I could use your help RE malaria in Roatan & the other Bay Islands.

[DocVikingo]

Have you, or has anyone you know and can put me in direct contact with, ever contracted malaria in this location?

Thanks.

DocVikingo

 

[wve]

This is a good question.

I just got back from my first visit to Roatan. After consulting my local travel clinic and the CDC web site, we all decided to take malaria prophylaxis -- which made us all a little nervous due to the potential adverse effects of the drugs most commonly prescribed. The CDC web site specifically mentioned that their Honduras recommendations included the Bay Islands.

However, I must say that we did NOT encounter a mosquito problem. I do not know whether this is because there is no problem or because the resort where we stayed fogged the grounds regularly. I am a mosquito magnet, and I MAYBE got two bites. No one else got bitten at all.

On the plane trip back, I sat next to a diving neurosurgeon who has been to Roatan and Utila many times. Since we are heading to Utila in a few months, I asked him whether he was taking malaria prophylaxis or thought it was needed. He responded by saying that on his first trip to Roatan he and his family took malaria precautions, but on subsequent trips they did not. He said that as long as the trade winds are blowing (which is most of the time), he has never been threatened by mosquitoes.

Finally, one fellow who dove with our group had also checked. This was his fourth trip to Roatan. He said that he could not find a reported case of malaria on the island.

I know a physician who will be traveling to Roatan this fall for missionary work. I expect she may work more inland, so it will be interesting to learn whether she runs into a mosquito problem.

The medications seemed to upset all our stomachs a bit and to cause unpleasant dreams for several of us. Thus we are inclined as a group to forgo the medications next time, although we may take them and start on them should we run into a mad bunch of the pesky creatures.

 

[DandyDon]

Interesting question DocV, hope some can help you. I just hear about it.

There were certaining mosquitoes on Roatan last time I was there. :11: Wve, I am curious as to which med you took?

 

[wve]

The short answer is mefloquine (Lariam).

The longer explanation is that is what was prescribed BEFORE I started checking to see what the effects might be while diving. I had checked the CDC web site which said:

Malaria risk area in Honduras: Risk throughout the country at altitudes below 1000 m (<3,281 ft) and in Roatán and other Bay Island. Risk exists in the outskirts of Tegucigalpa and San Pedro Sula.

I must admit that the potential adverse effects were quite scary, and I considered not taking anything. (It was too late to switch.) However, having never been, I reasoned that most of the reported adverse effects occurred in people taking much higher doses for treatment of malaria rather than for prophylaxis, and I thought I'd rather risk the side effects than malaria. I must also add that the side effects did not become particularly noticeable until after the third dose -- which was at the end of our week of diving.

Having been, I'm still not sure, but I'm less worried than I was. Next time around I may ask for Malarone (atovaquone/proguanil).

What do you do?

 

[vondo]

I thought cholorquine was adequate for Central America. Is that not true anymore?

The Lariam side effects scare me too, so I usually take malarone when those two are the choice. I never noticed any side effects. It is a daily pill as opposed to once a week, which is harder for those of us that don't take regular medications.

Edit: Also, talking to a good travel Dr. can help you assess relative risk. For instance, the CDC claims there is risk all throughout Brazil, but I hear other reports that cases are extremely rare there. So I chose to do nothing.

 

[Wayan]

The short answer is mefloquine (Lariam).

Scuba divers should be cautious using this in some people the side effects can present as a DCI hit.

there is also a Chinese drug artemether and artensunate which have been around for a long time that can be effective. Check with Dr that specializes in tropical diseases

 

[DocVikingo]

I thought cholorquine was adequate for Central America. Is that not true anymore?

You are correct, Vondo, cholorquine is stiil the drug of choice per the most current advice by both MDtravelhealth.com (bold lettering mine): "Malaria in Honduras: prophylaxis is recommended for all areas below 1000 m (3281 ft) and for Roatán and other Bay Islands. Historically, the highest incidence rates have occurred in the swampy regions in the east, but the number of cases reported from the north has risen dramatically over the last several years. There is risk in the outskirts of Tegucigalpa and San Pedro Sula. The drug of choice is choloroquine, taken once weekly in a dosage of 500 mg, starting one-to-two weeks before arrival and continuing through the trip and for four weeks after departure. Chloroquine may cause mild adverse reactions, including gastrointestinal disturbance, headache, dizziness, blurred vision, and itching, but severe reactions are uncommon. Insect protection measures are essential in rural areas."

and

The CDC: From the CDC (bold lettering mine): Drugs to Prevent Malaria (Antimalarial drugs). If you will be visiting a malaria risk area in Honduras, chloroquine is the recommended antimalarial drug.

Malaria risk area in Honduras: Risk throughout the country at altitudes below 1000 m (<3,281 ft) and in Roatán and other Bay Islands. Risk exists in the outskirts of Tegucigalpa and San Pedro Sula."

Helpful?

Regards,

DocVikingo

This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice.

 

[DocVikingo]

The short answer is mefloquine (Lariam).

Hi wve,

No, that really isn't the short answer. The short answer is the one I provided to Vondo immediately above.

Mefloquine (e.g., Lariam) is not advised and here's why. The following is an edited excerpt from an article I wrote on mefloquine for Rodale's Scuba Diving:

"In my book, mefloquine is out due to the reasons in this general informational item I wrote on the drug:

"Lariam (mefloquine) is a very effective drug in preventing and treating malaria, but can give rise to unwanted side effects, including vivid and disquieting dreams, hallucinations, anxiety, depression, confusion and forgetfulness.

The US package insert directs that "...caution should be exercised with regard to driving, piloting an airplane, and operating machinery as dizziness, a disturbed sense of balance, neurological or psychiatric reaction have been reported during and following the use of Lariam," and states that "dizziness, sensory & motor abnormalities, headache and fatigue have been recorded in patient's taking the drug." These cautions are consistent with suggestions by some in the medical and dive communities that mefloquine may produce side effects which mimic DCS.

Interestingly, the German package insert adds it should not be used for "certain activities which have a need for full attention and undisturbed motor activity," with a specific direction that pilots should not use Lariam for the prevention of malaria during their work.

Of most concern to the diver are the positions of some medical professionals that the drug simply should not be taken for malaria prophylaxis by those who are actively diving. These sources include the German Society for Tropical Diseases. This later group, whose policies can be used as a basis for professional and legal action in cases of harm resulting from a physician's failure to follow them, states that people with a special need for three-dimensional orientation, for example pilots, scuba divers and others, should not take mefloquine as prophylaxis. Similar advice regarding scuba diving is provided by Dr Bridget Farham, B.Sc (hons), Ph.D, MB.ChB., an expert on tropical medicines, and appears in the package insert accompanying mefloquine dispensed in South Africa.

The above information suggests it would be prudent to take this drug only after detailed discussion with a physician who is fully aware of its current status, and to closely monitor for any adverse reaction.

The FDA has come out with the following warning regarding mefloquine:
http://www.fda.gov/bbs/topics/NEWS/2003/NEW00921.html"

Helpful?

Regards,

DocVikingo

This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice.

PS: Atovaquone/proguanil (e.g, Malarone) is very effective and much less problematic than mefloquine (e.g., Lariam)

 

[DocVikingo]

The question I asked was:

"Have you, or has anyone you know and can put me in direct contact with, ever contracted malaria in this location?"

It was not about malaria chemoprophylaxis in the Honduras.

I'm writing another article on the topic and would like to include a name and brief interview.

Thanks.

DocVikingo

 

[wve]

DocV,

Actually my "short" response was in reply to DandyDon who asked me what I took. I didn't mean to imply that this is what I SHOULD have taken.

Our local travel clinic is run by an Infectious Disease specialist, but he is not a diver. Knowing that, I started investigating on my own (including reading your article). But by the time I figured out that mefloquine might not be such a smart idea, it was too late to change. We had already started on it, and the trip came up before the pharmacy could order something different.

I will be interested in your report. The issue of actual risk seems to be key, and I thought this was what you might be driving at. That's why I mentioned that I had visited with two people who had never heard of any cases of malaria in the Bay Islands.

When I began reading about all of the anti-malarials, I frankly found all of them to be potentially problematic. A major difficulty is the paucity of reliable comparison data, especially within the context of malaria prevention (with its much lower dosing vis a vis treatment) among scuba divers.

If, in fact, the actual malaria risk is low, then the question about which drug to take becomes almost moot. Instead, the question becomes whether to take anything at all. In reality, the latter question is already being answered by many who, based upon their own impressions of perceived risk, seem to be deciding to ignore the CDC recommendations altogether, skipping the malaria prophylaxis.

As it stands currently, it seems to be a bit of a crap shoot between undesirable alternatives. Do you want to risk getting malaria, or would you rather risk having nightmares, nausea, or neuropsychiatric problems?

Clearly we need more data, and I hope your article will give us some answers!