Malaria in India

jaz · Jul 7th, 2006, 06:47

I'm sticking in delhi for just over 10 months and will not be taking anti-malaria tablets on the advice of doctors. I think for that amount of time have been told it could do me alot of damage. And have heard from other people l know or travellers l've met re horror stories of taking them. Beeen to India for 2/3 months before and had no probs just took precautions, like light colours, repellent, that all in one plug in thingy, probably taking a risk but l'd be taking a risk having the anti-malaria aswell. May consider it for 2-4 months travels around India.

Nick-H · Jul 7th, 2006, 09:59

Statistics. I'm in the inumerate camp, I'll leave those to people like SP . I have heard that Malaria is more often found in the North of the City. I don't know much about what's up there past Parry's: Docks, industrial stuff, ... ...? Not many tourists!
Stagnant Water is something we have plenty of. The huge mossie population could probably be greatly reduced if only the corporation would sort out the Buckingham Canal; they show no signs of doing so.
World Bank Heard a BBC program about this back in the UK some months ago. It sounded pretty damning. On the other hand...
Chloroquine: According to my Chennai doc, the malaria here is not Chloroquine-resistant, and that is what he advised me to take. But that is only one doc, and maybe he read the World Bank report
Air Conditioning: In an AC environment it is unlikely that doors and windows will be open, thus fewer mossies should be found indoors. But to say that they don't like it is quite wrong! They, like us, don't like it too hot! In my place they are most likely to be found sitting on the net in the cool air from my bedroom AC unit!
Silk: Interesting, I haven't heard that before. But silk is just too hot and sweaty for the S. Indian climate. They have no difficulty biting through light cotton ---or through a mossie net if you lie, or put your feet, against it!
Urban/Rural: From SP's Tamil Nadu link (very interesting) it looks as if the danger is greater in urban areas than rural. So to think "I'm only going to the city, I will be ok" could be utterly wrong!

edwardseco · Jul 7th, 2006, 10:06

Nick is right, mosquitos love the cities. I suspect that a lot of rural cases don't get reported. The same in urban areas. My own case wasn't. It was home care and why bother with paperwork? More recent research at the world conference on malaria indicated a vast under-reporting of cases worldwide. Long term is the proble since no malarial I know is rated for that length of time..

edwardseco · Jul 7th, 2006, 10:06

problem..

PeakXV · Jul 7th, 2006, 11:13

So then the odds are really pretty good that in a city with approximately 7 million tasty treats (people) that a malarial mossie will not infect you. Especially if you are not barefooted/ankled, have a little bit of insect savy, and squirt the occassional spritzer of repellent in your general direction every now and then!?

AnneT · Jul 7th, 2006, 13:32

Just to add a bit more to the debate - vivax malaria has been known to kill. As for antimalarials - doxycycline 100 mg/day has few side effects if taken with food and if you don't lie down for half an hour after taking it. The main problems with it are increased sensitivity to sunlight and interference with oral copntraceptives.

adam_carsis · Jul 11th, 2006, 20:54

I will be in North-east India from Sept-Jan. Are mosqitoes everywhere no matter what time of year or do they slow down in the winter? Are they in Nepal during this time at high alt.?

icetea · Jul 12th, 2006, 13:42

Are you long-timers really taking any anti-malaria stuff? I mean...how long can one keep on taking those pills, really...

I never took anything, except for some doxicycline in the beginning, for 10 days. Then I got bored, it just seemed useless..I can't be taking it for years anyway. And biting is there...plenty of it.

Anyone who came up with a nice, ancient, herbal method of making the mosquitos dizzy in the room?

These All-Out and Good Knight solutions are giving me horrible headaches...I used to try citronella at some point...but my goodness...what strong smell! Neem oil is also said to be effective..but that one has a horrible smell.

Nick-H · Jul 12th, 2006, 14:36

Yes, I take chloroquine once a week.

...when I remember!

I had a malaria test last time I had a severe fever: it was negative.

icetea · Jul 12th, 2006, 15:40

hmm...so you do take it...
No but honestly..do you plan on taking it all your life?

I've actually not enquired much into this aspect, so I dont know: are locals' immune systems better equiped against malaria than ours?

Penri · Jul 12th, 2006, 15:48

It was hammered into me by my Dr in the UK (and my company) that I must take anti-malarial tablets if going to Chennai. I take the combination dose of chloroquine & proguanil and do suffer some mild side effects (mood swings, nausua).

I have seen what it's like to live with Malaria and happily accept these side effects to the drugs.

Long term? Chloroquine & proguanil can cause retina damage after 3 years continual use as well as sensitivity to sunlight. I hope I'll be allowed back home before then

Whenever someone's asked me for advice on this, I've always suggested that they find out about malaria and to make their descision based on whether or not they can accept a greater risk of being infected.

Nick-H · Jul 12th, 2006, 15:54

I don't know, to be honest. I suspect that, one day, I'll think, Oh! haven't taken a malaria pill for the last few years...

Nor do I know what determines immunity to Malaria. Many locals in malarial areas are immune*, but many are not, or malaria wouldn't be one of the world's biggest killers.

*what does this mean? does it mean that the buggy can't live in their blood, or that it does live, but doesn't harm them?

icetea · Jul 12th, 2006, 16:32

yup...Nick...so...I'm really not worring about it anymore, becase I simply know that I can't be taking anti-malaria pills all my life. Plus..as you say...so many locals get infected anyway. It's a lottery game that you have to play.

I have been living here without anti-malaria protection since April last year...so that's more than a year now. Lots lots of bites, but no health problems so far.

I just hate the bites themselves, of course. I used to get bad rashes and scars from each bite, in the beginning. Now the bites are barely visible. So I guess I'm beginning to become more like the locals myself

...let's hope that works for anti-malaria protection as well!

Penri - you are of course right, but some of us are living here, maybe for good (

but god forbid!). So the situation is a bit different.

Penri · Jul 12th, 2006, 17:00

Quote:

Originally Posted by icetea

Penri - you are of course right, but some of us are living here, maybe for good (

but god forbid!). So the situation is a bit different.

Why is it different?

The risk of malaria exists whether you are bitten once or a thousand times. In fact, probability would indicate that your chances of being infected increases with time.

I've had this discussion with an American colleague who's been living here for the past 6 years. He's a very strong advocate of not taking any anti-malarial drugs (due to side effects and long term damage). Actually, I've yet to meet anyone who lives here long term that continues to take these pills.

I apprecaite that the pills are not for everyone - and certainly not for long-term usage, however there must be an alternative?

70s-80s overlander · Jul 13th, 2006, 04:45

Dox does NOT cause a problem with PROGESTERONE based contraceptives. See my longer post dated January 4th, 2006, 09:53 PM, titled "Doxy does not affect Progesterone-based Contraception".
Short blip:

reference: http://www.nathnac.org/pro/misc/faq_malaria.htm
[this is long, but the topic seems important enough to merit this length]

"Doxycycline can temporarily decrease colonic bacteria thus inhibiting the enterohepatic circulation of ethinylestradiol, the semi-synthetic oestrogen contained in all combined hormonal contraceptives. This can also occur with other antibiotics.
"There is no secondary re-absorption of progesterones via the enterohepatic circulation and therefore doxycycline (and other antibiotics) has no effect on the efficacy of progesterone-only contraceptives (including the pill, injectables, implants, the levonorgestrel releasing intrauterine system, or progesterone only emergency contraception). Therefore, this advice only applies to those taking combination contraception.

****
Let me add, as a physician and as a traveler, that Doxycycline is by far one of the most useful antibiotics to have available, as, according to the dose given, it treats so many things. If I were to have only one antibiotic with me, it would be Doxy.

Jul 7th, 2006, 09:59	#17
Nick-H Loud-mouthed, Noisy Bird Join Date: Oct 2004 Location: Chennai, India Posts: 28,426	Statistics. I'm in the inumerate camp, I'll leave those to people like SP . I have heard that Malaria is more often found in the North of the City. I don't know much about what's up there past Parry's: Docks, industrial stuff, ... ...? Not many tourists! Stagnant Water is something we have plenty of. The huge mossie population could probably be greatly reduced if only the corporation would sort out the Buckingham Canal; they show no signs of doing so. World Bank Heard a BBC program about this back in the UK some months ago. It sounded pretty damning. On the other hand... Chloroquine: According to my Chennai doc, the malaria here is not Chloroquine-resistant, and that is what he advised me to take. But that is only one doc, and maybe he read the World Bank report Air Conditioning: In an AC environment it is unlikely that doors and windows will be open, thus fewer mossies should be found indoors. But to say that they don't like it is quite wrong! They, like us, don't like it too hot! In my place they are most likely to be found sitting on the net in the cool air from my bedroom AC unit! Silk: Interesting, I haven't heard that before. But silk is just too hot and sweaty for the S. Indian climate. They have no difficulty biting through light cotton ---or through a mossie net if you lie, or put your feet, against it! Urban/Rural: From SP's Tamil Nadu link (very interesting) it looks as if the danger is *greater in urban areas than rural.* So to think "I'm only going to the city, I will be ok" could be utterly wrong! __________________ . Just one member of the IndiaMike Mod Team

Jul 7th, 2006, 11:13	#20
PeakXV Naan.tering Nabob Join Date: Oct 2005 Location: Abode of Glooscap Posts: 4,515	So then the odds are really pretty good that in a city with approximately 7 million tasty treats (people) that a malarial mossie will not infect you. Especially if you are not barefooted/ankled, have a little bit of insect savy, and squirt the occassional spritzer of repellent in your general direction every now and then!? __________________ What lies behind us and what lies ahead of us are tiny matters compared to what lives within us. ~ Oliver Wendell Holmes Don't go to India ~ Pre-trip Warnings & Misconceptions?

Jul 11th, 2006, 20:54	#22
adam_carsis adam carsis Join Date: Jun 2006 Location: Dallas, Texas, USA Posts: 34	mosqs in winter? I will be in North-east India from Sept-Jan. Are mosqitoes everywhere no matter what time of year or do they slow down in the winter? Are they in Nepal during this time at high alt.?

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Jul 7th, 2006, 06:47	#16
jaz Senior Member Join Date: Aug 2003 Location: UK Posts: 192	I'm sticking in delhi for just over 10 months and will not be taking anti-malaria tablets on the advice of doctors. I think for that amount of time have been told it could do me alot of damage. And have heard from other people l know or travellers l've met re horror stories of taking them. Beeen to India for 2/3 months before and had no probs just took precautions, like light colours, repellent, that all in one plug in thingy, probably taking a risk but l'd be taking a risk having the anti-malaria aswell. May consider it for 2-4 months travels around India.

Jul 7th, 2006, 10:06	#18
edwardseco Maha Guru Member Join Date: Sep 2001 Location: Land that shakes and bakes. Posts: 4,436	Nick is right, mosquitos love the cities. I suspect that a lot of rural cases don't get reported. The same in urban areas. My own case wasn't. It was home care and why bother with paperwork? More recent research at the world conference on malaria indicated a vast under-reporting of cases worldwide. Long term is the proble since no malarial I know is rated for that length of time..

Jul 7th, 2006, 13:32	#21
AnneT Member Join Date: May 2005 Location: Australia Posts: 43	Just to add a bit more to the debate - vivax malaria has been known to kill. As for antimalarials - doxycycline 100 mg/day has few side effects if taken with food and if you don't lie down for half an hour after taking it. The main problems with it are increased sensitivity to sunlight and interference with oral copntraceptives.

Jul 12th, 2006, 13:42	#23
icetea 'sort of hate India' club member Join Date: Aug 2004 Location: Chennai, via Romania Posts: 917	Are you long-timers really taking any anti-malaria stuff? I mean...how long can one keep on taking those pills, really... I never took anything, except for some doxicycline in the beginning, for 10 days. Then I got bored, it just seemed useless..I can't be taking it for years anyway. And biting is there...plenty of it. Anyone who came up with a nice, ancient, herbal method of making the mosquitos dizzy in the room? These All-Out and Good Knight solutions are giving me horrible headaches...I used to try citronella at some point...but my goodness...what strong smell! Neem oil is also said to be effective..but that one has a horrible smell.

Jul 12th, 2006, 14:36	#24
Nick-H Loud-mouthed, Noisy Bird Join Date: Oct 2004 Location: Chennai, India Posts: 28,426	Yes, I take chloroquine once a week. ...when I remember! I had a malaria test last time I had a severe fever: it was negative.

Jul 12th, 2006, 15:40	#25
icetea 'sort of hate India' club member Join Date: Aug 2004 Location: Chennai, via Romania Posts: 917	hmm...so you do take it... No but honestly..do you plan on taking it all your life? I've actually not enquired much into this aspect, so I dont know: are locals' immune systems better equiped against malaria than ours?

Jul 12th, 2006, 15:48	#26
Penri Senior Member Join Date: Feb 2006 Location: Chennai Posts: 169	It was hammered into me by my Dr in the UK (and my company) that I must take anti-malarial tablets if going to Chennai. I take the combination dose of chloroquine & proguanil and do suffer some mild side effects (mood swings, nausua). I have seen what it's like to live with Malaria and happily accept these side effects to the drugs. Long term? Chloroquine & proguanil can cause retina damage after 3 years continual use as well as sensitivity to sunlight. I hope I'll be allowed back home before then Whenever someone's asked me for advice on this, I've always suggested that they find out about malaria and to make their descision based on whether or not they can accept a greater risk of being infected.

Jul 12th, 2006, 15:54	#27
Nick-H Loud-mouthed, Noisy Bird Join Date: Oct 2004 Location: Chennai, India Posts: 28,426	I don't know, to be honest. I suspect that, one day, I'll think, Oh! haven't taken a malaria pill for the last few years... Nor do I know what determines immunity to Malaria. Many locals in malarial areas are immune, but many are not, or malaria wouldn't be one of the world's biggest killers. what does this mean? does it mean that the buggy can't live in their blood, or that it does live, but doesn't harm them?

Jul 12th, 2006, 16:32	#28
icetea 'sort of hate India' club member Join Date: Aug 2004 Location: Chennai, via Romania Posts: 917	yup...Nick...so...I'm really not worring about it anymore, becase I simply know that I can't be taking anti-malaria pills all my life. Plus..as you say...so many locals get infected anyway. It's a lottery game that you have to play. I have been living here without anti-malaria protection since April last year...so that's more than a year now. Lots lots of bites, but no health problems so far. I just hate the bites themselves, of course. I used to get bad rashes and scars from each bite, in the beginning. Now the bites are barely visible. So I guess I'm beginning to become more like the locals myself ...let's hope that works for anti-malaria protection as well! Penri - you are of course right, but some of us are living here, maybe for good ( but god forbid!). So the situation is a bit different.

Jul 13th, 2006, 04:45	#30
70s-80s overlander 70s-80s overlander Join Date: Sep 2005 Location: chicago,il,usa Posts: 177	Dox does NOT cause a problem with PROGESTERONE based contraceptives. See my longer post dated January 4th, 2006, 09:53 PM, titled "Doxy does not affect Progesterone-based Contraception". Short blip: reference: http://www.nathnac.org/pro/misc/faq_malaria.htm [this is long, but the topic seems important enough to merit this length] "Doxycycline can temporarily decrease colonic bacteria thus inhibiting the enterohepatic circulation of ethinylestradiol, the semi-synthetic oestrogen contained in all combined hormonal contraceptives. This can also occur with other antibiotics. "There is no secondary re-absorption of progesterones via the enterohepatic circulation and therefore doxycycline (and other antibiotics) has no effect on the efficacy of progesterone-only contraceptives (including the pill, injectables, implants, the levonorgestrel releasing intrauterine system, or progesterone only emergency contraception). Therefore, this advice only applies to those taking combination contraception. **** Let me add, as a physician and as a traveler, that Doxycycline is by far one of the most useful antibiotics to have available, as, according to the dose given, it treats so many things. If I were to have only one antibiotic with me, it would be Doxy.

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