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Taking Malaria pills in Angkor Wat and Siem Reap 2013?

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The Netherlands
posts: 28
reviews: 29
Taking Malaria pills in Angkor Wat and Siem Reap 2013?

I just returned from Cambodia where we stayed for 7 days in and around the Siem Reap area. Before we went I read a lot about taking malaria pills such as Malarone or Doxy. What I noticed was that many people, just like us, are not sure if they should take the pills or not bother with it. Even our local travels clinic gave contradicting advice. I just wanted to share our personal experience so it can maybe help in the desicion making. I'm not a doctor, just a traveler :)

We decided to take Malarone because we wanted to keep our options open regarding the places we would visit. If we were sure we would only stay in Siem Reap and the main temples in the Angkor area we probably wouldn't have taken them. I was glad we did cause during our trip we ended up traveling to higher risk malaria area's 3 out of 7 days.

We visited the parents and other family members of a friend we made during our trip which gave us a unique opportunity to explore the rural way of life in Cambodia. This village was a quite a long drive from Siem Reap and not in the malaria safe area. Things like this you can't plan at home and just cross your path while traveling :))

Also I wanted to shed some light on what the "Angkor area" most travel clinics talk about actually is. When they say there is no malaria at Angkor Wat they mean at the main sites. These are the temples closest to Siem Reap and the most visited ones (Angkor Wat temple, Angkor Thom, Ta Phrom, etc). (I noticed that most doctors working at the travel clinic have never been to Angkor and don't even know exactly where all these temples exactly are). This main area is considered malaria safe as far as my information goes. There are also more remote temples that are from the same Angkorian period and for some you can even use your Angkor daypass. We visited for example Koh Ker and Beng Maelea. There are a lot more bugs at these temples and they are not in the malaria safe area. Koh Ker is about 2,5 to 3 hours from Siem Reap and Beng Maelea is halfway. So when planning your trip think about what temples you want to visit and how far away from the main temples these are.

We visited Angkor and Siem Reap in April, during the hot season. It was 40 degrees Celcius and that meant sweating A Lot!! We applied mosquito repellent (Deet) to make sure we wouldn't get dengue or other mosquito borne deceases you can't prevent by taking pills or injections. But what happened was that it washed off by the sweat very soon and we had to reapply very often. Of course we did get bitten and you can never prevent that 100%, but we didn't get sick. But I'm pretty sure that if we would have only relied on Deet also in the not malaria safe areas it would have caused a bit of stress for me cause you can't prevent sweating!

Personally next time I'd visit Cambodia for a week or longer and not have a clear idea what places we want to visit, I'd take malaria pills again. If I'd do a pre planned tour for lets say 3 days and only visit the main temples or if I was sure I'd only visit some main temples for 2 or 3 days and stay by the pool in Siem Reap for another couple of days, I think I'd rely on Deet. But this is based on my personal experience! I'd advice anybody to visit a travel clinic or doctor before making a decision about malaria pills. But I do hope I was able to give some information that makes the decision easier or to discuss with your doctor.

Cambodia is an amazing country and I absolutely loved it!

Italy
Destination Expert
for Livigno, Lombardy
posts: 39,355
reviews: 139
1. Re: Taking Malaria pills in Angkor Wat and Siem Reap 2013?

Thanks for taking the time to explain the malaria tablets or not dilema, it's definitely a personal thing and as you say people should get professional advice before deciding.

The Netherlands
posts: 28
reviews: 29
2. Re: Taking Malaria pills in Angkor Wat and Siem Reap 2013?

You are welcome! By the way what I also did was ask the doctor if I could try a few pills before our vacation to see how I reacted to it. This made it easier to decide to take them or not, cause I was I little afraid of the side-effects I experienced with another malaria pill in the past. And I agree very much, it's a very personal choice and I don't want to push anybody in a certain direction, just give some thoughts from my experience.

Kurashiki, Japan
Destination Expert
for Kurashiki, Cambodia, Myanmar
posts: 14,820
reviews: 85
3. Re: Taking Malaria pills in Angkor Wat and Siem Reap 2013?

Thanks for your report.

Malaria IS a problem in villages not too far from Siem Reap, and many of my local friends there have had it at least once. The locals do not use bug repellents.

Visitors are another story. People have to weigh in the following factors before deciding to take malaria prophylaxis;

Assessment and awareness of malaria risk-

Detailed geographic location of trip (see www.nathnac.org)

Duration of time in area

Activities undertaken (are you sightseeing/shopping or sleeping in remote villages?)

Bite avoidance-

Protective clothing

Repellents

Longlife insecticide-reated netting

Chemoprophylaxis-

Is chemoprophylaxis indicated or would bite avoidance be sufficient?

Does the area have chloroquinine resistant P falciparum?

Consider medical history and other medications

These are areas outlined by tropical medicine professionals advising doctors how to advise their patients.

(British Medical Journal)

I visit Cambodia, Laos and Thailand, and often in malarial areas, annually, and have never made the choice to take anti-malarial drugs. I DO take precautions to cover up as much as possible, use a mosquito net when staying in rural areas, and using air-con when staying in hotels in the urban areas. Mosquito coils are very useful as well. Just so you know, P falciparum (in mosquitoes!) along the Cambodia-Thai border is becoming resistant to artemesinin-based anti-malarials, so the best advise heading to that area is cover up and use bug repellent.

There is also dengue to be concerned about, which is in some areas far more prevalent than malaria, and which can only be prevented by covering up and using bug repellent, so the choice is up to you.

Adelaide
posts: 4,122
reviews: 199
4. Re: Taking Malaria pills in Angkor Wat and Siem Reap 2013?

No amount of anti-malarial drugs can protect you from dengue fever. And malaria is treatable, dengue not so. The only protection you have against dengue is to avoid getting bitten in the first place. So covering up and lots of repellent, applied frequently, are essential.

If your doctor, after due consideration, and in possession of all the relevant information, suggests that you take anti-malarials, then the obvious path is to do just that. But don't let them lull you into a false sense of security. You may have an added level of protection against malaria, but that dengue is still there, and still a major health risk.

By spraying, mozzie coils, covering up et al, you minimize the chances of contracting dengue, You also minimize the chances of being bitten by a malarial mosquito. So it's a personal choice, aided by your doctor. By all means use the meds if you want, or are advised to. But protecting against dengue goes a long way towards also avoiding malaria.

Kurashiki, Japan
Destination Expert
for Kurashiki, Cambodia, Myanmar
posts: 14,820
reviews: 85
5. Re: Taking Malaria pills in Angkor Wat and Siem Reap 2013?

Here is a report on the drug-resistant strain of plasmodium falciparum

time.com/time/…00.html

The report seems to hint at the resistance being a new thing, but I recall readign reports on this in the medical journals more than several years ago. Now along the Vietnam border as well, and in some parts of Thailand are the resistant strains starting to emerge.

The Netherlands
posts: 28
reviews: 29
6. Re: Taking Malaria pills in Angkor Wat and Siem Reap 2013?

You are right about dengue. That's why we also used Deet and reapplied often. Avoiding being bitten was hard though... I felt like the humid weather and sweating made the mosquito repellant less reliable.

By the way I also read that mosquitos are developping resistance to Deet as well. If thats true it a problem :(

The Netherlands
posts: 28
reviews: 29
7. Re: Taking Malaria pills in Angkor Wat and Siem Reap 2013?

Thank you Maneki-neko for posting this very interesting article in another threat. I'll post it here as well because it's very usefull: nature.com/news/…news.2010.216.html

NomadicForever
posts: 3,693
reviews: 16
8. Re: Taking Malaria pills in Angkor Wat and Siem Reap 2013?

We all seem to focus n malaria when travelling, but people overlook dengue. Latter is not only in rural areas but all over SEA incl. big cities like Bangkok and Singapore.

The Netherlands
posts: 28
reviews: 29
9. Re: Taking Malaria pills in Angkor Wat and Siem Reap 2013?

I don't think people typically overlook dengue. Of course we used bug repellant and covered up as much as possible. No hesitation at all. You don't have a choice but to use Deet. Every travel clinic will tell you. It's the malaria pills that is controversy about. Using them is a personal choice and many people are not sure what they should do.

LaPorte, Indiana...
posts: 1
reviews: 12
10. Re: Taking Malaria pills in Angkor Wat and Siem Reap 2013?

Thank you for this