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Old Wednesday 13th September 2017, 08:02   #1
birdboybowley
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Malaria tablets for Ethiopia

Hey all,
Off for a 17-day trip next month and am getting conflicting info regarding malaria tablets. I'm assuming I will need them but just wanted to ask past visitors on here what they did.
TIA
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Old Wednesday 13th September 2017, 09:28   #2
Bryon Wright
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Malarial tablets

Hi BB,
this is a difficult one and I am not a doctor! Recently went for hep. A and the nurse said there was no vaccine available in the UK. We compromised by saying to each other that by now I was probably immune anyway. I have had a few exotic diseases but never malaria. I used to take tablets regularly and as prescribed in those days. I would suggest you forget about tablets because the effective ones are ultra expensive and have the potential for some really bad side effects that might spoil your birding. Use all other preventive methods and never sleep without a net. If you are going into a specific area with recognized cerebral malaria outbreaks then do take the prescribed tablets without fail. You can buy the localised medication throughout Africa now but obviously supply cannot be guaranteed 100%. Surely you will be at altitude anyway for some of the time and other non malarial but mosquito transmitted diseases can be more of a problem for the short term visitor, anyway. Doxycycline will not protect you much from malaria these days but it is cheap when bought locally, and is a temporary prophylaxis against a host of tropical diseases. It also has minimal short term side effects. Finally remember what happened to the researcher who bought fake anti malarial tablets in Cambodia.

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Old Wednesday 13th September 2017, 10:01   #3
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Originally Posted by birdboybowley View Post
Hey all,
Off for a 17-day trip next month and am getting conflicting info regarding malaria tablets. I'm assuming I will need them but just wanted to ask past visitors on here what they did.
TIA
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It doesn't sound like the sort of place where it would be worth it - most of the sites are fairly high up and / or dry. I wouldn't think you would get very good advice from the NHS sites / staff so need to look carefully at other international sources and look at each province / region. I can't recall whether I used anything on my trip, about 10 years ago.

cheers, alan
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Old Wednesday 13th September 2017, 13:22   #4
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Hi BB,
this is a difficult one and I am not a doctor! Recently went for hep. A and the nurse said there was no vaccine available in the UK. We compromised by saying to each other that by now I was probably immune anyway. I have had a few exotic diseases but never malaria. I used to take tablets regularly and as prescribed in those days. I would suggest you forget about tablets because the effective ones are ultra expensive and have the potential for some really bad side effects that might spoil your birding. Use all other preventive methods and never sleep without a net. If you are going into a specific area with recognized cerebral malaria outbreaks then do take the prescribed tablets without fail. You can buy the localised medication throughout Africa now but obviously supply cannot be guaranteed 100%. Surely you will be at altitude anyway for some of the time and other non malarial but mosquito transmitted diseases can be more of a problem for the short term visitor, anyway. Doxycycline will not protect you much from malaria these days but it is cheap when bought locally, and is a temporary prophylaxis against a host of tropical diseases. It also has minimal short term side effects. Finally remember what happened to the researcher who bought fake anti malarial tablets in Cambodia.
Not wanting to be rude, but this is almost complete bullshit. Just for starters, advising anybody to forget about tablets because the cheap ones are ineffective is total nonsense, especially when you then go on to talk about sourcing anti-malarial tablets locally in Ethiopia.

Where do you get your information that doxycycline "won't protect you much", given that it is one of the prophylactics recommended for Ethiopia by people who actually are doctors? Who in their right mind would opt to buy malarial prophylactics in Ethiopia if they could buy them from a licensed pharmacist in the UK for next to nothing?

http://www.fitfortravel.nhs.uk/desti...laria-map.aspx

https://wwwnc.cdc.gov/travel/yellowb...pia#seldyfm879

Take your pick: there is some malaria risk throughout the country below 8,500ft. The NHS describes it as "high" risk, CDC as "moderate". Personally, I took doxycycline as it is cheap and I don't react badly to it.
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Old Wednesday 13th September 2017, 13:38   #5
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Hey all,
Off for a 17-day trip next month and am getting conflicting info regarding malaria tablets.
Ditto to DMW.

I'd add it does also depend a little on your itinerary - though clearly there is potential of risk, similar to Alan, I travelled through without any tablets - wasn't rainy season, was mostly in high country, was bone dry everywhere ...didn't personally rate it as much risk.

If you choose to travel without taking tablets, still not a bad idea to have a supply to use as a treatment if you do get malaria - if in remote area, it is possible local clinics might not have supplies available. In this case, do know in advance the required dosage that should be used as treatment as opposed to prophylactic use.
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Old Wednesday 13th September 2017, 13:59   #6
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I'll check and get back to you tomorrow - one of my colleagues is working on various malaria projects in Ethiopia so should be able to give you a comprehensive answer.

I really can't remember if I took antimalarials in Ethiopia (it was 18 years ago!) but spent nearly all my time at high altitude so guessing not.
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Old Wednesday 13th September 2017, 16:16   #7
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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3473321/

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p.s. there is also a perfectly good Hepatitis A virus vaccine available in the UK
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Old Wednesday 13th September 2017, 16:21   #8
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It doesn't sound like the sort of place where it would be worth it - most of the sites are fairly high up and / or dry. I wouldn't think you would get very good advice from the NHS sites / staff so need to look carefully at other international sources and look at each province / region. I can't recall whether I used anything on my trip, about 10 years ago.

cheers, alan
My pharamcist has a handbook with the relevant info for each country, region, state etc. How reliable that is I don't know but when ever I've checked, it's always corresponded with what I found online.

Bottom line, I'd trust my health to a qualified professional, not a bird forum!


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Old Wednesday 13th September 2017, 16:24   #9
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Not wanting to be rude, but this is almost complete bullshit. Just for starters, advising anybody to forget about tablets because the cheap ones are ineffective is total nonsense, especially when you then go on to talk about sourcing anti-malarial tablets locally in Ethiopia.

Where do you get your information that doxycycline "won't protect you much", given that it is one of the prophylactics recommended for Ethiopia by people who actually are doctors? Who in their right mind would opt to buy malarial prophylactics in Ethiopia if they could buy them from a licensed pharmacist in the UK for next to nothing?

http://www.fitfortravel.nhs.uk/desti...laria-map.aspx

https://wwwnc.cdc.gov/travel/yellowb...pia#seldyfm879

Take your pick: there is some malaria risk throughout the country below 8,500ft. The NHS describes it as "high" risk, CDC as "moderate". Personally, I took doxycycline as it is cheap and I don't react badly to it.
Agree with all this, 'Doxy' brings an elevated risk of sunburn but AFAIK that's it.

Malarone is pretty expensive but Proguanil is a much cheaper generic.

The biggest problem in many areas now is resistance to the drugs by Malaria so even if you do take them, they never give a guaranteed 100% protection and that is what Bryon meant I think with his comment about protection? The time is getting close I think when a whole new range of drugs will be needed to combat Malaria.


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Old Wednesday 13th September 2017, 19:59   #10
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Originally Posted by andyadcock View Post
M

Bottom line, I'd trust my health to a qualified professional, not a bird forum!


A
Well I'd never trust my health to a bird forum either. My point is to do your own research. Although I have not discussed Malaria with a 'travel health professional' for a long time, my memory was that they have a very limited knowledge of intra-country variations, elevational considerations and seasonal issues (wet / dry). I don't think it is wise to entrust important decisions to a single individual, whether a GP or a mortgage adviser.

cheers, alan
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Old Wednesday 13th September 2017, 20:28   #11
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Well I'd never trust my health to a bird forum either. My point is to do your own research. Although I have not discussed Malaria with a 'travel health professional' for a long time, my memory was that they have a very limited knowledge of intra-country variations, elevational considerations and seasonal issues (wet / dry). I don't think it is wise to entrust important decisions to a single individual, whether a GP or a mortgage adviser.

cheers, alan
I agree, as I said, my pharmacist has a handbook but it's a rough guide at best as you suggest. It's also true as I said that with increased resistence to prophylaxis, even historically proven drugs, are no longer guranteed to be totally effective.

Don't know about Africa but the American CDC has a good database of all nasties in the Americas.



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Old Wednesday 13th September 2017, 20:37   #12
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Malarial tablets

Hi Lewis,
your point taken but I solved this problem by birding in many African malarial and trypanosome infected areas in the company of very keen birders who were also doctors.
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Old Wednesday 13th September 2017, 20:48   #13
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My experience is that specialized doctors tend to recommend you to take something. They even recommended me a vaccination against cholera for Uganda because there was a single case the year before. I guess they do this to cover their own ass.

Malarone is expensive and it seriously disturbed my sleep. Nobody can tell you about the long-term effects if you take it regularly. And if you buy locally you should know that there are a lot of fake medicaments on the market.

I travel several times per year to Africa for professional reasons and do not take any malaria tablets. But please don't take this as advice, it's just the result of my own long-term risk assessment (no malaria in almost 20 years...)
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Old Wednesday 13th September 2017, 21:45   #14
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Hi flownek,
very balanced advice you have given here. Sleep disruption obviously opens up the immune system further and chronic sensitivity to sunlight can be a real problem for some, this will seriously spoil any holiday. Your mention of cholera makes me think in fact that dengue and Japanese encephalitis and even cholera are more of a birder's problem disease than malaria itself. Also arguably Uganda is a relatively benign place by African standards! Anybody read Redmond o'hanlon?

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Old Wednesday 13th September 2017, 21:48   #15
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My experience is that specialized doctors tend to recommend you to take something. They even recommended me a vaccination against cholera for Uganda because there was a single case the year before. I guess they do this to cover their own ass.
Most third World countries also come with a recommendation for rabies shots but the cost (three shots at 40 each last I heard) puts most people off.

All you can do, is take onboard as much qualified advice as possible and make your own mind up.



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Old Saturday 16th September 2017, 10:48   #16
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All you can do, is take onboard as much qualified advice as possible and make your own mind up.
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Yes, that is very true. And it's also true for many other health problems which are beyond the standard of a regular appendicitis (for instance).
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Old Sunday 17th September 2017, 06:10   #17
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Got some feedback from my colleague (I work for one of the world's leading malaria research teams) who actually contacted one of his Ethiopian collaborators to answer this.

The Ethiopian response was "Information are conflicting though, our [national malaria control programme] guideline recommend mefloquin, a 5mg tab per week. We also use single dose CQ [chloroquin] per week. It's good to use nets and replents as well."

My colleague also suggests considering malarone, which I think would not be in Ethiopia's national guideline on the basis of its high cost. My colleague went on to say:

"There are two schools regarding antimalarial prophylaxis:
1) use prophylaxis and don't worry
2) use stand-by medication because you worry about prophylaxis "side effects". If you have a fever you test and treat or in the absence of a test just treat yourself with a full course of antimalarials.

"I am firmly in the second camp - taking on-off malaria prophylaxis is too complicated and not cost efficient. Malaria prevalence is very difficult to predict and changes over short distances. Us visitors have in general only minimal risk to be exposed to infected mosquitoes. I personally carry a course of co-artemether or dihydroartemisinin/piperaquine in my travel bag. I don't carry a rapid diagnostic test (as some people do) because the shelf-life is limited and if you are in doubt you take the antimalarial anyway."
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Old Sunday 17th September 2017, 07:13   #18
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Hi all,
thanks for this very detailed and pertinent information Gandytron. It certainly helps me to make a personal decision.
One thing worth emphasizing is that the health professional must be made aware that as a birdwatcher you might possibly spending long periods in remote areas away from the beaches. Also keep in mind most UK health professionals have never seen a patient with malaria. Nominally safe Vietnam for instance, the border areas abut really virulent, areas in Cambodia. An Asian pharmacist told me doxy is no good as an anti-malarial anymore, we use it to treat adolescent acne was his laughing reply! I personally think doxy combined with another anti malarial is almost 100% effective.

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Old Sunday 17th September 2017, 08:40   #19
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Hi all,
thanks for this very detailed and pertinent information Gandytron. It certainly helps me to make a personal decision.
One thing worth emphasizing is that the health professional must be made aware that as a birdwatcher you might possibly spending long periods in remote areas away from the beaches. Also keep in mind most UK health professionals have never seen a patient with malaria. Nominally safe Vietnam for instance, the border areas abut really virulent, areas in Cambodia. An Asian pharmacist told me doxy is no good as an anti-malarial anymore, we use it to treat adolescent acne was his laughing reply! I personally think doxy combined with another anti malarial is almost 100% effective.
Hi Bryon

I had pointed out to my colleague that Adam was heading to remote, lowland areas of Ethiopia, so the advice was offered in this context...and last time I checked Ethiopia didn't have any beaches as its landlocked!

As for doxy it is still used to treat multiple non-malarial infections that our group works on.

Best

Dave
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Old Sunday 17th September 2017, 15:54   #20
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Many thanks for the replies - and especially Dave for contacting his colleague. Looks like alot of our group are going the malarone route as it's pretty cheap from Asda apparently...?
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Old Sunday 17th September 2017, 16:37   #21
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[quote=birdboybowley;3618012. Looks like alot of our group are going the malarone route as it's pretty cheap from Asda apparently...?[/QUOTE]

Really?

I'd have thought it would most likely be the generic thus cheaper Proguanil?

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Old Sunday 17th September 2017, 17:06   #22
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Surprised me too
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Old Tuesday 19th September 2017, 12:52   #23
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Surprised me too
Probably shouldn't be too much of a surprise, you can apparently get Viagra at Tesco now...a friend tells me



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Old Tuesday 19th September 2017, 13:48   #24
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Malarone is the trade name for a *combination* of proguanil and atovaquone. Proguanil may be cheaper, but it's not a generic version of malarone and won't produce the same effects.

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Old Tuesday 19th September 2017, 15:21   #25
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Malarone is the trade name for a *combination* of proguanil and atovaquone. Proguanil may be cheaper, but it's not a generic version of malarone and won't produce the same effects.

cheers,
James

Anyone who asks for a generic Malarone will be steered to Proguanil with whatever else is required for the same effective cover as Malarone.



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