Malaria medication on the Amazon

[Kween Karen]

My next cruise will be sailing for a week up the Amazon. We have 5 port stops including an overnight in Manaus. My "Travel Med Doctor" has recommended taking malaria medication for just this portion of the cruise (we are 66 days around South America).

 

It seems most people on my roll call say they don't take the meds because they don't think malaria is a problem.

 

I am wondering if people could post the pros and cons here.

 

Thanks in advance.

[dfb]

Here's my experience. I too spent 2 weeks cruising the Amazon to and from Manaus as part of a Circle South America cruise. I did not take anti-malarials for 3 reasons. 1- not 100% effective 2 - undesireable side effects. 3 - there are a lot of other insect-borne diseases to worry about

So, what I did was wear clothes that were bug-repellent treated and wear DEET insect repellent. No matter what drugs you are taking if you don't get bit, you don't get sick. All that said, I never got a mosquito bite on that trip so may you have the same good luck.

http://wwwnc.cdc.gov/travel/destinations/brazil.aspx

[barante]

I used to live in Africa and never took malaria pills in big cities, where the risk was small or nonexistent for various reasons. And whenever I spent a night in the countryside I always bought the pills from a local pharmacy. They have pills that kick in in 24 hours and they sell the type of pill that is likely to work. If you get them prescribed in U.S., you will likely end up with pills for a strain that is totally wrong. Different type of malaria in various geographical regions of the world.

I'll do the Amazon trip in March and will get the pills at the first port. Since no one is likely to spend a night in a jungle or diseased city slum, the risk is negligible.

[smeyer418]

My next cruise will be sailing for a week up the Amazon. We have 5 port stops including an overnight in Manaus. My "Travel Med Doctor" has recommended taking malaria medication for just this portion of the cruise (we are 66 days around South America).

 

It seems most people on my roll call say they don't take the meds because they don't think malaria is a problem.

 

I am wondering if people could post the pros and cons here.

 

Thanks in advance.

 

You are going up a river which breeds mosquitoes. You aren't staying in a large city. the drug most US doctors give is Malarone which is effective in all places with Malaria and has relatively little side effects.

 

http://www.webmd.com/a-to-z-guides/malarone-for-malaria

You are supposed to take it two days before and 7 days after your presence in a high incidence area.

 

http://cdc-malaria.ncsa.uiuc.edu/

 

http://www.cdc.gov/malaria/travelers/index.html

 

I would follow the recommendation of my doctor over any one here or on your ship....

 

and

this about buying the drugs over seas

 

A Special Note about Antimalarial Drugs

 

You should purchase your antimalarial drugs before travel. Drugs purchased overseas may not be manufactured according to United States standards and may not be effective. They also may be dangerous, contain counterfeit medications or contaminants, or be combinations of drugs that are not safe to use.

 

Halofantrine (marketed as Halfan) is widely used overseas to treat malaria. CDC recommends that you do NOT use halofantrine because of serious heart-related side effects, including deaths. You should avoid using antimalarial drugs that are not recommended unless you have been diagnosed with life-threatening malaria and no other options are immediately available.

 

For detailed information about these antimalarial drugs, see Choosing a Drug to Prevent Malaria.

[barante]

I urge the OP to do whatever she is comfortable with. I personally don't think there is any undue concern for malaria in Manaus, a city of 1.8 million, where the overnight is likely to be on the ship. However, should the poster venture deep into the bush either by land or sea, precautions may be advisable.

As to the propaganda about only using U.S. medicine, that is simply propaganda. I, for one, would not hesitate taking any medicine manufactured in Brazil or many other countries (Israel, India, South Africa). Since they are often exported to the U.S. and sold under U.S. labels, they are manufactured to U.S. standards.

I have said my piece and won't argue with anyone about any of this. Some insist that they can get a good cruise only by buying from the cruiseline and paying the top dollar, others use the Internet and discounters. Same difference in medicine.

[broberts]

You are going up a river which breeds mosquitoes. You aren't staying in a large city. the drug most US doctors give is Malarone which is effective in all places with Malaria and has relatively little side effects.

 

http://www.webmd.com/a-to-z-guides/malarone-for-malaria

You are supposed to take it two days before and 7 days after your presence in a high incidence area.

 

http://cdc-malaria.ncsa.uiuc.edu/

 

http://www.cdc.gov/malaria/travelers/index.html

 

I would follow the recommendation of my doctor over any one here or on your ship....

 

and

this about buying the drugs over seas

 

A Special Note about Antimalarial Drugs

 

You should purchase your antimalarial drugs before travel. Drugs purchased overseas may not be manufactured according to United States standards and may not be effective. They also may be dangerous, contain counterfeit medications or contaminants, or be combinations of drugs that are not safe to use.

 

Halofantrine (marketed as Halfan) is widely used overseas to treat malaria. CDC recommends that you do NOT use halofantrine because of serious heart-related side effects, including deaths. You should avoid using antimalarial drugs that are not recommended unless you have been diagnosed with life-threatening malaria and no other options are immediately available.

 

For detailed information about these antimalarial drugs, see Choosing a Drug to Prevent Malaria.

 

Well said. I'd add that malaria carrying mosquitoes are equally comfortable in urban areas as they are up river. Lots of standing water in most tropical cities.

 

While these days for most people Malaria is rarely fatal it is a serious disease that can have lasting deleterious effect on a suffer. I contracted Malaria as a child and have had several flare ups over the course of my life. Thankfully none were very severe. None the less the parasite is likely still in my body.

 

CDC health information for Brazil can be found here. Also see the CDC recommendations re yellow fever vaccination here.

[ROZO'SBEAU]

Hey KK,

You have a "travel med doctor." S/He advised you to take malaria medicine. That's a pro I'm assuming you paid for. Why ever are you asking folks on here? I echo smeyer418's comments. You were advised to do it. Just do it!

[barante]

The real danger -- negligible, though real -- is contracting dengue fever in the Amazon. There is no antidote, not preventive shots for it. A friend of mine contracted it in Africa decades ago and has been pretty much a basket case ever since. For the longest time tropical disease specialists at Johns Hopkins and elsewhere could not even diagnose her ailment.

Don't let any of this scare you because as a cruise tourist you are unlikely to go into any areas or live in any conditions where this could be a problem. If you are an ordinary tourist you will be hopping from one airconditioned space to another, pretty much.

As to the ultimate malaria medicine, it may be gin and tonic. For decades, the best medical minds recommended frequent and substantial doses of gin and tonic because the tonic water used in those days contained quinine, which has anti-malarial properties. The active ingredient, however, was gin. British colonials throughout the globe believed in this treatment.

[megmcw]

I have asked G.P's pharmacists, ex cruisers, travel agents, cruise travel agents and noone can up with a definite regime. We are doing a circumnavigation of South America in January 2012 (Seven Seas Mariner) and wondered whether to have it or not.

I like your prevention and am partial to the odd gin and tonic. If I take anti malarial would take Malarone which in Australia is astronomically expensive - they have the least side effects. Then again as you say I may get dengue - seems the prevention of getting bitten is the most practical - light coloured clothes, long sleeved, tropical strenth repellant - all a bit of a carry on. People who take prevention think they will be immune and dont bother with repellant or the most suitable clothing.

Saying all that we are still undecided what to do and as I am 75 I guess I have to die of something. Any suggestions re the above.

megmcw

 

 

The real danger -- negligible, though real -- is contracting dengue fever in the Amazon. There is no antidote, not preventive shots for it. A friend of mine contracted it in Africa decades ago and has been pretty much a basket case ever since. For the longest time tropical disease specialists at Johns Hopkins and elsewhere could not even diagnose her ailment.

Don't let any of this scare you because as a cruise tourist you are unlikely to go into any areas or live in any conditions where this could be a problem. If you are an ordinary tourist you will be hopping from one airconditioned space to another, pretty much.

As to the ultimate malaria medicine, it may be gin and tonic. For decades, the best medical minds recommended frequent and substantial doses of gin and tonic because the tonic water used in those days contained quinine, which has anti-malarial properties. The active ingredient, however, was gin. British colonials throughout the globe believed in this treatment.

[John Bull]

My fourpenn'orth:

 

Your doctor knows better than us.

Yes, there are different strains of malaria in different parts of the world - in the UK malaria tabs have to be prescribed by a doctor, so no risk of a dumb saturday-girl in the drugstore offering the wrong tabs - I don't know if that's a risk in the US.

Cheaper tabs are more likely to have side-effects & have to be taken daily for about a week before & 2 weeks after travel in the risk area, more expensive tabs need less time & less likely to have side effects. Side effects can be less or more risky depending on the cruiser's medical history, another reason why your doctor knows better than us.

 

As dfb's post, other precautions make a lot of sense. Long pants tucked into your socks (ankles are targetted), solid shoes, long sleeves, repellant sprays.

 

Not so sure about a G&T :confused: - but it can't do any harm :)

Though as a pre-dinner precaution its best dispensed in an air-con bar than on the open deck, mosquitos are particularly active in the evening.

 

Your cruise is in the Amazon for quite some time, increasing the risk.

 

At least mosquitos aren't big enough to eat you - but some insects are HUGE :D

 

JB :)

[Fattony]

I have asked G.P's pharmacists, ex cruisers, travel agents, cruise travel agents and noone can up with a definite regime.

 

Similar discussions go on for other regions. I would never, ever suggest to someone, especially someone I didn't know, that they forego anti-malarial prophylaxis. I would not rely on anecdotal evidence such as "I went to (fill in name of area) for weeks and didn't take anything and was fine." Malaria is nasty stuff and with longer lasting effects than any medication (I worked in Mozambique for two years and met people who took nothing and had no ill effects and people who took nothing and got malaria). Malaria can kill. You should talk with a physician who knows about it. Maybe at a traveler's health clinic (where they give vaccinations). Look at the malaria section at www.cdc.gov. Remember, you're asking for medical advice from strangers here. Risking your health to save a few bucks seems insane to me. If a doc finds specifc conditions for you that preclude the use of major anti-malarial medications, they should have alternatives in mind. Gin and tonic will do nothing (maybe help prevent scurvy, but not malaira).

[piper28]

FWIW, we took the malarial medication on the advice of our doctors. Obviously, it's everyone's choice. (Helped that we'd had it once before and knew we didn't have issues with side effects.) The Amazon area is an area that is endemic for malaria. One thing that is very important is that if you get sick after having traveled there, regardless of whether you took the medication, make sure your doctors know that you traveled there. The doctors here aren't likely to think malaria as a diagnosis without knowing that you might have been exposed. (Also note, I think the treatment is generally pretty much the same medication, but at a much higher dosage, which is far more likely to cause the side effects.) Personally, if I make it again, I'll take the medication again.

 

Now, all that said, I don't think we saw a single mosquito in our time there :). Wish I could say the same thing about home.

[Fattony]

Another mosquito-borne illness, much more widespread than malaira (in fact found in much of Brazil) is dengue. It is carried by the Aedes aegyptus mosquito which can be active during the day. There is no vaccination against dengue-- just prevention by not getting bit (i.e., use repellent, long clothes)-- but it is usually not seriousness if symptoms caught and treatment begun right away (this applies to the common strain of dengue, not the much more serious but also much more rare hemorrhagic variety).

 

Re malaria I urge you to read up on it and talk with a physician familiar with it before making a decision.

[mains_dream]

Our daughter got malaria and didn't show signs until we were home. It took forever to get her diagnosed, by then she was very ill in the hospital. Believe me, it is not worth getting. She now has it for life. It can come back anytime. So, she has to be very careful with any fevers.

So, my advise is to take the medication! Why take the chance????:rolleyes: