a controllable sickness, I'd come to a different conclusion to balancing a stomach upset against something that might need treatment for the rest of my life.

I'm also amazed at the way bite-prevention gets talked about as something people wouldn't do anyway! Mosquito bites are a pain in the... well, whichever bit of you they bite, ankle quite often, in my case.

Malaria is not the only disease they carry: a new one has featured in the press only recently, called something like chikengunya (no, not bird-flu type chiken, actually I think I've mis-spelt it, but it sounds like that).

If your immune system is used to them, you hardly notice, but to most of us Mossie bites are painful, nasty, potentially infected wounds.

jaz

Check out

http://www.newkerala.com/news3.php?a...ews&id=1 7151

IVAN

Mosquitos seem to have difficulties to bite trough silk clothes...

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Shaktipalooza

Why so? Take one urban example: Chennai. That city reports over 60% of the malaria cases for the entire state of Tamil Nadu.

The side affects can in rare occasions be serious with larium but there are other medications available with little to no side effects.

I'm quite skeptical of this report. So many other resources have made opposite claims for years. That falciparum type malaria is becoming more prevalant, over 50% in some regions of India. I certainly hope this TropMed group didn't base their findings on published world bank statistics. They've been heavily criticized for skewing the numbers for highly suspect reasons.

Here's an article more consistant with what I've been reading for years.

Malaria botch rap on World Bank

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Shaktipalooza

A couple of intersting reads on malaria in India.

Malaria in India

Mangalore Malaria in depth

Chennai Malaria

Year-Tamil Nadu cases-Chennai%
2000 - 43053 - 74%
2001 - 31551 - 75%
2002 - 34523 - 78.8%
2003 - 43396 - 67%
2004 - 41640 - 67.8%
2005 - 40594 - 62%
2006*- 7308 - 67.8%

* year to date (april)

This Chennai based software company's 'visit us' page is humorous:

"Malaria is prevalent in India, but in the Chennai region it is quite rare. The type of malaria which exists is called M. Vivax and is quite harmless, compared to the tropical malaria M. Phalsipharum. Though it is extremly unlikely to get malaria the mosquitoes are a problem at nights but they do not like an air-conditioned environment. Most westerners staying here long time do not take any malaria prevention since the drugs may actually harm you more than malaria, and the statistical risk of getting it is very low. Swedish doctors suggest that you take Chloroquin as profylax on short strips in case you plan to go outside major cities."

They include a link to a travel health network so you can have a look for yourself. For some reason the link is broken . But hey, it's on the internet so it must be true...

PeakXV

Shaktipoolza: Good point! They were actually claiming 74% in Chennai in 2000 (check link below). Wow nearly 75% of TN's cases in Chennai - although it seems a bit high to me. I guess these are due to the close quarters (jhuggis) and stagnant water. I wonder if there is a class/caste breakdown to those stats. Somehow I feel less threatened in the cities with business attire then kicking back in the Kerala backwaters - see alot less mossies too - with all the pollution/petroleum exhaust in the city air.


http://www.tnhealth.org/dphdbmal.htm

Merchant

This is not because there is more malaria in Chennai--just more PEOPLE.

PeakXV

Still TN pop is what about 60 Million, Chennai about 5 Million so the numbers don't exactly crunch. Maybe there are more hospitals/Dr's and thus more diagnosed cases. I wonder if Nick-H has heard about these unfortunate stats.

Shaktipalooza

Tamil Nadu: 62 million
Chennai Metro: 7.6 million

Chennai pop% of Tamil Nadu: 12%

12% of the population records 60%-75% of the malaria cases. I'd say there is indeed more malaria in Chennai.

PeakXV: Yeah there is probably a great deal of potential for reporting omissions to skew the numbers. It's hard enough enough understanding the situation without considering theoretical data.

The dissection of Mangalore's malaria on http://www.malariasite.com/post.htm is really fascinating, especially the map showing the clusters of malaria activity.