Which Malaria Preventive Do You Use In Risk Areas: Mexico & Central America?

[Kevrumbo]

Unfortunately, Doxy is one of the most photosensitizing agent we have. Don't want to be out in the sun too long without a good sunscreen. Miss a spot, and you'll burn.

Doxycycline is a good antiinflammatory agent, and is used for the long term treatment of acne. It is possible that you might not have Staph aureus folliculitis, but rather have pustular acne. My gut feeling is, long term use of doxycycline will result in Staph resistance within a few months.

I usually tell my patients to stop their doxycycline prior to going on a tropical vacation - so they don't get burned.

No, in my case I've got lifelong chronic Atopic Dermatitis/Eczema ("The Itch that Rashes") with concurrent bouts of folliculitis; because of the general dryness of my skin coupled together with several immersion/drying cycles per day on a liveaboard divetrip, I'm very susceptible to staph infections and inflammations like "Prickly Heat" in the tropics (contracted a bad case of Impetigo on a past liveaboard trip to Indonesia).

Also have a history of Dengue Fever contracted in PNG, so I'm more worried and at greater risk for developing complications --Dengue Shock & Hemmorrhagic Syndrome-- should I ever get bit again by the Aedes aegypti Mosquito.

IMO Dengue is just as deadly as Malaria, but unfortunately in terms of a prophylaxis --there are no currently available vaccines against the four viral serotypes of Dengue Fever.
From the CDC website:

In 2005, dengue is the most important mosquito-borne viral disease affecting humans; its global distribution is comparable to that of malaria, and an estimated 2.5 billion people live in areas at risk for epidemic transmission . . . Each year, tens of millions of cases of DF occur and, depending on the year, up to hundreds of thousands of cases of DHF. The case-fatality rate of DHF in most countries is about 5%, but this can be reduced to less than 1% with proper treatment. Most fatal cases are among children and young adults.

 

[fisherdvm]

No, in my case I've got lifelong chronic Atopic Dermatitis/Eczema ("The Itch that Rashes") with concurrent bouts of folliculitis; because of the general dryness of my skin coupled together with several immersion/drying cycles per day on a liveaboard divetrip, I'm very susceptible to staph infections and inflammations like "Prickly Heat" in the tropics (contracted a bad case of Impetigo on a past liveaboard trip to Indonesia).

Next question I'd ask with some one like you is, have you ever been skin prick tested for common food allergens? Have you ever been patch tested for contact allegens? Have a good dermatologist talked to you about not using bathing aids (wash cloths, sponges, luffa) - and limiting your soap to certain area of the body? I am not sure, but some folks with recurrent skin infection and eczema can have a hyperIgE syndrome or Job syndrome. Might be good to look into it.

If you haven't I'd suggest seeing an allergist for the skin prick test, and a dermatologist or allergist for the patch test.

As counterintuitive as it might sound, antibacterial soap might aggravate your eczema, but certainly has a role in the control of recurrent skin infection. I usually use antibacterial soap or benzoid peroxide soap in individuals like yourself, but limitted to the groin and body folds. BP soap is great for folliculitis of the scalp. Also consider using mucopuricin ointment in the nostrils nightly, and topical antibiotics in the body folds.

 

[fisherdvm]

Thanks Dannydon, for looking that up. When I went to Ecuador in the 80's, I was banned from blood donation for like 2 or 3 years after taking chloroquine. Apparently they claimed that it might delay symptoms for longer than 1 year.

They must have changed their mind since, as I see now the hold period for blood donation is only 1 year, irregardless of prophylaxis?

 

[wve]

... saving the big-gun medication until it's needed might make more sense.

You are correct, but a number of physicians think that in some circumstances it is better to go ahead and use the big gun now, figuring that it is better to maximally protect the individual patient and let the drug companies come up with something new for the masses.

Such a view is admittedly controversial.

 

[wve]

Looks like you didn't vote for Lariam? Also seems I am the only one so far following CDC guidelines.

No, the side effects we experienced, though only annoying, make me not want to use that again unless necessary.

Since we are planning a trip to Utila, this is an area of active interest to me. As soon as I get the chance, I plan to talk to my travel doc. I want to raise these issues of concern to divers which I bet he has not thought about. He is a very smart guy, and he will take the questions seriously. I'll be interested in what he has to say.

 

[reefduffer]

Setting up a poll that will communicate the questions effectively for accurate results can be a challenge. That's the way I have done it, so I voted Chloroquine. I'm not clear on why you chose other? The qustion was "which do you use?" Not "which were you precribed."

I'm probabably guilty of being a little pedantic, basicly pointing out that IMO you've set up the poll poorly, and I agree that can be challenging. I really don't want to sabotage your intent to discuss the subject of what malaria drugs people use, or why they might ignore CDC recommendations. Just having the discussion here might get a few people to remember about immunizations before travel. Worthy stuff.

But since you say you don't understand why I said "other", let me explain my quibble. You asked "which do you use?", not "which have you used.". Maybe it's because you see diving in malaria-affected areas as a continuing frequent process, where you will form an opinion about what specific drug to use and then apply that opinion repeatedly.

For me, every tropical trip is still a one-off, to be researched independently. So the answer for me about "which do you you use" is correctly "Whatever CDC currently recommends", not what they recommended, and I took, on one specific trip last February. "Chloroquine" is the wrong answer to your question for me, although that is in fact what I took on my most recent trip. If next year I was going back to Belize and CDC then recommended buttered-popcorn flavored jelly beans, that's what I'd take, not Chloroquine.

I also think that my interpretation of your question has more long term general value as the way for most people to think about the problem, which is why I decided to quibble about your construction of the poll.

But on the other hand, then we don't get to discuss whether anybody thinks they know better than CDC. So, now back to our regularly scheduled discussion about the merits of various antimalarial drugs, which I don't feel competent to participate in, but I'll certainly read.

 

[DandyDon]

Thanks reefduffer - super answer!

Yeah the discussion and thought review is the important thing. And has been mentioned above, there are other risks to take seriously in what amounts to adventure travel for those us accustomed to the mild hazards we experience in the US, other mosquito born illness in the same league, other prophylactics and vaccines to consider, other safeguards to attempt. My aim was to address this one issue and why there are so many problems, but there is much more to be learned.

 

[Kevrumbo]

If you're going to be on an air-conditioned liveaboard at sea for the duration of your dive vacation, then whichever of the prophylaxis meds listed above as recommended by the CDC and your physician is good.

Should you be spending anytime on land however, a skin applied Deet repellent, permethrin treated clothes and a mosquito bed net gives you reasonable protection against the Dengue Fever mosquito vector as well.

On my 2001 Papua New Guinea trip, I was on week long liveaboard using the Lariam anti-malarial and mistakenly thought I wouldn't need any mosquito barriers or repellents. Then I spent one night at the land resort in Walindi before boarding the morning flight back to Port Moresby . . .and promptly came down with Dengue symptoms three days later. Spent the remainder of my vacation in a Koror (Palau) Hospital being treated by a US Navy Corpsman.

Point of all this is --take whatever recommended malarial prophylaxis as indicated, but also use it in conjunction with effective mosquito barriers and repellents as well. . .

 

[wve]

... there are other risks to take seriously in what amounts to adventure travel for those us accustomed to the mild hazards we experience in the US, other mosquito born illness in the same league, other prophylactics and vaccines to consider, other safeguards to attempt. My aim was to address this one issue and why there are so many problems, but there is much more to be learned.

An update: I have been doing some checking, and there have definitely been cases of malaria reported in Roatan and Utila in the last few years. Most cases seem to involve residents in the rural areas. I have not yet found anything that specifically addresses resorts and their visitors.

One problem may be that there is a time lag between the infecting mosquito bite and the onset of symptoms. Consequently, many travelers will not manifest symptoms until they have already returned home. So we may need to check U.S. records and see if they backtrack to the Bay Islands. (My next project, I guess.)

 

[DandyDon]

Yep, there are areas on Roatan, Utila, Belize, Yucatan, etc. that are certainly quite different from the resort areas where mosquito control is high. I like to visit those when I can tho, so I'm sticking with the Chloroquine and on non-dive days DEET. For dive days with reduced exposure, bio-friendly repellent that won't hurt the coral.