Do You Really Need Anti Malarial Medication On Your Gap Year?

Malaria

Travelling the world is an amazing journey, filled with wondrous sights, amazing experiences and exciting adventures. It has its highs and lows, its good times and its bad times and a whole array of issues that divide and bring together travellers of every nationality, creed and description, but the one thing that unites all backpackers in a cohesive whole of seething hatred, the one thing all world travellers agree on, is that mosquitoes are a bloody pain in the arse!

Most of the time they are an irritation, leaving us with annoying and sometimes painfully itchy welts on our skin and causing most of us to spray clouds of chemicals all over ourselves as we get the DEET spray out and sleep under permethrin coated nets, but depending on where you travel there can be a much more serious side to the mosquito issue too. Malaria.

This isn’t one of the happiest travel related topics, but it is one of the most important ones, and one that I get a lot of questions and emails about. Malaria is an issue that scares a lot of potential backpackers, often through a lot of misinformation and lack of education on the topic as much as any practical concerns about the disease. This is especially true when it comes to taking antimalarial tablets to protect themselves. Anti malarial medication, or prophylaxis as it is technically called, has been the cause of debate amongst travellers for a long time now, do you need to take it or don’t you? Are the side effects worth it?

Well the simple answer is yes, if you are travelling in an area that is a high risk and especially if you are spending an extended amount of time there. But the debate is often far more complex than that.

What is malaria?

Malaria is a potentially fatal disease that is spread exclusively through the bite of the female Anopheles mosquito. It is caused by a parasite called Plasmodium, which multiply in the liver and then affect red blood cells.

There are essentially four primary types of plasmodium parasites that affect humans.

  • Plasmodium Falciparum,
  • Plasmodium Vivax,
  • Plasmodium Malariae,
  • Plasmodium Ovale.

There is also plasmodium knowlesi found in macaques which is a cause of zoonotic malaria in humans and is found in in South East Asia.

Basically speaking, the top two – falciparum and vivax – are the most common and are unfortunately also the most dangerous in humans. Malaria is prevalent throughout tropical and sub tropical regions, and outbreaks of various intensities and length are common in many countries throughout these regions, so the ‘danger zones’ can often wax and wane.

Symptoms of malaria.

Symptoms of malaria include sever flu like symptoms such as shivering, coldness, a dull muscular ache, mild to severe fever, rash, headaches, diarrhoea and vomiting. They can occur anytime, most often up to fifteen days after the actual bite but can in some people take up to 4 weeks.

When to seek medical attention. 

The big danger of these initial symptoms is that they can be very difficult to actually recognise as malaria, and if not treated promptly it does have the potential to cause serious long term damage to the liver or even be fatal. Diagnosis can only be made by health professionals taking a blood sample so it is important that you get yourself to adequate medical facilities as soon as possible if you suspect you have contracted the disease.

If you develop any of the above symptoms during or after your trip, even if it is a few months after, then go and get a blood test from your GP, specialist nurse, travel clinic or nearest medical facility as soon as possible.

What vaccines or medications are available?

Box Lariam (mefloquine) antimalarial tablets

There is no vaccine. A little blunt but true nonetheless. There are current clinical trials that are testing some potential vaccinations that are expected to publish results in 2015, but at the moment the only way to protect yourself against malaria is by minimising the risk as much as possible, and that involves taking anti malarial medication. There are a range of antimalarial prophylaxis available, and they are used to both prevent and to treat malaria.

Atovaquone plus Proguanil (also known as Malarone and a variety of brand names).

This is a common and popular anti malarial due to the fact that it has relatively few and mild side effects compared to others. Possible side effects include headaches, mouth ulcers, rash and sometimes intestinal upset. It is not recommended for pregnant women during the first trimester or those with kidney problems. The adult dose is one tablet taken once a day every day you are travelling, and the child dose is also once a day but at a lesser strength. It should be started two days before you travel and for a week after you return. It is also relatively expensive compared to other anti malarial tablets so may be useful on shorter trips.

Mefloquine (also known as Lariam and a variety of brand names).

This is a tablet that is taken once a week. It should be started three weeks before you travel and four weeks after you get back. Serious side effects are rare, but do include depression, anxiety, psychosis and seizures, insomnia, panic attacks and hallucinations amongst others. Mefloquine has gained quite a bad reputation because of these side effects, but the benefits of taking the anti malarial outweigh the risks. Many people take this medication quite safely, but the side effects if you are susceptible to them are sever, so it is strongly recommended that you do a three week trial at least a month before you travel to test if you develop any side effects.

Doxycycline (also known as Vibramycin D and a variety of brand names).

This is a capsule taken daily. You should start the course two days before you travel and take it for a month after you return. This is popular because it is relatively cheap compared to other anti malarial tablets and the side effects are not as severe. It can cause increased susceptibility to sunburn in some people, as well as heartburn, stomach upset and thrush, and is not recommended for pregnant women or children under 12 at all. It can also reduce the effectiveness of combined hormone contraceptives such as the pill.

Chloraquine (also known as Avloclor and and a variety of brand names).

This is one of the most common anti malarials and the normal dose is 2 tablets once a week, started one week before you leave, throughout your trip and for 4 weeks afterwards. There are a wide variety of potential side effects which may include nausea, diarrhoea, headache, rashes, skin itch, blurred vision, hair loss, dizziness, mood change, sun sensitivity or seizures. Those with kidney or liver disease should be assessed carefully before taking this medication and it is normally not recommended for long term use.

Proguanil (also known as chlorguanide, chloroguanide and and a variety of brand names).

The normal dose is a 200mg tablet daily and is generally safe for long term, extended use. One or two doses should be taken before departure, continued throughout your trip and for 4 weeks afterwards. It is very important to complete the course. Side effects may include: anorexia, nausea, diarrhoea, constipation, skin itch and mouth ulcers.

This list is not comprehensive and does not include the variety of combinations or brand names available in other countries. Some countries and regions have developed varying degrees of resistance to some, so not all prophylaxis will be recommended for all areas. It is essential you speak to your GP or nurse practitioner who will be able to use your medical history and clinical judgement to determine which drug is right for you as an individual.

Do you need to take them?

There are a number of things you need to consider about your own individual trip and circumstances as to what the answer will be, but to be honest this is a personal decision that you will have to take for yourself. All I can do as a health professional is give you all the facts, the pros and cons, then recommend you take them if the situation warrants it; but the final decision on the risk management is down to you.

The first thing you should do is weigh up the risk of where you are going. The excellent malaria map at the Centre of Disease Control (CDC) website or the National Travel Health Network and Centre (NaTHNaC) website (I know, stupid name but it really is good) are both excellent resources for finding up to date and current information on high, medium or low risk areas, or where there are currently any outbreaks of the disease.

When you know what your destination or destinations are, ask yourself these questions.

  • Are you travelling in a tropical country where malaria is present?
  • Are you travelling in parts of that country or countries where the risk of contracting malaria is high?
  • Will you be spending more time in the high risk parts of each country such as rural regions, than you are in the lower risk regions such as major cities?
  • Are you in a high risk group? (Such as volunteers or those spending significant amounts of time in rural areas for trekking or activities for example).

The more ‘yes’ answers you get to these questions, the more likely it is that you should take some form of anti malarial tablet, conversely the less ‘yes’ answers you have, the more likely it is you won’t need them.

You should also assess how much risk you will be in. If you are travelling for an extended period in rural or jungle areas, especially near bodies of water, or are working or volunteering for extended periods in areas where malaria is present everywhere, then you will be at significantly more risk of contracting the disease than if you were simply in a major city for a few days and your exposure to malarial areas limited, and you should act accordingly.

Basically speaking, if you are travelling in a tropical country (usually a red zone on a malaria map) or an area where malaria is present everywhere, and you are in a high risk group or staying in that area for a long time, then it is strongly recommended that you take anti malarial medication.

If you are travelling through a country or region where malaria is only present in small areas, and your exposure to these areas is limited, then it isn’t always necessary to take prophylaxis.

Another thing to consider is the potential side effects of each medication. This is the big issue amongst many long term travellers and one of the big reasons some travellers don’t take them. For some people, this is the right choice too as the side effects (ranging from hallucinations to depression and anxiety amongst many others) can be severe in a small percentage of people and the cons of taking the medication outweigh the pros. Even mild side effects such as sensitivity to sunlight or nausea or diarrhoea can make taking the medication unpleasant at best and not worth it if the exposure risk is minimal.

The best thing to do is to go and speak to your GP or even better a specialist travel nurse at a travel clinic. Researching is essential but can only get you so far. Speak to the professionals who will be able to examine you and tailor this advice on your specific medical history as well as your own unique individual needs.

Any good examination and prescription should take into account a wide range of factors including (but not limited to):

  • Your destination (or destinations) as some antimalarial medication will not be suitable in all areas,
  • Your potential risk of exposure,
  • Your age and general health,
  • Relevant medical history (both yours and your family history – if relevant)
  • Any allergies that you may have,
  • Current or recent medication regimes (including birth control),
  • Other physical factors such as pregnancy.

Go at least 6 weeks (preferably longer) before you plan to start your trip, as this will allow you time to get the right information and make an informed decision, and also take a three week short course of anti malarials (if you have never taken them before) to see if you develop any side effects. Trust me, the last thing you want to do is leave it until the last moment and then find out you are having severe panic attacks and seeing pink elephants on the night train to Mumbai once you are on your travels!

kenya malaria

Mosquito avoidance and prevention measures.

Regardless of whether you decide to take antimalarials or not, and regardless of whether the country or region you are travelling in has malaria in all or just some areas, you should always – in every circumstance and without fail – use a variety of preventative measures to stop the little buggers from biting you in the first place! Never has the expression prevention is better than a cure been more apt, because if they can’t bite you, they can’t infect you! Luckily there are a whole variety of ways to help you do this.

Air conditioning, screening and nets.

Air conditioned hotel rooms are generally safe from mosquito bites provided that windows are left shut. They are not completely bug free, but they are more secure than most rooms. If you are staying somewhere without air conditioning, check that windows or doors have at least mesh insect screens on them. If your accommodation has none of these and you are essentially at risk, then you should try and sleep under a mosquito net where you can. These are available to buy almost everywhere, and if you buy one in the UK before you go, it should already be pre treated with permethrin, a solution that kills insects on contact. If your net is old or you cannot be sure if it has been pre treated, then you can get permethrin solution to soak it in. Nets should be treated like this every six months.

Repellents.

DEET sprays are extremely effective at repelling mosquitoes and other biting insects. Clinical evidence suggest they are very safe. There are a variety of strengths right up to 100% but it is generally not necessary or recommended to use a concentration any greater than 50% DEET. You should apply repellents to all exposed skin when outside and reapply regularly as needed dependent on the strength you are using.

Repellents containing natural ingredients are also popular among many backpackers who may not like the idea of using a load of chemicals, but evidence suggests that whilst some do work, they do not work for as long as DEET based products and need to be reapplied more regularly.

Clothing.

Loose fitting, light cotton clothing should be worn. Cover up as much skin as is comfortable. Long trousers and at least a T shirt is best. Malarial mosquitoes are more active at night, particularly at dusk and dawn, so it is wise to cover up more during these times.

Coils and plug in devices.

Mosquito coils release an insecticide when burned and are effective if sitting outside on a balcony. They should not be used indoors. Electronic plug in devices are available to use inside, and release an insecticide spray.

 mosquito malaria

You can start to see why it is such a confusing issue for many people, as the very personal choice of whether to take antimalarial prophylaxis or not is based on a risk assessment of a wide variety of factors, and whilst as a medical professional I can advise, inform and recommend airing on the side of caution, I cannot and would never try to force you to take them. That decision is wholly down to you.

I hope that this short article has at least provided you with some of the information or answers you need, but no article can be completely thorough especially in a diverse a field as health care issues. So please if you have any questions please feel free to ask me below or email me if you prefer. Remember I am here to help and offer advice to all first time or even experienced backpackers out there. I am a qualified nurse as well as a backpacker and I will do my best to help, or at least point you in the right direction if I can’t.

Related Articldes

Anti Malarial Medication.

Malaria And Dengue Fever.

Mosquito Avoidance.

Travel Clinic.


 

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Michael Huxley is a published author, freelance travel writer and founder of Bemused Backpacker. He is also a charge nurse by vocation with an interest in emergency nursing and travel medicine, but his real passion is travel. Since finding his wanderlust a decade ago in South East Asia, he has bounced from one end of the planet to another and has no intention of slowing down.

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42 comments on “Do You Really Need Anti Malarial Medication On Your Gap Year?
  1. Amanda says:

    Thanks for that. This article came just at the right time for me as I’m just about to go get all my shots. I was wondering, how hard is it to get good anti-malarials on the road? I’m going to SE Asia but my trip is pretty open ended so I don’t know all the places I’ll be going to yet or how long I could be in a malarial zone. So it makes it hard for the doctor here to prescribe something.

    • Hi Amanda, I’m glad you found it useful. 🙂

      Buying anti malarials on the road is very easy across SE Asia, and is a lot cheaper than buying it at home too. Countries such as Singapore, Thailand and Malaysia for example have amazing levels of health care, but some things are different. In Thailand for example you can buy most medication at reputable pharmacies over the counter without a prescription. Just ensure that you are buying from reputable and professional pharmacists.

      One thing you SHOULD discuss with your GP or nurse specialist before you go is which antimalarial is right for you and find out if you will suffer any side effects. You don’t want to figure that out when you are out there.

      Also be aware that depending on where you go you may not need them at all as much of SE Asia is low risk. Unless you are spending a significant amount of time in the Northern border of Thailand/Myanmar or inland Borneo where the risk of Malaria is high you may get away with needing them. Use the Malaria map from the CDC and try to figure out how long you will be spending in the red zones based on your route.

  2. vickyinglis says:

    Good advice. I’ve taken a few different anti-malarials for my travels, each with different side-effects, but however unpleasant I wouldn’t take the risk of forgoing them and contracting malaria. Where photosensitivity is a risk, pack a hat with a wide brim and sunblock, and use it regularly on your face and neck. I took a net with me in Africa and Central America, and at the end of my trips gave it to a family with young children rather than pack it back home.

    • Great tips, I completely agree. Getting the balance right and choosing the right meds can be tricky, but it isn’t worth taking the risk of contracting malaria if you are travelling in a high risk zone. Thanks for commenting. 🙂

  3. Milene says:

    Great article! Very informative.. I lived in an area with high risk of Malaria. In the Netherlands I got pills for that and never had any problems although these mosquito´s kept feeding themselves with my own blood. I was very happy for the pills as my little Ugandan brother got malaria 3 times while we were sleeping in the same room. Thanks for informing others about the risk and the prevention!

  4. Charles Rahm says:

    I prefer the Deet spray and have never used any of those pills. So far it worked for me.

    • I take it you’ve stuck to places with low or no risk of malaria then Charles? Preventative measures are perfect in those areas and antimalarials aren’t always necessary. In high risk areas though they are still strongly advised.

      • charayrah says:

        I have been to rural areas of Myanmar.
        I have been to more places in Cambodia than just Phnom Penh and Siem Reap.
        I have been in the south of Laos recently and once in a jungle area in central Laos.

        So I have been to some so called high risk places. But in those high risk areas I really use the spray excessively and spray my T-shirt before wearing it and so on. Like this I can reduce the bites to 3 to 5 in one week. And that is a risk I’m willing to take.
        Maybe I would take the drugs if I go to Africa one day, as it seems to be much worse there.

        Which areas, that you have been, did you use the medication? I’m curious. 🙂

      • Charles I suggest you look at the malaria map on the link above. Much of S.E Asia is low or no risk, (it even varies within certain countries) but there are parts – such as rural areas of Myanmar – that are as high risk as much as parts of Africa are. High risk is high risk, and antimalarials are always advised in those areas. Whether you take them or not is completely up to you, I am not imposing a decision on anyone in any way shape or form I just want to inform people of the risk, but it only takes one single bite from an infected mosquito to contract malaria. Preventative measures help reduce the bites and therefore the risk, but they won’t help if you still get bitten by an infected mosquito.

        As for me? Haiti, Belize (due to significant time in the jungle),Nicaragua, Panama, Congo, Rwanda, Ivory Coast, Myanmar… and others. I’ve been to plenty of countries where I assessed the risk wasn’t high enough for me to take them too. It’s all about personal choice based on risk assessment. Just make sure that risk assessment is based on the right info.:) Thanks for commenting and visiting.

  5. alicesgapyearadventures says:

    I love this site. Thank you so much for this. I went to my GP for the exact same advice and it wasn’t nearly as thorough! Would you mind if I emailed you a couple of extra questions about malaria tablet side effects?

  6. Mark A says:

    Hmm, I might need dumbed down version of the post? Haha

    • If you have any questions or want me to clarify anything Mark then please feel free to ask or send me an email through the contact form above if you prefer? I’m happy to provide more information or clarification. 🙂

  7. We spent 10 months in Southeast Asia and didn’t take any malaria tablets at all – and nothing happened. It was a calculated risk because we had heard that the tablets were really expensive and that the side effects of taking them could be worse than actually having malaria.

    • That’s partly the point Kelly, you need to research and know what the risk is in the places you are going and act accordingly. The vast majority of SE Asia is low to no risk, especially if you stick to the more popular trails and antimalarials generally aren’t required or advised there with the exception of one or two notable areas such as Laos for example. You have it half right, the side effects are sometimes quite bad in some individuals (not everyone gets all if any of the side effects, everyone reacts differently), and if there is a very low or no risk of malaria then yes the cons outweigh the benefits of taking them. However if you plan on spending any length of time in a high risk area then suddenly the benefits outweigh the cons. Yes the side effects may be bad, but so is potentially dying from a malarial mosquito bite if you don’t get treatment in time. It’s all about research, having the right information from the right sources and risk assessment.

  8. Great article, we are preparing for our 6 week Africa Safari and need to stock up on Malaria meds soon.

  9. Thank you for posting this! I spent a bunch of money on malaria medication that I never even ended up taking. I think doctors prescribe it just to cover their asses. Jules took one (i think it was doxy) and ended up having really weird dreams and just feeling super out of it. Not how you want to feel in a foreign country!

    • Why did you buy it and not take it? Where you in a high risk area?

      I don’t think it is about covering their asses, medical professionals will generally err on the side of caution and prescribe prophylaxis if there is a real risk of malaria.

      The key is to know the exact level of risk in the areas you are visiting (there is generally no need for antimalarials in low risk areas), and also to know which prophylaxis works best for you. Antimalarials affect individuals very differently, one person may experience heavy side effects, the next none at all, and that is why it is recommended to take a test run a month or so before you leave.

      I’m glad the article was useful for you though. Thanks for the comment. 🙂

  10. Dan Norris says:

    Great post, it’s nice that you tell people to consider all the variables instead of just nagging them they should get vaccinated “just in case”. Although you missed one of the biggest variables of all, the season when you travel to the country!

    I went to India during the dry season and asked a local doctor if I should be worried. He told me that he almost never sees any cases (local or foreign) of malaria during the dry season and that is extremely rare. I only know this for sure in South Western India but I think it should be the same for all tropical countries.

    • Hi Dan, thanks so much for the comment. You can’t really get vaccinated for malaria, but you are right and that is an excellent point. Wet seasons often do present a higher risk of contracting Malaria simply because the mosquitoes carrying the disease are more active and prevalent in those conditions, but that doesn’t mean that malaria isn’t present at all in dry seasons. Studies by the CDC and others are only in early stages at the moment on this issue, and aren’t fully conclusive as of yet. So I would say that whilst you are right and the risks of contracting malaria are lower during dry seasons, In my personal professional opinion I wouldn’t discount them completely. Thanks so much for the interesting comment though. 🙂

  11. Lina says:

    I am someone that always seems to suffer nasty side effects from Malaria pills.Even the atovaquone- I can’t take it without milk. When we were traveling in Indonesia we had to start taking malaria pills for our jungle trek in Sumatra and I tried taking them the recommended time in advance but they made me too sick. I found on the second try that if I was able to find milk and take them with that, I didn’t get sick. I seem to attract mosquitos of an epic proportion and despite my bathing in repellent I got bit up pretty good camping in the jungle, so I was glad that I kept taking them. It’s a hard decision, especially when you get side effects. Great article, thanks!

    • Everyone reacts very differently to prophylaxis, some get really bad symptoms, some get none at all, many fall on a sliding scale somewhere in the middle. I agree that the side effects can be rough for some people, but when you consider the risks of the alternative the decision becomes much easier. Thanks for the comment. 🙂

  12. Henry says:

    Great informative and in depth article.

    This is has already been asked earlier, but I wanted to get some more specifics.

    Last year while travelling in India I was taking Atovaquone when in high risk areas, however they were too pricey so am not going to take them again.
    Am off to Myanmar, Laos, Cambodia and Vietnam for 3-4 months and have got some leftover Atovaquone which I might start with to last me 2 weeks, then I’ve got some Doxycycline to cover me for the next month, but was wondering on the availability and price of further anti-malarials while out there, specifically in Laos, Cambodia and Vietnam?

  13. amanda says:

    Thank you so much for this article! Question, do you recommend how to get this medicine while in South America? Insurance dos not cover it, and it is very costly at over $6 per pill where I am! Thanks!

    • You’re welcome Amanda. I’m not sure exactly what you are asking, if you are asking if you are able to buy antimalarials in south America, then yes you can. You can buy them in many reputable clinics, pharmacies and hospitals. But I would still advise you to consult with a professional before you leave to ensure you are taking the RIGHT antimalarial for a) the region and b ) you as an individual. Also, south America is a HUGE region, and not everywhere will require antimalarials, so a lot would depend on where you are going on whether you will need them or not.

  14. Jince. says:

    Nice tips for travellers. Prevention from mosquitoes bites is very important. We need to follow guideline for mosquitoes spread diseases.

  15. Sarah says:

    I found this SO useful, thank you. I’ve been trying to research this for ages but have found all the stuff online to be really contradictory. It’s good to know that you’re a nurse too so all of this is coming from a good, expert source. Thank you!

  16. Judie says:

    Thanks for this, I was looking for something that would explain all this to me properly in plain English! It’s so confusing to know which information to trust sometimes.

  17. Donna Bradshaw says:

    Perfect! I was so confused and worried about antimalarials, I wasn’t sure what I needed to do for my upcoming trip and my GP wasn’t much help! Could I make an appointment with you to ask a few more questions?

    • Of course Donna, just fill in the form for the travel clinic in the main menu and I’ll set you up with an appointment. 🙂 And don’t worry, not all GPs have specialist knowledge or experience in this area, which is why specialist travel clinics are usually a better bet.

  18. Kat says:

    Hiya, I’m just wondering if you know how easy it is to buy malarone (or other brand equivalents of atovaquone and proguanil) in South America? I know this one works for me, but as I won’t be in an at risk area until quite a long way through my trip i’d prefer to get them out there if possible. Thanks!

    • Hi Kat, Malarone isn’t generally licensed for sale in South America, but you can get Mefloquine (Lariam, Tropicur, generic mefloquina) and doxycycline (doxiciclina, vibramicina), which are effective in preventing malaria in South America and will be less expensive than in the UK. Of course it depends on whether those options are right for you.

  19. Craig Holden says:

    Thank you for this, I’ve been trying to get some plain and simple facts about what to do for my own trip and this is the first site I have found to give me just that.

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