Rabaul and Malaria Tablets

In March we are travelling on QE from Sydney to Tokyo. Rabaul is the only place on this route that the Cunard brochure mentions the taking of malaria tablets. I know what the medics will suggest but before making my mind up some practical advice from seasoned travellers would be helpfully. We are only there for the day so won't be sleeping in a tent in the hinterland/ jungle for several days!

On QE-2 a few years ago the ship's Chief Medical Officer gave a talk in the theatre. Afterwards, during questions, I asked him whether he took malaria tablets in the places where it was suggested to do so in the brochure. He waffled on about one doing so where suggested and I stopped him and said that wasn't what I asked. Did he take them and in the end he said no.

I also new an Aussie who travelled to Rabaul for several weeks a year and when I asked him about taking malaria tablets he laughed as if wondering why I had asked.

What do other travellers think please, particularly those from Australia? How about you Whitemarsh?

I'm certainly no expert, but last year I did call at Rabaul for a few hours on QM2.

I'm a regular blood donor, but when I went to donate a few months after my return from the voyage I was declined on the basis of my visit to Rabaul - I was advised that I was not permitted to donate blood for 2 years from the date I had been there because of the danger of mosquito-borne disease.

I'm certainly no expert, but last year I did call at Rabaul for a few hours on QM2.

 

I'm a regular blood donor, but when I went to donate a few months after my return from the voyage I was declined on the basis of my visit to Rabaul - I was advised that I was not permitted to donate blood for 2 years from the date I had been there because of the danger of mosquito-borne disease.

AussieVoyager, had you taken anti-malaria medications? -S.

What do other travellers think please, particularly those from Australia? How about you Whitemarsh?

I have been there and would not bother getting of the Ship. Malaria is the least of your problems in my humble opinion

AussieVoyager, had you taken anti-malaria medications? -S.

Hi Salacia

I had not taken the medications, but according to the Red Cross the issue was simply that I had been there, and even if I had taken the medications I was still ineligible to donate blood. My understanding was that it was diseases other than malaria they were concerned about. By contrast, I went to Cambodia some time ago (another malaria-prevalent country) and I was still eligible to donate even though I hadn't taken anti-malaria medication then either.

In March we are travelling on QE from Sydney to Tokyo. Rabaul is the only place on this route that the Cunard brochure mentions the taking of malaria tablets. I know what the medics will suggest but before making my mind up some practical advice from seasoned travellers would be helpfully. We are only there for the day so won't be sleeping in a tent in the hinterland/ jungle for several days!

 

On QE-2 a few years ago the ship's Chief Medical Officer gave a talk in the theatre. Afterwards, during questions, I asked him whether he took malaria tablets in the places where it was suggested to do so in the brochure. He waffled on about one doing so where suggested and I stopped him and said that wasn't what I asked. Did he take them and in the end he said no.

 

I also new an Aussie who travelled to Rabaul for several weeks a year and when I asked him about taking malaria tablets he laughed as if wondering why I had asked.

 

The only way not to be infected is not to go where the risk is. Even with all the medicaments you would have to take for weeks before and after your voyage, there is no absolute security; Malaria can be mortal. At present there is no anti-Malaria medicament at all that provides sufficient protection, although some latest research results seem to be promising.

 

It's up to you to decide whether you want to take the risk and I wonder whether Rabaul and Papua-N in general justify it.

 

All best wishes!

In March we are travelling on QE from Sydney to Tokyo. Rabaul is the only place on this route that the Cunard brochure mentions the taking of malaria tablets. I know what the medics will suggest but before making my mind up some practical advice from seasoned travellers would be helpfully. We are only there for the day so won't be sleeping in a tent in the hinterland/ jungle for several days!

I am on the same cruise and the doctor at the travel clinic I consulted did not mention malaria tablets. I am curious as to which Cunard brochure mentions the tablets because I have received nothing from Cunard about malaria and PNG. (This may be a case of people in the UK and the US getting different materials from Cunard.)

BTW, you are invited to join us on our roll call.

http://boards.cruisecritic.com/showthread.php?t=1692699

I am on the same cruise and the doctor at the travel clinic I consulted did not mention malaria tablets. I am curious as to which Cunard brochure mentions the tablets because I have received nothing from Cunard about malaria and PNG. (This may be a case of people in the UK and the US getting different materials from Cunard.)

 

BTW, you are invited to join us on our roll call.

http://boards.cruisecritic.com/showthread.php?t=1692699

'There is a risk'.......'see your practitioner' is mentioned in the UK Cunard brochure August 2013 - January 2015. That's why I raised it.

I am on this world cruise also. I never take malaria tablets. I was on QM2 world cruise in 2012 and we went to Rabaul. We stayed half a day. It is a tender port. Nothing there of interest but worth a look if you like something different ;) I bought a nice bag from the locals and gave away plenty of dollars to the poor kids who had no clothes or shoes on!:) Take plenty of single dollar bills.

I was there on QM2 in 2010. I took no medication, but did cover up all but my hands & face & used Deet spray on those.

I have very recently spent 3 full days in 3 different PNG ports -- didn't see a mosquito on any day.

Barry

Hi Salacia

 

I had not taken the medications, but according to the Red Cross the issue was simply that I had been there, and even if I had taken the medications I was still ineligible to donate blood. My understanding was that it was diseases other than malaria they were concerned about. By contrast, I went to Cambodia some time ago (another malaria-prevalent country) and I was still eligible to donate even though I hadn't taken anti-malaria medication then either.

Hi AussieVoyager, thanks for that info. I've been reading about malaria, and there seems to be conflicting guidelines about when the anti-malaria meds are indicated, as has been previously mentioned. I know 2 people who contracted malaria in their travels years ago. They recovered, but have repeated mild episodes. The long term effects of current anti-malaria drugs are yet to be determined. Perhaps the decision whether or not to take anti-malaria meds is best made between an informed patient and his or her physician. Regards, -S.

I have very recently spent 3 full days in 3 different PNG ports -- didn't see a mosquito on any day.

 

Barry

Barry, I need to stand next to you on my next voyage - you are apparently a natural mosquito repellant ;) Cheers, -S.

http://www.mosquitnoband.com/why-do-mosquitoes-like-me-more-than-anyone-else/

Barry, I need to stand next to you on my next voyage - you are apparently a natural mosquito repellant ;) Cheers, -S.

 

 

http://www.mosquitnoband.com/why-do-mosquitoes-like-me-more-than-anyone-else/

To late to add to my previous post relating to the web site specified. I'm certainly not advocating any product advertised - I just thought the information regarding mosquitos attraction to humans was interesting. I've found that I have a sensitivity to most bug repellants, so I'm in no position to advocate any of them.

I also spray with repellent that contains 50%DEET. The DEET is what makes it work so before boarding the ship in Southampton for the world cruise pop into BOOTS store in the high Street, they sell BOOTS Insect Repellent with 50% DEED. It is their own brand.

http://www.boots.com/en/Boots-Pharmaceuticals-Repel-Insect-Repellent-Roll-On-50-DEET-6-months-_1121459/

Barry, I need to stand next to you on my next voyage - you are apparently a natural mosquito repellant ;) Cheers, -S.

 

 

I did get bitten by some sea lice however.

Barry

I did get bitten by some sea lice however.

 

Barry

Baby jellyfish (jellyfish larvae) - no lice at sea. Ok, maybe a louse here and there ...

Baby jellyfish (jellyfish larvae) - no lice at sea. Ok, maybe a louse here and there ...

Hmmm -- There seems to be some conjecture about that http://en.wikipedia.org/wiki/Sea_louse

What bit me was a flea like hard shelled "creature" - large enough to be easily seen by the naked eye. I can't really believe it was any kind of baby jellyfish -- but what would I know about such matters?? :)

Barry

'There is a risk'.......'see your practitioner' is mentioned in the UK Cunard brochure August 2013 - January 2015. That's why I raised it.

My doctor got our practice nurse to answer all my medical questions and this is an extract that might be relevant to your question:

 

Malaria

 

Note: Country specific malaria information and malaria maps are available via Destinations.

 

• Introduction
  
• Avoidance of Bites
  
• Taking Antimalaria Tablets
  
• Drugs most commonly used for Malaria Prevention
  
• Prompt Treatment
  
• Emergency Treatment of Malaria (new page)
  

Introduction

 

Malaria is widespread in many tropical and subtropical countries and is a serious and sometimes fatal disease. You cannot be vaccinated against malaria, but you can protect yourself in three ways:

 

Avoidance of Bites

 

Mosquitoes cause much inconvenience because of local reactions to the bites themselves and from the infections they transmit. Mosquitoes spread malaria, yellow fever, dengue and Japanese encephalitis.

 

Mosquitoes bite at any time of day but most bites occur in the evening.

 

Precautions to Take

 

1. Avoid mosquito bites, especially after sunset. If you are out at night wear long-sleeved clothing and long trousers.
   
2. Mosquitoes may bite through thin clothing, so spray an insecticide or repellent on them. Insect repellents should also be used on exposed skin.
   
3. Spraying insecticides in the room, burning pyrethroid coils and heating insecticide impregnated tablets all help to control mosquitoes.
   
4. If sleeping in an unscreened room, or out of doors, a mosquito net impregnated with insecticide is a sensible precaution. Portable, lightweight nets are available.
   
5. Garlic, Vitamin B and ultrasound devices do not prevent bites.
   

Taking Anti-Malarial Tablets

 

1. Start before travel as guided by your travel health advisor (with some tablets you should start three weeks before).
   
2. Take the tablets absolutely regularly, preferably with or after a meal.
   
3. It is extremely important to continue to take them for four weeks after you have returned, to cover the incubation period of the disease. Atovaquone/proguanil (Malarone®) requires only 7 days post-travel)
   

Drugs Most Commonly Used for Malaria Prevention

 

Travellers must always, through discussion with their doctor or pharmacist, make sure they use a drug which they can tolerate (only the more common side effects are given here) and one which is appropriate for their destination(s). No drug is 100% effective.

 

In Britain, chloroquine and proguanil can be purchased from local pharmacies or chemists. All other drugs require a doctor's prescription.

 

Further information on the commonly used drugs:

 

• Atovaquone/Proguanil
  
• Chloroquine and/Proguanil
  
• Doxycycline
  
• Mefloquine
  

Chloroquine (licensed for prophylaxis in UK)

 

• Preparations available: Avloclor® (Zeneca) and Nivaquine® (Rhône-Poulenc Rorer). Adult dose is 2 tablets (each containing 150mg chloroquine as base) taken once a week. Nivaquine is available in syrup form.
  
• Consider a trial course before departure, if using this regime for the first time, to detect if you are likely to get side effects (e.g. for two weeks). Otherwise, when possible, chloroquine should be started one week before exposure (to ensure adequate blood levels), throughout exposure and for 4 weeks afterwards.
  
• Nausea and sometimes diarrhoea can occur which may be reduced by taking tablets after food.
  
• Headache, rashes, skin itch, disturbance of visual accommodation (often expressed as blurred distance vision which may take up to 4 weeks to reverse) or hair loss may warrant changing to alternative drugs.
  
• Retinopathy (eye changes) which can be permanent is unlikely to occur until 100g have been consumed (i.e. over 5 years treatment at prophylactic doses).
  
• Caution in liver and renal disease.
  
• Can aggravate psoriasis and very occasionally causes a convulsion so it should not normally be used in those with epilepsy.
  
• Chloroquine is very toxic in overdose - parents must take special care to store the tablets safely.
  
• It is generally accepted, as a result of long usage, to be safe in pregnancy.
  

Proguanil (licensed for prophylaxis in UK)

 

• Preparations available: Paludrine® (Zeneca). Adult dose is 200mg daily.
  
• Can normally be used continuously for a period of up to 5 years.
  
• One or two doses should be taken before departure. It should be continued throughout exposure and for 4 weeks afterwards.
  
• Anorexia, nausea, diarrhoea and aphthous (simple) mouth ulcers can occur.
  
• Can delay the metabolism of the anticoagulant, warfarin, and result in bleeding. Those planning to take warfarin must discuss this with their doctor before starting any treatment.
  
• Caution in renal impairment.
  
• Considered to be safe in pregnancy, but folate supplement is advised.
  

Mefloquine® (licensed for prophylaxis in UK)

 

• Preparations available: Lariam® (Roche). Adult dose is 250mg weekly.
  
• One dose should be taken a week before departure and it should be continued throughout exposure and for 4 weeks afterwards however three (3) doses at weekly intervals prior to departure are advised if the drug has not been used before - this can often detect, in advance, those likely to get side effects so that an alternative can be prescribed.
  
• Not licensed in Britain for use for more than 1 year (in countries where it is licensed for more than 1 year, additional side-effects are rare).
  
• Nausea, diarrhoea, dizziness, abdominal pain, rashes and pruritus can occur.
  
• Headache, dizziness, convulsions, sleep disturbances (insomnia, vivid dreams) and psychotic reactions such as depression have been reported. These reactions most commonly begin within 2-3 weeks of starting the drug and may be worse if alcohol is taken around the same time as the mefloquine.
  
• Avoid in epilepsy, if there is a close family history of epilepsy (e.g. parents or siblings) or if there is a history of psychiatric illness.
  
• Caution, and avoid if alternatives are available, in severe renal or liver failure and those with heart rhythm defects. Also caution in those taking digoxin, beta or calcium channel blockers when arrhythmias and bradycardia can occur.
  
• Although there is no evidence to suggest that mefloquine has caused harm to the foetus it should normally be avoided during the first trimester of pregnancy or if pregnancy is considered possible within 3 months of stopping prophylaxis.
  

Doxycycline (licensed for prophylaxis in UK)

 

• Preparations available: Doxycycline (non-proprietary), Vibramycin® (Invicta). Adult dose is 100mg daily.
  
• Can normally be used continuously for a period of at least 6 months - be guided by your doctor.
  
• Consider a trial course before departure, if you are using this regime for the first time, to detect if you are likely to get side effects (e.g. for one week). Otherwise doxycycline need only be started just before exposure (e.g. 2 days), continued through exposure and for 4 weeks afterwards.
  
• When other tetracyclines are being already used for acne this will provide protection against malaria so long as an adequate dose is taken (you can change to 100mg doxycycline per day if your doctor agrees).
  
• Erythema (sunburn) due to sunlight sensitivity can occur. Use of sunscreens is especially important and if severe, alternative prophylaxis should be used.
  
• Heartburn is common so the capsule should be taken with a full glass of water and preferably while standing upright.
  
• Contraindicated in pregnancy (including one week after completing the course), breast feeding, in those with systemic lupus erythematosus, porphyria and children under 12 years because permanent tooth discolouration can occur.
  
• 01/03/11: New Guidance on Antibiotics and Combined Hormonal Contraceptives - the Royal College of Obstetricians and Gynaecologists have stated that women on non enzyme inducing antibiotics (doxycycline) are no longer required to take additional precautions during or after the course. The use of additional precautions does apply if vomiting or diarrhoea occurs as a result of antibiotic use or underlying illness.
  
• Occasionally anorexia, nausea, diarrhoea, candida infection and sore tongue (glossitis) have been reported and rarely hepatitis, colitis and blood dyscrasias.
  

Atovaquone plus proguanil (licensed for prophylaxis in UK)

 

• Preparations available: Malarone®. Adult dose is one tablet daily - each tablet contains 250mg atovaquone plus 100mg proguanil. Child doses will be based on the weight of the child but will be once daily also.
  
• DO NOT confuse with Maloprim® which is not now advised for prophylaxis since more effective alternatives are available.
  
• Should be taken for 1 or 2 days before entering the malarious area, throughout exposure, and for 7 days after leaving the infected area. Licensed for trips of up to 28 days but there is no evidence of increased side-effects if used for longer.
  
• Atovaquone/proguanil need only be commenced one or two days before exposure.
  
• Abdominal pain, headache, anorexia, nausea, diarrhoea, coughing and aphthous (simple) mouth ulcers can occur.
  
• Absorption may be reduced in diarrhoea and vomiting, and blood levels are significantly reduced with concomitant use of tetracyclines, metoclopramide and especially rifampicin or rifabutin.
  
• The proguanil component can delay the metabolism of the anticoagulant, warfarin, and result in bleeding. Those planning to take warfarin must discuss this with their doctor before starting any treatment.
  
• Caution in renal impairment.
  
• Lack of experience in pregnancy and during breast feeding means that it should be avoided in these circumstances unless there is no suitable alternative.
  
• The high cost makes popular for short trips.
  

Prompt Treatment

 

Following these guidelines faithfully might not guarantee complete protection. If you get a fever between one week after first exposure and up to one year after your return, you should seek medical attention and tell the doctor that you have been in a malarious area.

 

 

 

I have no idea if the links will work, I have copied and pasted this information as I saw the web address at the bottom of the documentation I was sent.

I thought I would copy and paste this post just in case some members could not access the UK web-site.

I understand why you are asking whether folks take the medication, but how do we allow for Murphy's Law? :eek:;)

For those who can access UK web sites, I found this information here

Hmmm -- There seems to be some conjecture about that http://en.wikipedia.org/wiki/Sea_louse

 

What bit me was a flea like hard shelled "creature" - large enough to be easily seen by the naked eye. I can't really believe it was any kind of baby jellyfish -- but what would I know about such matters?? :)

 

Barry

Right you are, Barry. I stand corrected. Sea lice...I'll add that to my list of things to avoid :eek: -S.

I think I ran into sea lice while snorkeling off Bonaire in 2011. They felt like jellyfish stings but they were little bitty critters like Barry says.

After reading all those side affects? I'll just stay on the ship! Psychotic episodes? No, thank you. I'm also not a fan of dousing myself in toxins like Deet (no offense, Maggie :D).

After reading all those side affects? I'll just stay on the ship! Psychotic episodes? No, thank you. I'm also not a fan of dousing myself in toxins like Deet (no offense, Maggie :D).

What appeals to my sense of humour is when ladies state they do not take certain medication because of the risk of side effects and yet they smother themselves in all sorts of make-up!

Just had a quick peep and wow!!

This was from an American site but everywhere I looked sites were offering similar warnings.

She looks radiant and healthy but…her looks are killing her.

 

 

Let’s take a look at what this woman’s particular brands of cosmetic and makeup products have exposed her to in a matter of minutes.

• The deodorant soap has a pH of 9, which removes the protective acid mantle of the skin making it more alkaline and therefore, more vulnerable to penetration. It also contains ammonia, formaldehyde and phenol, which are known carcinogens and triclocarban, which is under suspicion of being a cancer causing agent with daily use.
  
• Her shampoo contains cocamide DEA, which is associated with carcinogenic nitrosamines and sodium lauryl sulfate, a known mutagen.
  
• The hair tint contains quaternium-15, which releases carcinogenic formaldehyde and the carcinogen, phenylenediamine.
  
• The conditioner contains methylisothiaolinone, an ingredient that is mutagenic and is presently being evaluated as cancer-causing.
  
• The shaving cream contains a-pinene, a chemical that damages the immune system.
  
• Her body lotion contains mineral oil, which, as a cosmetic grade petroleum product, includes the contaminant polycyclic aromatic hydrocarbons (PHAs) known as xenoestrogens that can mimic estrogen in the body.
  
• The dusting powder contains talc, a substance like asbestos. When talc was combined with a common air pollutant, benzo(a)pyrene, it induced tumors in 80% of the animals tested.
  
• The toothpaste contains saccharin and FD&C Blue#1, which are carcinogens. It also contains resorcinol, which can cause a blood disorder (methemoglobinemia), convulsions and death.
  
• The mouthwash contains 27% ethanol, which is suspected of causing esophageal cancer. It also contains phenol, which can cause fatal poisonings through skin absorption.
  
• The hairspray contains polyvinylpyrrolidine (PVP) and reports show that it may cause harm if the particles are inhaled. Modest intravenous doses fed to rats caused tumors.
  
• The moisturizer contains phenol carbolic acid, which can cause circulatory collapse, paralysis, convulsions, coma and death as a result of respiratory failure. It also contains PEG-40, which contains dangerous levels of dioxin and propylene glycol, which studies show can negatively alter brain waves and cause liver and kidney disorders.
  
• Her blush contains FD&C Red #3, which caused human breast cells to grow, mimics the effect of natural estrogen at the molecular level and damages the genetic material of human breast cells.
  
• The eyeshadow contains iron oxide, which although deemed safe by the FDA for use in the eye area, is a suspected carcinogen, teratogen or toxin. The eyeliner, contains ascorbyl palmitate, and studies suggest that the palmitates are to be considered carcinogenic, mutagenic, or toxic.
  
• The mascara may be contaminated with bacteria. Is also contains polyvinylpyrrolide (PVP), a carcinogen.
  
• The lipstick contains paraffin, which is a mixture of hydrocarbons and is derived from petroleum. It is known to be contaminated with the carcinogens, benzo-a-pyrene and benzo-b-fluroanthene.
  
• The perfume contains toluene, a suspected potent carcinogen that was found in every fragrance tested, and benzaldehyde, which is a central nervous system depressant that may cause kidney damage.
  
• The sunscreen contains padimate O and the preservative, BNPD, which together create the carcinogenic nitrosamine, NMPABAO.
  

This article raises valid concerns on the chemicals found in every day articles. The concern should not stop there as our foods are subject to a vast array of pesticides, genetic engineering and chemical additives.

Right you are, Barry. I stand corrected. Sea lice...I'll add that to my list of things to avoid :eek: -S.

Sea lice are a big problem to the salmon farms in Scotland.

You don't want to be bitten by one if you are a salmon.

David.

I have ALWAYS found reading the side effects of medication to be terrifying, I cannot help thinking it is the manufacturers trying to cover their backs 'just in case'

 

What appeals to my sense of humour is when ladies state they do not take certain medication because of the risk of side effects and yet they smother themselves in all sorts of make-up!

 

Just had a quick peep and wow!!

 

This was from an American site but everywhere I looked sites were offering similar warnings.

 

That depends on how choosy one is about one's personal care products. :) I'm as picky about that as I am about other things. Obviously sometimes one has to make exceptions, for instance, Cunard does not offer organic food (do any of the lines offer it?), but that's one of those things I'm going to have to forgo in order to do our worldie! :D