Mosquito Season??

pundabee

There are two aspects of WHO's policy: the long term approach (prevention of resistance) and the short term approach (immediate protection).

The simple fact is that if everyone uses malaria protection in all situations, drug resistance will speed up. It is not in anyone's interest, especially not the people who actually live in malaria affected areas, to completely lose effective protection and treatment from malaria infection. That is why the ideal approach is the long term approach where the use of protective malaria drugs is limited. Other preventative methods (application of neem or deet and the use of mosqito nets etc.) should be used effectively.

The short term approach of using drugs protects the traveller, but, to some extent, is in conflict with the long term approach. Even if WHO believed that preventative methods were sufficient protection for travellers they would always recommend malaria drugs; you can't have too many westerners getting ill with malaria.

The recommendations by WHO for travellers are:

"Malaria risk exists throughout the year in the whole country below 2000 m, with overall 40% to 50% of cases due to P. falciparum. There is no transmission in parts of the states of Himachal Pradesh, Jammu and Kashmir, and Sikkim. Risk of falciparum malaria and drug resistance are relatively higher in the north-eastern states, in Andaman and Nicobar Islands, Chhattisgarh, Goa, Gujarat, Jharkhand, Karnataka (with exception of the city of Bangalore), Madhya Pradesh, Maharashtra (with the exception of the cities of Mumbai, Nagpur, Nasik and Pune), Orissa, and West Bengal (with the exception of the city of Kolkata). P. falciparum resistance to chloroquine and sulfadoxine–pyrimethamine reported. Recommended prevention: III. In the listed higher risk areas: IV"

http://www.who.int/ith/countries/listi/en/index.html

Location type III
Malaria Risk: Risk of malaria transmission and emerging chloroquine resistance
Type of prevention: Mosquito bite prevention plus chloroquine+proguanil chemoprophylaxis

Location type IV
Malaria Risk: High risk of falciparum malaria plus drug resistance, or moderate/low risk falciparum malaria but high drug resistance
Type of prevention: Mosquito bite prevention plus either mefloquine, doxycycline or atovaquone/proguanil (take one that no resistance is reported for in the specific areas to be visited

Nick-H

Yes, that it what I read.

Ideally, the effective control of malaria is by control of the mosquito. I think most authorities agree on this, and I think we agree on this.

The trouble is, politicians seem to love to talk about this. Apparently crores are being spent on mosquito control in Chennai --- but the Buckingham Canal continues to be three inches of stagnant water, just as one example of why there are plenty of mosquitoes where I live.

I guess that, if no-one took anti-malarials, malaria would not become resistant.

But what is the traveller to do?

I don't know. It is a matter of individual choice.

In the past I've used drugs, homeopathy, and nothing.

But I could not recommend anyone to use nothing. Or to rely on personal mosquito control.

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Just one member of the IndiaMike Mod Team

guidedeba

Yes, My book is a little old. But don't you think the tablets you take which ends with 'quine' are just a derivative of "Quinine". " Just a copy of some lines from the WHO paper on Malaria for travellers from website by "pundabee.

"Quinine, along with its dextroisomer quinidine, has
been the drug of last resort for the treatment of malaria, especially severe disease. Chloroquine is a
4-aminoquinoline derivative of quinine first synthesized
in 1934 and has since been the most widely used antimalarial drug".

Sorry to let you know that, if you check about the lines in the same site a little down you will found that it is not really known why doxy work for the antimalaria and not as the Treatment of Malaria. It works as a kind of radical while used with some real medicines against Malaria to work better and may be while in Malarial condition helps not to get some other infection.

Moreover I think You are forgetting about the side-effects of taking any anti-biotic for long term and it's extra effect of making some other micro-organisms get resistant with doxy.

Further, I think if you read the post of 'pundabee' about the long-term & short-term strategy of WHO about any kind of disease. You will understand my idea behind taking this pain of checking these books and sites and writing this. A project is going on to make the mosquitoes not to get resistant so why not help it?

To Mr. Nick - H, Sorry friend if I was rude... But after reading the last post by you in this thread I understood that you understood the inherent casue why I wrote the first msg. Thanks for changing your view. And I think You can use coconut too for the vector control. In India we always do that. Burn (I mean smoke) the dry fibres of the skin of the coconut with some Dhuna / or neemleaves in the evening. you will get instant action. So use your "COCONUT".

Nick-H

Well, I was fairly rude in my first answer to you, so fair enough!

I think all this stuff makes for great discussion, the thing is that the practical advice to the traveler still seems to be: take the pills.

I've come across burning coconut fibre as a repellant, but the link I gave is to do with using the coconut to culture a bacteria that is lethal to mosquito larvae --- then chucking the coconut in the water! I think the bacteria is something called Bti? (lazy to check the link again...). Apparently it is expensive to buy, but this method makes for a cheap way of producing it.

Imagine: the Buckingham canal (if you know Chennai) sorted at the cost of a few hundred coconuts every month or so! Although it would take more than that to deal with the stench

ISTR that it was the discovery of quinine as an antimalarial/treatment that made the construction of the Panama Canal possible. Previously the sickness/mortality rate was just too high.

Recently I read that this discovery was made by Dr Haanaman (not sure of spelling) --- the father of Homeopathy!

Anders

Quinine has a lot more side effects than Chloroquine. From rxlist.com "Quinine can adversely affect almost every body system."
Doxy is used as a malaria prophylax. I have never said that it works as a treatment of malaria. I said "Doxy has been videly used for a long time, it's efficacy and toxicity should be very known by now."
I am not forgetting about anything. I am simply trying to correct a few of your incorrect statements.

martintheveg

Hi People,
I was just reading these posts.
yesterday somebody told me that my wife and i will have to pay a minimum of £2.50 a tablet for anti malaria.
For a trip of 50 days i am thinking this is going to be VERY expensive.
I do not understand your debate on quinine, i have been taking this for about one year now,with no side effects whatsoever,i take them because i was waking up with terrible cramp in the backs of my legs,(calf),I also suffer permanent back ache.
my point is, will the fact that i am a long term user of this drug actually aid my malaria protection?
Interesting stuff, can`t wait to question my doctor,
Regards,
Martin.

UberBone

It's hard to keep this issue at the top of my list - with so many things to do before leaving (I'm shutting up shop here, so lots of wrapping stuff in pastic and putting into various lofts).

Still, GP on Friday for final jab, so I'll have to make my mind up before then - the debate here is extremely interesting and informative, whatever decison I make, I can atleast assure myself that I have thoroughly thought it through, so thanks.

Nick-H

£2.50 a tablet! Martin?

Good grief. What is this doc recommending?

I would think that the proguinil/ chloroquine (both probably mispelt) combination usually (? ) recommended for India should be more like a few pence per tablet, even in UK! And is available without prescription from your local chemist

martintheveg

Hi Nick,
Sorry,it was an aquaintence that went on safari to Africa that told me this,he said he was told to take malarone and that he could not find them any cheaper than this,even on the web.I hav`nt even thought about my/our protection yet,we don`t go `till march.because of my long term medications,i assume my doctor will be very careful in what he reccomends me.
Thanx 4 input.
martin.

Nick-H

Mmmm... if you are taking regular meds, then interaction is a further complication.

The trouble with the docs is that, unless they happen to be tropical medicine specialists (or, at least, maybe have roots, not too long ago, in a tropical country) I think a lot of them just look up the travel book.

UberBone

They use this in UK http://www.travax.scot.nhs.uk/

Nick-H

...and they keep it to themselves, by the looks of it

cyberhippie

Chloroquinine and Proagunil is the recommended treatment for India and Malarone simply isn't needed, so save your money!!

The people of India have partial resistance to the parasite anyway!! so don't need to use antimalarials!

Banarasi at heart

You have not seen Indian mosquitoes if you have not been to Chennai. There used to be a cricket club called mambalam mosquitoes(I think i have said this elsewhere). What is curious is that I have seen malaria more in the North with fewer mosquitoes.

<Nick> Of course there are mosquitoes in the North but they cannot compare to the swarms in Mambalam or saidapet (in Chennai) or the painful stingers in the suburbs (like Adambakkam and further south Chennai). So if you have survived Chennai, you have seen them all. When I was a kid, I used to catch 2 or 3 in a audio casette box and shake 'em well. When released, they used to look (and act) drunk. Fortunately, I later found less cruel pastimes.

Nick-H

I just fry them with an electric zapper bat . But they have often bitten me first.

And I'm moving further south

And closer to the canal

So thanks for the encouragement!