Jump to content


Photo
- - - - -

Raja Ampat - Anti-malarials?


  • Please log in to reply
20 replies to this topic

#1 pompeygreg

pompeygreg

    Triggerfish

  • Member
  • Pip
  • 33 posts
  • Gender:Male
  • Location:Bristol, UK

Posted 24 September 2012 - 11:15 AM

I'm heading for a liveaboard in Raja Ampat in November.

I'm interested in whether people bother with anti-malarials, I'd assumed I wouldn't bother given the limited exposure. Am I taking a risk?

I'll only be in Sorong for a few hours either side of my flights.

Greg

#2 Alex_Mustard

Alex_Mustard

    The Doctor

  • Super Mod
  • 8376 posts
  • Gender:Male
  • Location:Peterborough

Posted 24 September 2012 - 11:18 AM

On one trip I led there I had 4 doctors on board. And they were all doing different things - and all convinced they were right!

Alex

Alexander Mustard - www.amustard.com - www.magic-filters.com
Nikon D4 (Subal housing). Nikon D7100 (Subal housing). Olympus EPL-5 (Nauticam housing).


#3 blaisedouros

blaisedouros

    Moray Eel

  • Industry
  • PipPip
  • 79 posts
  • Gender:Male

Posted 24 September 2012 - 12:16 PM

Drink lots of gin and tonics. The quinine in the tonic water won't prevent malaria, but is helpful in treating the symptoms. Plus you have an ironclad excuse to have your cocktail hour every night. I make sure to take plenty of precautions against malaria symptoms wherever I go ;)

#4 AllisonFinch

AllisonFinch

    Eagle Ray

  • Member
  • PipPipPip
  • 399 posts
  • Location:Chapel Hill, NC
  • Interests:Caves, photos and long distance travel to dive.

Posted 24 September 2012 - 01:17 PM

I ALWAYS use anti-malarials in the Pacific region. I know too many people who live there and who have malarial bouts. Simply not worth the risk. The one I find the least problematic (I've used them ALL over the years) is Malarone.

Yes, you are fairly safe in liveaboards, except they get close to shore and even have shore excursions. AND, you need to get to and from the boat. All of this puts you at risk.

It reminds me of dirty Harry......you feel lucky? Do ya?

#5 pkrupela

pkrupela

    Starfish

  • Member
  • Pip
  • 6 posts
  • Location:Southern California
  • Interests:Sharks - big, scary, open-water sharks - and macro on occasion. If it's new, different, and has an expedition smell about it - sign me up.

Posted 24 September 2012 - 01:44 PM

I've been to Raja Ampat four times and never saw a mosquito - then again, I didn't do any of the shore excursions that may have been offered. The boats are far enough offshore to not worry too much about mosquitoes.

But then again, I always take anti-malarials and my drug of choice over the years is doxycycline, 100 mgs per day. You have to take it beginning a couple days right before the trip and then for 28 days after you return, but there aren't any side effects. Some people get sun sensitivity but I've never had that happen and I actually get pretty tan in Indo.

I also take Malarone with me in case I develop malaria, and the dosage for treatment is four tabs once a day for three days. This is the treatment dosage, not the prophylactic dosage.

I'd rather take the Doxycyline since I know I tolerate it well and there are no real side effects as long as you don't take it longer than four months, which is why it's not an option for people that live in a malarial area.
"Quis custodiet ipsos custodes?" - Juvenal

#6 eyu

eyu

    Great Hammerhead

  • Member
  • PipPipPipPip
  • 725 posts
  • Gender:Male
  • Location:Wilmington, DE

Posted 24 September 2012 - 01:49 PM

You should check out the CDC website and DAN in regards to malaria prophylaxis.
Also you should consult an infectious disease physician who specializes in tropical medicine since the antimalaria medications have significant side effect profiles.

Nikon D800E, D800, Subal ND800, Inon Z240, ULCS with StiX floats


#7 pompeygreg

pompeygreg

    Triggerfish

  • Member
  • Pip
  • 33 posts
  • Gender:Male
  • Location:Bristol, UK

Posted 25 September 2012 - 12:21 PM

Thanks for the advice all.

The sum of it seems to be that I should go with the anti-malarials and I'm happy to do that. I've used Malarone before when diving so if the doc says that's ok then I'll go with it.

#8 divengolf

divengolf

    Wolf Eel

  • Member
  • PipPip
  • 149 posts
  • Gender:Male
  • Location:Virginia
  • Interests:User name says it all- Dive & Golf, plus a little fishin' when I can.

Posted 25 September 2012 - 04:06 PM

Whenever I travel to third world countries, I always consult the CDC web site. But their advice tends to be rather general for a large country like Indonesia. So I rely on a local medical practice that specializes in travel medicine. They have the knowledge and resources to give specific, detailed advice for each area of the world.

I'm headed to RA next month. They strongly recommend using either doxycycline or malerone. There are other malaria prophylaxis that are not effective for the maleria strains in RA. They also recommend that you have a current typhoid innoculation. Typhoid shots are only good for two years as I understand.

Also carry pepto for & stomach distress and cypro for serious stomach bacteria.

Note that there is now a generic malerone pill. I got 28 days worth for less than $10 through my medical insurer (BC/BS). It used to cost about $100+.

Also take bug spray with at least 30% DEET. Nothong works like DEET to keep the little bas...ds away.

Edited by divengolf, 25 September 2012 - 04:10 PM.


#9 okuma

okuma

    Great Hammerhead

  • Industry
  • PipPipPipPip
  • 737 posts
  • Gender:Male
  • Location:Anaheim, CA USA

Posted 25 September 2012 - 04:10 PM

With 12 live aboard trips to Raja and PNG we have always taken anti malarials.
On our last trip to PNG in 2010, we were introduced to "Artemedine".

You take this drug upon contracting malaria and according to the boat owner/Captian you will be diving within 4 days. While there we purchased 4 sets of the drug for US$12.00/set. Each set contains two drugs.One is made from a plant growing in China and the other is a sulpha drug that has been around for a while..

Our pharmasists has never heard of it , but one of our doctors said he heard it is under going tests by the US Drug agency .
We will no longer take anti drugs while on a live aboard, but will do so if staying on land for a period of time.

I do not know if it is effective for all types of malaria, but supposedly it is now widely used in PNG.

Any one know any thing about this???
Underwater Photography:
If it is so easy every one would be doing it!

Nikon D 7000, Subal Housing, Inon Z 240 strobes.

#10 troporobo

troporobo

    Sting Ray

  • Member
  • PipPipPip
  • 286 posts

Posted 25 September 2012 - 04:29 PM

You should check out the CDC website and DAN in regards to malaria prophylaxis. Also you should consult an infectious disease physician who specializes in tropical medicine since the antimalaria medications have significant side effect profiles.


This is excellent advice. Some people have more serious side effects with some prophylaxis than others.

I lived full time in Solomon Islands on two occasions, for total of five years. I took various prophylaxis in that time, and had major problems with a couple of them. And I acquired malaria once (fortunately p. vivax not p. falciparum which is much more serious).

For the past 12+ years I have traveled throughout the Pacific islands for work on average 8 times a year for perhaps a total of three months a year, including significant field time in villages in the Solomons and PNG, and have not taken any prophylaxis on work trips since I would be on it more or less permanently. I have not had a problem in any of that time. I put this down to the standard precautions which are well worth knowing and following: insect repellent at all times, cover exposed areas an hour either side of sunrise and sunset, and as sensibly mentioned above, repeated applications of G&T!

#11 KirkD

KirkD

    Sting Ray

  • Member
  • PipPipPip
  • 248 posts
  • Gender:Male

Posted 25 September 2012 - 04:54 PM

As a heath care provider, you should consult a travel medicine physician. You do not want Malaria. Some have more SE than others. Additionally, there may be other diseases that you need vacinated for

#12 AllisonFinch

AllisonFinch

    Eagle Ray

  • Member
  • PipPipPip
  • 399 posts
  • Location:Chapel Hill, NC
  • Interests:Caves, photos and long distance travel to dive.

Posted 25 September 2012 - 08:56 PM

With 12 live aboard trips to Raja and PNG we have always taken anti malarials.
On our last trip to PNG in 2010, we were introduced to "Artemedine".

You take this drug upon contracting malaria and according to the boat owner/Captian you will be diving within 4 days. While there we purchased 4 sets of the drug for US$12.00/set. Each set contains two drugs.One is made from a plant growing in China and the other is a sulpha drug that has been around for a while..

Our pharmasists has never heard of it , but one of our doctors said he heard it is under going tests by the US Drug agency .
We will no longer take anti drugs while on a live aboard, but will do so if staying on land for a period of time.

I do not know if it is effective for all types of malaria, but supposedly it is now widely used in PNG.

Any one know any thing about this???



It's been used in PNG for years. I know many expats who have used it, since antimalarials can't be taken for long periods. Unfortunately many of them have contracted malaria and it doesn't seem to help that much. I have seen a liveaboard captain brought down by a bout of malaria....poor guy.

#13 pompeygreg

pompeygreg

    Triggerfish

  • Member
  • Pip
  • 33 posts
  • Gender:Male
  • Location:Bristol, UK

Posted 25 September 2012 - 11:36 PM

As a heath care provider, you should consult a travel medicine physician. You do not want Malaria. Some have more SE than others. Additionally, there may be other diseases that you need vacinated for


I've already got my appointment sorted with the health clinic to have any outstanding vaccinations and get a prescription for anti-malarials, luckily it's one of the few times I have cause to use the National Health Service!

Greg

#14 johnjvv

johnjvv

    Sting Ray

  • Member
  • PipPipPip
  • 254 posts
  • Gender:Male
  • Location:Frankston, Australia

Posted 26 September 2012 - 12:14 AM

Dont get bitten! Use bug spray....all malaria pills have some sort of side effect from halucinations to nightmares....some make you drowsy and malanol says it is without side effects but hard on the stomach....i was in zimbabwe and you could see the mozzies hovering around your legs without landing because of bug spray...

#15 Drew

Drew

    The Controller

  • Video Expert
  • 10639 posts
  • Gender:Male
  • Location:GPS is not reliable in South East Asian seas

Posted 26 September 2012 - 04:36 AM

On our last trip to PNG in 2010, we were introduced to "Artemedine".

I've answered this in this thread:
http://wetpixel.com/...showtopic=38538

Basically in combination (and only effective in combo like COARTEM), Artemesinin derived drugs have been effective as a TREATMENT, NOT as a prophylaxis. However, using only Artemesinin has caused the disease to become more resistant. To further this, I believe there was an article in Time about Artemisinin resistance strain in South East Asia, mainly Indochina.

Dont get bitten! Use bug spray....all malaria pills have some sort of side effect from halucinations to nightmares....some make you drowsy and malanol says it is without side effects but hard on the stomach....i was in zimbabwe and you could see the mozzies hovering around your legs without landing because of bug spray...

The Anopheles mosquito is crepuscular and bite at night. So avoid activity outdoors in the night and spray down your room. When you want to take pics of those gorgeous sunsets in R4, then wear long sleeve baggy clothes and use some sort of repellent.

In answering the OP's question, you can look at it statistically. The Anopheles mosquito (carrier of the malaria virus) bites at night. Near dusk, coverup with repellent and if on an outlying island, stay indoors and kill every mosquito in the bedroom. If you don't go onto the mainland or exposed to any local population at night, the exposure risk is lower. On a liveaboard, the exposure risk is much lower than being on an island resort with locals around. Managing your activities to avoid the mosquitoes will definitely help. Of course, the choice is yours whether to take that risk.

Drew
Moderator
"Journalism is what someone else does not want printed, everything else is public relations."

"I was born not knowing, and have only had a little time to change that here and there.


#16 AllisonFinch

AllisonFinch

    Eagle Ray

  • Member
  • PipPipPip
  • 399 posts
  • Location:Chapel Hill, NC
  • Interests:Caves, photos and long distance travel to dive.

Posted 26 September 2012 - 10:58 AM

Dont get bitten! Use bug spray....all malaria pills have some sort of side effect from halucinations to nightmares....some make you drowsy and malanol says it is without side effects but hard on the stomach....i was in zimbabwe and you could see the mozzies hovering around your legs without landing because of bug spray...


Only one tends to have those side effects....Larium. And, because some of the effects mimic DCS, it is not allowed on many LOBs. Doxy MIGHT make you photosensitive. I have had no side effects from either doxy or malarone. Bug spray is only ONE level of defense. If you don't use antimalarials, that is YOUR decision. It is not wise to try to talk anyone else out of protecting themselves, IMO.

It is not just the anopheles that carries malaria. Luckily, it is not likely to be found in RA.

http://ens-newswire....found-in-kenya/

Edited by AllisonFinch, 26 September 2012 - 11:04 AM.


#17 johnjvv

johnjvv

    Sting Ray

  • Member
  • PipPipPip
  • 254 posts
  • Gender:Male
  • Location:Frankston, Australia

Posted 26 September 2012 - 11:54 AM

Only one tends to have those side effects....Larium. And, because some of the effects mimic DCS, it is not allowed on many LOBs. Doxy MIGHT make you photosensitive. I have had no side effects from either doxy or malarone. Bug spray is only ONE level of defense. If you don't use antimalarials, that is YOUR decision. It is not wise to try to talk anyone else out of protecting themselves, IMO.

It is not just the anopheles that carries malaria. Luckily, it is not likely to be found in RA.

http://ens-newswire....found-in-kenya/



Sorry i did not want to come across as saying that you should not take medication. Growing up on SA and visiting parks frequently i always took the pills and dont want to come across like I am Rambo! The last type I took was Malanol as we wanted to avoid side effects however both my partner and I had upset stomachs and ot hampered our hols. I will go back to Lariam next time...

But above all....dont get bitten which is easy if you take the right precaution!

#18 troporobo

troporobo

    Sting Ray

  • Member
  • PipPipPip
  • 286 posts

Posted 26 September 2012 - 02:19 PM

Only one tends to have those side effects....Larium.


This is not necessarily the case. People react differently, and some have more or less severe side effects. There are documented cases of psychosis, depression, and anxiety attacks with all types of prophylaxis inclusing Lariam / mafoloquine

In my experience, chloroquine (thankfully now mostly discontinued due to resistance) made it almost impossible to sleep due to nightmares, and paludrine (now prescribed wth chloroquine) caused vision problems over a longer-term prescription. I have also taken mefloquine and suspect it led to depression, again over a period of months not weeks.

I also agree with other posters that it is up to each traveller to decide the level of risk they face and the appropriate response, in consultation with a doctor. Prophylaxis is sometimes necessary, and I can attest that experiencing malaria was far less fun than the side effects of the medicine!

Edited by troporobo, 26 September 2012 - 02:21 PM.


#19 danielstassen

danielstassen

    Sting Ray

  • Member
  • PipPipPip
  • 229 posts
  • Gender:Male
  • Location:Alor (for work) Bali (to live)
  • Interests:Dive, dive, and dive again.

Posted 26 September 2012 - 08:10 PM

Lived there for two years, never took any malaria medicine and never got malaria. However, many of the workers on the pearl farm I worked have malaria... Now I have been living for 1 year in Alor, which is also a high risk area, but so far I have been lucky. Again many workers here have malaria. I think it is not a question of if we have malaria, but when.

I'd recommend malarone. I took it for more than 1 month many years ago, and did not get any side effects. With some malaria medicine one can become sensitive to the sun, which might not be the best when travelling in a tropical country.

If you only go for a couple of day trips and when you are in Sorong, some good mosquito cream would suffice though.

Cheers,

Daniel


Lived there for two years, never took any malaria medicine and never got malaria. However, many of the workers on the pearl farm I worked have malaria... Now I have been living for 1 year in Alor, which is also a high risk area, but so far I have been lucky. Again many workers here have malaria. I think it is not a question of if we have malaria, but when.

I'd recommend malarone. I took it for more than 1 month many years ago, and did not get any side effects. With some malaria medicine one can become sensitive to the sun, which might not be the best when travelling in a tropical country.

Cheers,

Daniel

Edited by danielstassen, 26 September 2012 - 08:11 PM.

Daniel Stassen

Marine Biologist, Pearl Farmer, and photographer at heart...

My Blog: www.dstassen.com

My equipment: Canon 7D, Nauticam ND7, Nauticam 180 degree viewfinder, lenses (canon) 100 mm, 60 mm, 10-22 mm. Twin Inon Z240 strobes, 3 x Sea&Sea YS110 alpha.

#20 AllisonFinch

AllisonFinch

    Eagle Ray

  • Member
  • PipPipPip
  • 399 posts
  • Location:Chapel Hill, NC
  • Interests:Caves, photos and long distance travel to dive.

Posted 27 September 2012 - 10:21 AM

Eugenie Clark decided not to use antimalarials when doing research on New Ireland in PNG. That decision almost killed her.