Travel Health: vaccinations, malaria pills

[MONTRÉAL] This morning I consulted the website of the McGill Centre for Tropical Diseases, which operates in Montréal within the McGill University Faculty of Medicine, to learn more about what preventative measures they recommend for travel to Sudan. I still haven’t made an appointment for getting the vaccinations but from what I’ve read on their website, and in the international travel and health information of the World Health Organization, I will probably have to get vaccinations for Yellow Fever, Hepatitis A + B, Typhoid, Meningitis, Rabies, Diptheria, Tetanus, maybe Cholera. The documentation also encourages Malaria pills but not chloroquine because the malaria in Sudan is immune to chloroquine.

(source: World Health Organization, 2007

I’ve always been reluctent to take Malaria pills for periods longer than a 4-6 weeks. According to the Center for Disease Control and Prevention (CDC), the following are the anti-malarial pill options: atovaquone/proguanil, chloroquine, doxycycline, mefloquine or primaquine. Some of the prescriptions require to take a pill once a day during travel in areas where malaria is prevalent, and up to one week before and after being in the area. For me that would mean taking anti-malarial medication for more than three months! Side effects vary depending on which of the pill options are prescribed but common ones include: stomach pain, nausea, vomiting, headache, dizziness, blurred vision, and itching.

These general side effects are listed in various combinations for most of the prescriptions listed above. Some have specific side effects. Doxycycline increases sun sensitivity (sunburning faster than normal) and women may develop a vaginal yeast infection. More disturbing are the side effects associated with mefloquine. After reading through the CDC’s side effects and warnings for mefloquine (which is more elaborate than the others) I remembered a friend of mine who travelled extensively through eastern Asia for longer than six months, taking anti-malarial pills the entire time. When he returned to Canada he was not well at all. He has symptoms of psychosis, schizophrenia that lasted weeks if not months! He was probably taking mefloquine based on the CDC’s list of side-effects and warnings:

The most common side effects reported by travelers taking mefloquine include headache, nausea, dizziness, difficulty sleeping, anxiety, vivid dreams, and visual disturbances. Mefloquine has rarely been reported to cause serious side effects, such as seizures, depression, and psychosis. These serious side effects are more frequent with the higher doses used to treat malaria; fewer occurred at the weekly doses used to prevent malaria.

Mefloquine is eliminated slowly by the body and thus may stay in the body for a while even after the drug is discontinued. Therefore, side effects caused by mefloquine may persist weeks to months after the drug has been stopped.

Most travelers taking mefloquine do not have side effects serious enough to stop taking the drug. (Other antimalarial drugs are available if you cannot tolerate mefloquine; see your health care provider.)

Travelers Who Should Not Take Mefloquine

The following travelers should not take mefloquine and should ask their health care provider for a different antimalarial drug:

  • persons with active depression or a recent history of depression
  • persons with a history of psychosis, generalized anxiety disorder, schizophrenia, or other major psychiatric disorder
  • persons with a history of seizures (does not include the type of seizure caused by high fever in childhood)
  • persons allergic to mefloquine
  • Mefloquine is not recommended for persons with cardiac conduction abnormalities (for example, an irregular heartbeat).
  • persons traveling to areas where mefloquine-resistant malaria exists

(source: Centers for Disease Control and Prevention, US Department of Health and Human Services)

During an extensive cycling trip to eastern Asia in the 1990s, I took chloroquine as my anti-malarial preventative treatment. Once I ran out after three months, I decided not to renew my supply after hearing of side-effect stories. I spoke to a doctor in Hong Kong who suggested I carry mefloquine with me in a two-pill doze as a self-treatment. He suggested that if I get the symptoms: extreme flu-like sypmtoms that may include fever, shaking chills, headache, muscle aches, tiredness, nausea, vomiting, and diarrhea. He suggested that if I got anyof these symptoms and did not have access to a doctor, to take the two pills to stop the disease from progressing while I sought a doctor to diagnose and treat my symptoms. The doctor told me that mefloquine was very strong, and after reading the above warnings, it seems as though it is.

After visiting the Medecins sans frontières/Doctors Without Borders (MSF) website, I came across their Malaria Overview page, that begins with, “Every year, nearly 2 millions people die of malaria.” MSF discusses diagnosis, treatment and prevention. They have been treating patients with malaria in Africa, Asia, and Latin America since 1985 and have conducted many drug resistance studies in collaboration with national health ministries and Epicentre, MSF’s epidemiological research institute.

Another organiztion, The Global Fund is also mandated to support large-scale international prevention, treatment and care programs to to Fight AIDS, Tuberculosis and Malaria. To date, it has inveted 149$ billion in 140 countries in their program.

The organization Roll Back Malaria Partnership, whose self-proclaimed vision is “by 2015 […] malaria is no longer a major cause of mortality and no longer a barrier to social and economic development and growth anywhere in the world.” They discuss their goals of their Global Malaria Action Plan for a malaria-free world. Their website has a great segment of frequently asked questions commonly asked about the disease that are reviewed and answered by Aafje Rietveld from the World Health Organization, that has published the International Travel and Health guide to get “informed about the potential hazards of the countries they are travelling to and learn how to minimize any risk to their health.” Individual chapters of the guide can be downloaded directly from the site.

Other than the predeparture vaccinations, I will look into some naturopathic approaches to boosting my immune system prior to leaving as well as some alternative options to vaccinations.

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5 Responses

  1. Ceej says:

    Nice blog, Dave! Uh, yeah, count me among the freakazoids who won’t be taking mefloquine anytime soon. Ghana/Togo/Cote D’Ivoire experience was a really scary experience — so much so that when I went to Ethiopia/Somalia/Djibouti, I didn’t take anything. As Rory said, bug spray and nets.

  2. Linda Ibberson says:

    PLEASE be very careful when choosing or deciding to take an anti-malarial!
    The McGill Center for Tropical Diseases prescribed Lariam (Mefloquine) before my 6-month trip to India, and never bothered to tell me about the possible side-effects.

    I started taking the pills a month before my departure, and things went downhill from there. I became more and more anxious, and then I started hearing voices…. very threatening voices. Luckily, I was staying with friends in France at the time, and they realized that things were not “right” with me. They took me to their doctor who glibly asked “Are you taking Lariam?” and proceeded to tell me about the side-effects. He prescribed doxycycline which gave me severe hives. I then made the decision to simply be careful, cover up at dusk, and not take any meds.

    CBS Story

    I consider myself a fairly “normal” person, and wasn’t prone to depression or psychosis. To me, it just proves that taking those meds implies a serious risk. I spent 6 months in India (including a rainy season) without meds and managed to come away with a clean bill of health.

    Best of luck in your travels!

  3. widge says:

    Thanks! It is my first official comment. I do plan on having some kind of malaria prevention but I haven’t yet decided what approach to take. I have a scheduled appointment with the McGill Centre for Tropical Diseases to get their point of view. I am also planning an interview with a Naturopath who specializes in tropical disease prevention and has considerable experience in Uganda. Expect a post about this interview.

  4. Rory says:

    Cool blog dude!!

    On the subject of mefloquine, I have taken it many times, to no ill effects…except some vague flu-like symptoms at the start. I have also had malaria, but was on malaria meds at the time, so it wasn’t as bad as it could have been – still sucked though. It would have been much worse if I had not been taking the meds. It was one of those fluke situations where I was waiting for a ride at the wrong time of day (sunset), and had to wait outside (Togo). You never know when these types of situations are going to crop up, so for me it was worth it to be on the meds. I’m presuming that you’re going to be more exposed to such situations than I was. For me, it boiled down to bednets and a lot of bug spray vs. the malaria meds – I hate using lots of bug spray….and there’s always tonic water, but I hate tonic water too, and question its efficacy against malaria.

    I’ve known a few people that have experienced bad dreams on mefloquine, but decided that these side effects outweighed the risk of malaria.

    I’d be happy to discuss by phone if you like, but I’d recommend that you take the meds.

    In any case, glad to see that you’re on your way!! It’s going to be awesome, and I look forward to following your progress on your blog!

    R

  1. February 22, 2009

    […] been hesitant to take mefloquine from the beginning because of the potential side effects (see previous post), which—according to the prescription—include but are not limited to “a sudden onset of […]

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