Anti-Malarials

[Thunderbug]

I'm taking 6 months unpaid leave and going travelling to distant parts of the planet. In particular I shall be in SE Asia (Vietnam, Cambodia, Thailand) and travelling tthrough rural areas were malaria mossies inhabit.

I'm looking to get some advice on which anti-malarial is best. I have been informed that there are 3 products which are recommended for the area, but they each have disadvantages.

(Apologies for spelling!)

1) Doxycyclone - makes you sensitive to UV, with consequence of increased sunburn.

2) Malarone - not recommend for courses longer than 30days ( I need approx 3 months worth)

3) Mefloquine - Not approved for pilots.

Mefloquine sound the best. I will not be operating whilst taking the malarials, nor for about three months after fininshing the course. Does the restriction for flight crew still apply in these circumstances?

Words of wisdom welcome!

Thunderbug

[PilotsPal]

Go see your doctor - he'll have the most up to date advice for the areas that you're planning to visit, both for the malarial and other recommended protections.

Oh lucky you! I'm green with envy. Are you planning to visit Phuket? If so, please do get in touch.

[BlueEagle]

As you are going to some lovely places in SE Asia, and I really do mean lovely, where sea food is in abundance, you should also ask your doctor about Hepatitis shots, shame to ruin a good holiday, your liver and your bank balance for the sake of an injection!

Have a lovely time.

[Thunderbug]

Pilots Pal & Blue Eagle

Thanx. I've seen the company medical service for some jabs. I'm now covered for Hep A, diptheria and a whole multitude of bugs with bad karma.

I was concerned about the aviation medicine aspects of Mefloquine. I am seeing a doctor for a malarials perscription in a couple of weeks and in the mean time I wondered if there were any experts on the forum.

As for destinations - Phuket may feature in our plans, but we are taking it pretty much as we find it. We have no firm plans beyond starting in Hong Kong late September and being in Sydney for New Year.

Thunderbug

[QDMQDMQDM]

Ask the CAA about what is acceptable. I took mefloquine for 5 months with no ill effects.

Also, the most important thing is to realise that the best protection against mossies is to avoid getting bitten -- cover up at dawn and dusk, repellent and medicated bed net. The next most important thing is to seek medical advice immediately if you get a fever in the tropics, irrespective of whether you're on prophylaxis or not. If you're in a very remote place and get a fever, start treatment for malaria immediately on spec.

QDM

[moosp]

The resistance of certain strains of malaria to the good old drugs of paludrine and chloroquine has become a problem for aircrew over the last few years. The most commonly prescribed prophylactics of doxycycline or mefloquine both have unacceptable side effects for aircrew.

Beware of general practioners (or worse, MHO operatives) who will prescribe mefloquine to you. As a pilot I was prescribed it by the MHO who provides a "health" service (my italics) to my airline.
When I questioned this operative (who had a medical qualification) as to the psychotic effects of the drug the answer was that it was not usually a problem but if I experienced any problem it would require psychiatric attention.

I reported this to my AME who quietly informed the MHO of their error.

To put the drug into perspective, when I got to my destination in Africa, the boat captain asked what anti-malarials I was taking. I told him paludrine and chloroquine, despite the prevalence in that area of Africa for resistance to those drugs. He replied that if I had been taking mefloquine he would not have allowed me on his boat. He told me that he had seen too many psychotic reactions in tourists who had been taking this drug such that it would endanger his small craft.

I was interested to see that QDM had no contra indications, so for some it is useful.

Also remember (and in my expererience it is often not mentioned by the prescribing doctor) that the other prophylactic for malaria, doxycycline, like most broad spectrum antibiotics can change gut absorbtion such that the contraceptive pill is reduced in efficiency. A vacation surprise that may not be in your future plans.

As QDM implies, if you have anything like flu symptoms after returning from the area seek serious professional advice. We lost a cabin crew last year for what many people think was a mis-diagnosis of cerebral malaria by her HMO.

[Flying Chicken]

The best place to get advice on treatment for malaria is

Hospital for Tropical Diseases
Mortimer Market
Capper Street
London WC1E 6JD

Switchboard: 020 7387 9300
Travel clinic: 020 7388 9600
Fax: 020 7383 4817

[QDMQDMQDM]

Try http://www.fitfortravel.scot.nhs.uk/

Or, if you can blag an entry, try the parent site for health professionals which really is the dog's: www.travax.scot.nhs.uk

QDM

[gingernut]

Vietnam: Risk of malaria in the whole country except urban area's, Red River Delta and coastal plains north of Nha Trang. Recommended prophylaxis: mefloquine, or doxycycline or atovaquone/proguinal.

Cambodia:Risk of Malaria throughout the whole country except Phnom Penh. Rec. Prophylaxis, same as Vietnam but mefloquine not suitable for Western Border Area's

Thailand: No risk in the cities or main touruist areas. Long stays in rural area's with forests, and in border areas with Laos, Mynamar or Cambodia, doxycycline or atovaquone.

Don't forget non pharmaceutical measures (avoiding getting bitten).


You really need an expert "risk assessment" by a travel clinic / specialist, if you are travelling for a while in local conditions. You may need more than the "bog standard" hep a + typhoid jabs. I suggest you contact an AME to discuss which drugs mix with flying, prior to going to the travel clinic. (As there is a choice of drugs available).

Also read "Health Advice for Travellers" available from the post office.

[papercut]

The schools of tropical medicine will of course be excellent sources of uptodate antimalarial advice but may well not be the best source of advice on taking antimalarials vs your professional aircrew status. I would suggest you ask an AME or go to the CAA for the "horses-mouth answer".

In the RAF our approach to mefloquine, which is probably the best A/M for where you are going, is that aircrew are not to fly for 3 months after taking it. (if they went on detatchment/holiday while on a ground tour for instance and were given it.) problem ia that Mefloquine has a very long half-life in the body (21 days springs to mind).

This is good advice, but you should confirm it is acceptable to your regulating authority first!

papercut:D