Sunday, January 14, 2007 India India

Let's talk parasites

Now seems like a good time to talk about malaria.

  • There are several strains of Plasmodium (the bacterium which causes malaria), which exist in different parts of the world. Different antimalarials are better at dealing with different strains, because the bacterium gradually develops a resistance to each drug that is brought out.
  • We are planning to travel to all the infected areas of the world.
  • Some antimalarials can have nasty side effects, especially if used for a long time.
  • It is advisable to stick to one antimalarial for your whole journey, so that you minimise the chances of developing a resistance to more than one drug—this is because if you do catch the disease, you will be treated with one of the other drugs.

OK, so taking all of this into account, we needed an antimalarial with good protection against all the strains, but as few side effects as possible. On the advice of our doctor at home, we bought the relatively new, very low side-effect, highly effective but ohmygod expensive Malarone. In the UK it is only licensed for four weeks' use but studies have shown it is safe and effective for three months, and probably much longer. By taking a private prescription we were able to get just over ten weeks' supply (at a cost of something like GBP 370 / USD 726!).

We cannot replace our stocks of Malarone until we get to a developed country because the high cost and lack of licensing arrangements with local manufacturers means it is not available in places like India, South East Asia and most of Africa. Also, we will need to take it for a full week after we leave a malaria-infected area. So once we start taking it, we will have exactly nine weeks to be out of the infected area, and then we've got to travel to somewhere like Japan that will sell us some more before we can re-enter a malarial area.

OK, so what's the malaria advice for India? It is not clear-cut and the different sources disagree. In theory, malaria exists all year across the whole country. In practice, you're far more likely to catch it in the wet season, away from the coast, at low altitudes, in rural areas. Our research in Dubai told us that both Mumbai and Goa count as 'low risk', particularly at this time of year. We need to start taking Malarone a day or two before entering an infected area, but having agonised for a while we decided not to start taking it until we saw what the mosquito situation was like in Mumbai.

So, our situation in the hotel room was this: we had air conditioning; we had closed, screened windows; we had a plug-in repellent thingy supplied by the hotel; our skin was covered in DEET; and we were in a low risk area at a low risk time of year.

And in the morning Glenn found a mosquito bite on his finger. Oh bugger.

We started our Malarone course there and then. We are almost certainly being paranoid, but we bought the Malarone to use it, not to carry it around in the box. We took a double dose on the first day in the vague hope that it would make up for not starting the previous day.

So now our future plans have been significantly narrowed down: we need to be out of India and well to the north by 18th March.


Paul said...

You guys are just way too paranoid about malaria. Spending that much money is just an unbelievable waste. Better to just be defensive using sprays or electric pluggins or a net. Those pills do more harm than good.

Glenn Livett said...

I'd be interested to see your evidence for Malarone "doing more harm than good". If you meant Larium I would agree with you, but not Malarone. It is generally accepted to be virtually free of side-effects. As we said in our post, we were using all the mechanical barriers and we still got bitten. While we were in Goa there was a case of malaria in a western tourist in the next village.
You think our attitude is overly paranoid, we see it as a worthwhile insurance policy. To us, given the implications of contracting P. falciparum malaria, it is worth every penny. Yes, the probability of catching it is very low, but the consequences are bad.
Happy travels, and if you choose not to take a prophylaxis, we honestly wish you the best of luck.