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Jabs and Malaria Tablets!

north wales
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Jabs and Malaria Tablets!

Went to the doctors with my partner today, the travel nurse didnt really give us any definate advice. Mentioned a few things that are 'optional' and told us to go away and do some research. After looking at a few posts still confused.

We are definately going to take anti-malaria Tablets..which ones would you recommend? I know they can have awful side effects?

Yellow Fever vaccine? hmm from what I gather most people dont have this? Am I just worrying?

Rabbies Jab? The nurse said this is also optional...

Any advice is appreciated! :)

Thanks

Washington DC...
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1. Re: Jabs and Malaria Tablets!

Haylie, most often doxycycline, Malarone, and Lariam are mentioned for prophylaxis. I recommend against Larium because of possible psychiatric side-effects. The regimens for the other two are different: doxycycline, start two days before entering an endemic area, throughout your stay in an endemic area and continue for four weeks after return; Malarone, start two days before entering an endemic area, throughout your stay in an endemic area and continue for one week after return. Doxycycline, preferred by many because of cost, can cause photo-sensitization (increase risk of sun burn). Some Malarone side effects relate to the gi tract. For whatever it's worth to you, my wife and I have always taken Malarone with no obvious side-effects.

At any rate, you should consult with your doctor or health specialist to make sure your health is considered when a drug is prescribed.

Lastly, whether you take prophylaxis or not, it is key to avoid mosquito bites by taking appropriate measures (e.g., keeping covered at dusk and dawn, using repellant as directed).

Durham, North...
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2. Re: Jabs and Malaria Tablets!

Good advice! We preferred Malarone, saving the cheaper Doxycycline for when we might need an anti-biotic. None of my party had problems with Malarone, and I often took it on an empty stomach.

Doxycycline is an anti-biotic, so it is possible that could also cause gi tract problems, by killing off the good bacteria. If this were to happen, just take some probiotics (I use cheap, ones available on grocery stores).

http://en.wikipedia.org/wiki/Probiotic

I did extensive research on insect repellents and insecticides, and my research can be found here:

www.woodsmall.com/insect-repellents.htm

Durham, North...
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3. Re: Jabs and Malaria Tablets!

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Mtwapa, Kenya
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for Barcelona, Newcastle upon Tyne, Bamburi, Mtwapa
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4. Re: Jabs and Malaria Tablets!

Hi,

You do not need any special vaccinations for Kenya, though as with travelling anywhere it is a good idea to be up to date with the vaccinations and boosters recommended for an adult living in Britain (Diptheria & Tetanus, Hepatitis A & Typhoid, Polio)

You do not need the Yellow fever vaccination if you are going directly to Kenya and returning directly without visiting any other African countries, it is a personal choice. The 'FAQ - Do I need a yellow fever Vaccination?' contains information to help people make the decision. Note that in April the WHO changed its advice and the vaccination is no longer recommended for 'North Eastern province, the states of Kilifi, Kwale, Lamu, Malindi and Tanariver in Coastal province, and the cities of Nairobi and Mombasa.'

As a tourist you do not need the Rabies vaccination either, unless you do something silly like trying to feed monkeys at your hotel you are not really at risk. The vaccinations (a course of 3) do not give you immunity to the disease, they increase the time you have in the event of being bitten or scratched before treatment needs to start. If you have had the pre-treatment you will still need two further vaccinations, if you haven't then you have the full series of 5. As a tourist on Safari or at the coast in Kenya you are never more than a few hours from treatment

The following are extracts from the Health Protection Agency's National Travel Health Network and Centre website

"Rabies pre-exposure vaccine should generally be given to adults and children who are at risk of rabies including

*Those travelling to remote areas where medical care is not readily available

*Those undertaking higher risk activities (e.g. cycling, running)

*Those who are travelling for long periods through rabies endemic countries

*Those at occupational risk e.g. vets, animal handlers, and laboratory workers who handle the virus.

The rationale for receiving pre-exposure vaccine is that it gives the individual time to reach medical treatment in the event of an animal bite or scratch; it may also protect an individual who has an unapparent exposure. Those who have received a pre-exposure course of rabies vaccine will require two further doses of vaccine post-exposure (according to UK schedules), rather the full course of five vaccines. In addition, rabies immune globulin (RIG) will not be necessary.

Ideally, those at risk should receive pre-exposure vaccination with three doses of inactivated rabies vaccine before travel. A 0, 7 and 21 day schedule can be given using either product, where there is less than four weeks before departure."

nathnac.org/travel/…Preexposure

Edited: 2:47 am, May 14, 2011
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Mtwapa, Kenya
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5. Re: Jabs and Malaria Tablets!

PS - Side effects with Doxycycline are rare, but the photo-sensitivity that two or three people have reported is not sun burn but rather a rash of small red blisters, personally I have taken it for periods of up to 6 months in Kenya with no side effects.

Many more people report side effects with Malarone, but as these are usually headaches and upset stomachs, there are lots of other potential causes for these than just Malarone. On my first few, short, visits here I took Malarone with no side effects

The fact is that the vast majority of travellers do not experience any side effects and unfortunately you will not know whether you will be one of the unlucky ones until you actually try the medication

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Isle of Man, United...
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6. Re: Jabs and Malaria Tablets!

I am shocked at the attitude of your practice nurse. You are going to her for professional advice not to be told to go away and do your own research. Complain to your doctor. You pay your taxes for a Health Service and this is simply unacceptable.

My only other comment is to the qualification or otherwise of Steveb108 to advise against Larium. It is actually more effective in Africa than Malarone. Thousands of folk use it, including me, it without any problems. There are reported problems with a minority of would be users but that is normal for any drug.

To requote Doffs last para.

<<The fact is that the vast majority of travellers do not experience any side effects and unfortunately you will not know whether you will be one of the unlucky ones until you actually try the medication.>>

Edited: 4:34 am, May 14, 2011
nyc
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7. Re: Jabs and Malaria Tablets!

I've used both Lariam and Malarone with no side-effects ever. Prefer the Malarone, though more expensive than Lariam, these two are specific for malaria.

Never used nor had interest in doxy as an option (even if the least expensive, but also has a 28/day need to take after returning home... didn't appeal), so have no further comment on this one.

Yellow Fever inoc is NOT required for entry to Kenya if arriving direct from UK and not heading onto another sub-saharan country.

Of course, you should do your own research, but for your practice nurse to offer such needs as "optional" is very irresponsible; s/he should be more proactive.

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Washington DC...
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8. Re: Jabs and Malaria Tablets!

To find information on the serious side effects of Lariam one can simply Google "Lariam incidence of side effects." One will find an extensive amount of information from a variety of sources. Readers can make up their own minds.

The oft-cited risk of serious psychiatric effects related to lariam is 1 in 10,000, though it might be lower. Given that serious side effects from doxy and Malaraone are less, it was an easy decision for me to limit my choice to these two.

It is of course true that "The fact is that the vast majority of travelers do not experience any side effects and unfortunately you will not know whether you will be one of the unlucky ones until you actually try the medication." Nevertheless, a large part of risk assessment/management is the hazard component. If I have a choice of three drugs that offer (1) sun sensitivity, (2) upset stomach or (3) hospitalization for psychiatric effects, why would I go with the third?

mfuwe, I am, like you, expressing an opinion here. I am puzzled by why you need to question my credentials---I don't ask for yours. The first sentence of your second paragraph could have read "I have a different view on the safety/efficacy of Lariam." Thanks, Steve

Isle of Man, United...
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9. Re: Jabs and Malaria Tablets!

No Steve, you were specifically recommending against Larium. Not quite the same thing. Now there is the suggestion of hospitalisation. Where did that come from?

Yes, I have a different view.

Washington DC...
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10. Re: Jabs and Malaria Tablets!

Mentions of hospitalization are widespread; some are in sources (e.g., class action law suits, groups that actively advocate against Lariam) that, I think, one should take with a grain of salt.

The following is from Wikipedia:

"Side effects

"Mefloquine is contraindicated in those with a previous history of seizures or a recent history of psychiatric disorders.[1] Severe side effects requiring hospitalization are rare.[2] Rates of side effects appear similar to other medications used for malaria prevention.[3]

"Neuropsychiatric

"Neuropsychiatric effects are reported with mefloquine use.[1] It is not known if this is a causal relationship.[1][2] The FDA product guide states it can cause mental health problems including: anxiety, hallucinations, depression, unusual behavior , and suicidal ideations among others.[6] Some have reported severe central nervous system events requiring hospitalization in about 1:10,000 people taking mefloquine for malaria prevention with milder events (e.g., dizziness, headache, insomnia, and vivid dreams) in up to 25%.[8] When some measure of subjective severity is applied to the rating of adverse events, about 11-17% of travelers are incapacitated to some degree.[3]"

CBS news did a piece on Lariam (cbsnews.com/stories/…main538144.shtml) relating to the drug's possible serious side-effects. Again, I would take it with a grain of salt. But I think that the total weight of all the information out there is waving a red flag and that posters asking advice on antimalarials should be apprised of the information.

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