Malaria

Alan D

Just had a letter from Maan Barua in Assam--see my write-up on Wildgrass Resort , Kaziranga, Assam in the hotels section. He has been ill with malaria for the first time in his life and describes it as "the ultimate wildlife experience". I would have thought being charged by one of those rhinos they have at Kaziranga would be even more ultimate.

This made me think about a few things. Assam has endemic malaria yet he had managed to avoid getting it for twenty years. Out of the 1 billion+ population of India what % actually suffer from the disease? Not the whole population, obviously. Are some individuals completely immune then like the Tharu tribe in Nepal?

If so can you find out if you are immune by having a simple blood test?

Now that the monsoon has arrived over most of the country the main risk season has begun and anyone travelling should take precautions, although if you are over 5000-6000 feet in the Himalayas or in the dry areas of Rajasthan you should be ok. Never believe the local hotel owner's assurance that there are no mosquitos in his particular neck of the woods. I have been told this in rooms where squashed remains of mosquitos decorate the paintwork.

Remember, if you have decided to take medication, that you need to do so for some time before you enter a malarial area and also after leaving for it to give you protection.

Looks like I was wrong about Rajasthan. Just found the following web site.

http:www.twnside.org.sg/title/india-cn.htm

archits

A quick survey of the ten houses in my neighbourhood over thirty years that we have lived next to each other - maybe two or three cases

Alan D

An interesting observation archits, but I wonder how typical this is of the general area you live in. I would imagine you don't exactly live on the wrong side of the tracks!

General lifestyle has probably got a lot to do with whether one contracts malaria eg sealed air-conditioned rooms at the height of the worst season, general good health and being able to afford the neccessary medicines. I would think the incidence of malaria must be higher in the poorer parts of town and among village populations.

The fact that many people in India don't get malaria ever in their lives still leads me to think that many individuals must have some immunity or is it that they never get to meet the wrong mosquito?

Alan D

"It is also possible, that they just do not get malaria because they do not"

How can I dispute the logic of that statement? It's quite apparent that some people do and some people don't but the poorer sections of society are generally more vulnerable to a whole range of diseases. The authors of the above report were warning about the gradual increase in reported cases in recent years and listed some of the factors -- the overuse and misuse of pesticides, increasing resistance to medicines, more irrigated areas with lying water etc They also suggested some solutions to the problem based not on insecticides and pesticides but on eco-friendly methods.

Malaria IS endemic to India, otherwise why would every pharmacy sell anti-malarial drugs? Why would most foreign visitors take anti-malarial drugs? The only thing in doubt is the actual statistics but I would guess any available statistics are an understatement of the actual number of cases. Many people probably can't afford the treatment and don't even go to see a doctor.

Fact from fiction? I am a very poor story teller!

archits

My last post on the topic.

See my first post - is true for all of India . I have lived in many parts and have family all over.

Yes , the incidence might be higher in the poorer unhygienic parts of town ; however , it is by no means alarming. To me alarming would be seventy percent.

Getting malaria is no big deal - I got it once. In three days it was over. Cost to me - 25 rupees doctors visit , 20 rupees blood test, fifteen rupees pills - costly to treat ? doubt it. sorry one more visit to doctor 25 rupees again , or maybe he did not charge me in the second visit.

if detected , malaria is the easiest to cure. Is it detectable ? sure . most times it is easy.

why do pharmacies sell malaria pills - sure , there is malaria right ?

why do foreigners take malaria shots coming into india ? beats me - there is enough malaria in their own coutnries - if they do not take it there , they should not here.

I know plenty foreigners who do not get unnecessarily alarmed. Has the LP contributed to this alarmist view? - sure.

finally the mystery on why so many do not catch malaria - no mystery ,really. same as many do not get flu or fever , or diarrohea or..........and some get it. Nothing special abt malaria.

Most research is triggered by the alleged "media noise" about malaria - Non issue to me , malaria. Same as any other disease by and large.

Alan D

My last post also archits. We could go on disagreeing about this for weeks.

The following might be of interest to some

Repellents with DEET most effective against mosquito bites


AP [ THURSDAY, JULY 04, 2002 10:46:32 AM ]

NEW YORK: Insect repellents containing the chemical called DEET provide the best protection against mosquito bites, according to a report in Wednesday's New England Journal of Medicine.

Bug sprays and lotions that rely on plant oils or another chemical do not last as long and might require several applications, according to the report. Three repellent wristbands tested did not work at all.

"I don't think there's anything wrong with using alternatives and I don't think DEET is a perfect repellent. But it is still more effective and very safe," said one of the researchers, dermatologist Dr. Mark Fradin of Chapel Hill, North Carolina.

DEET has been on the market in the US since 1957 and a 1998 review by the Environmental Protection Agency deemed normal us safe. Yet many consumers are reluctant to use DEET and seek out alternatives, the researchers said.
Knowing which repellent works best is important when used to protect against mosquito-transmitted diseases, they said.

Fradin worked with Jonathan Day of the Florida Medical Entomology Laboratory in Vero Beach to test the effectiveness of 16 products.
Each was tested three times on 15 workers at the University of Florida lab.
For the study, each worker applied repellent, put their arm into a cage with 10 mosquitoes for a minute and reinserted it at intervals until the first bite.


The DEET-based products offered complete protection for the longest time, and higher concentrations worked best, the researchers said.

tlotoxl

Malaria may be highly treatable in the modern age, but presumably it is not called the million-killer for nothing ( http://lists.isb.sdnpk.org/pipermail...st/000859.html ).

There are also various types of malaria, with some being much more treatable than others and some people being much more susceptible than others. Three days sick sounds like awfully good luck to me, though apparently some people are exposed to it and never even notice that they're sick.

While I was in India this September I read Amitav Ghosh's "The Calcutta Chromosome" in which a character describes the malaria fever as being one of the strongest psychedelic experiences imaginable, resulting in a permanent change of perceptions. Perhaps that character/author was more susceptible than most, but I'd still play it safe...

Tomi

Beyond the realities and percentages, diseases that are unfamiliar to us Westerners are scarier than the flu or pneumonia, even if the latter may kill more people, so why not take malaria pills to ease your mind?
And treatment against falciparum malaria is easy for most people. I have taken doxycycline several times and spent hours in the sun without any effect, and mefloquine (Lariam) twice and had no nightmares or psychological effects... I think
All that said, many Europeans go to India without malaria pills, and it's Americans and Canadians who are at the most paranoid end. It's obvious that the likelihood of getting it is small. And it's true that doctors in India are terrific and medical care very cheap, cheaper than the cost of the pills.
Has anybody heard if there are any studies about the effects of taking Malarone for over two months? It's a relatively new drug which I think is prescribed for Cambodia, but not for India.

tlotoxl

Yeah, speaking of unfamiliar - I was terrified when I learned that Filaria was the precursor to Elephantiasis.

Didn't feel any better when I saw some people in Fort Cochin with it, either. Still, you gotta figure it's rare if only 0.001% of the lifetime residents of a place have it.

Tomi

I posted a question about the availability of Lariam (mefloquine) in India, and since it didn't get answered here, I e-mailed both Kerala and Tamil Nadu tourism. The Kerala office answered:
"Mefloquine is available in India and is marketed under the trade name ‘Mefleam’ by Cipla. It is available as tablets containing 250 mg of mefloquine."
Their e-mail address is invis@vsnl.com, if anyone else has questions for them.
250 mg is the same dose of Lariam as prescribed here in the US. That's not always the case with Indian medications; as Indians come in smaller sizes than we yanks, their antibiotics dosage is sometimes smaller than what doctors here prescribe.

hereandnow

What parts are most affected by Malaria???

Tomi

Do you mean Kerala, Rajasthan, Uttar Pradesh, or do you mean toenails, spleen, urethra, lungs?
I still haven't heard from Tamil Nadu tourism. The difference between them and Kerala tourism by now is remarkable.
Took my first Lariam yesterday and dreamt that something or someone was hurting me but I don't remember what/who. Mild side effect, I'd say. Not yet suicidal; going to a congressman's inauguration party tonight and I hope I'm not homicidal.

absolut

I personally have never taken malaria pills to go to India and - knock on wood - also never got malaria, although most of the time i was staying with locals staying in local areas. I even got the advice of my doctor, specialised in tropical diseases, not to take malaria tablets if you go regularly and for longer periods, since the tablets can have some nasty side effects. They are not good for your eyes for example. Abt Lariam i have lastly read that there are cases known of getting paranoia or extremely agressive after or while using it for a longer period.
Also in my in-law family i have never heard of any of them getting malaria. I will not say there is no malaria in India because there is, but where the urge of taking malaria tablets is concerned i think it is mainly propaganda of the medical companies wanting to sell their tablets which is trying to make travelling people unnecessarily afraid so that they keep on buying and using these tablets.

Tomi

Again, this is not an endorsement; I take Lariam (mefloquine) and it doesn't give me any problems. Here's the list of Lariam equivalent medications (and the labs that make them) available in India. All are in 250 mg pills, the same as Lariam in the U.S. (Some names may be slightly misspelled--wrongly copied)
Mefliam, by Cipla.
Meflotas, by Intos.
Mefque, by Zydus.
MQF, by Sun Pharmaceuticals.
Confal, by Lupin.
Falcital, by Cadila.
Larimef, by IPCA.
Mefax, by Alkam.
Mefoc, by Aristo.
There is a slight problem, though: it doesn't appear to be easily available. Pharmacies in Trivandrum (Kerala) would say things like "Mefiam is no longer available", "no malaria medication is available in India, except chloroquin", etc.
I had to go to the Medical College Hospital pharmacy, where I got LARIMEF, labeled "for hospital use only". It cost less than 40 rupees a pill, a fraction of what it costs in the west.
If you are persistent, and you realize that a large percentage of what people tell you in India is false, I'm sure you can get it in sizable towns, but you might prefer to pay the high price and bring them from home. It's up to you.
If you choose not to take any malaria medication, people here tell me that newspapers report malaria cases, so you know about the region you're visiting. I haven't checked for myself.

vistet

Tomi,
relieved to hear from you again- I guess this means the congressman made it ...

One missing point in the discussion on the side effects is what the drugs actually protect you against. The worst case scenario for the drugs (very rare) must be compared to the worst case scenario of the disease( also very rare).
If I could "choose" between streaking through an Indian bazaar and spending a week in Intensive Care on a ventilator I would hope to avoid both and prefer the former.