Malaria:Cambodia,Laos,Thailand,Vietnam

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First published 12th August, 2007

One of the most commonly asked questions by first-time travellers to Southeast Asia is "Should I take malarials?". It's a simple question, with a complicated answer, best summed up as "it depends". Here's ten pointers that we hope will help you make a more informed decision regarding malarials and travel to Southeast Asia.


Dengue fever in Southeast Asia

As a casual visitor to Southeast Asia you're fare more likely to contract Dengue fever than malaria.
Click here to learn more about the disease including first hand reports from those who have suffered the virus.

1) Talk to a travel doctor.

Malaria is a serious disease which kills over one million people every year, and the best place to start is with a doctor who is a travel specialist. Your local medical practitioner or family doctor may not have the expertise nor experience to give you an accurate opinion on what you should be doing. "Traveller's Medical Centres" are a growing niche which you should avail yourself of.

If you talk to your doctor, mention Asia and they lunge for the prescription book, without even asking where in Asia you are considering going, then you need to get a more informed opinion.

Talking of a more informed opinion, we talked to a tropical medicine specialist we've known for years and here's what he had to say:

"Generally travel medical doctors try to individualise it with the patient and their trip, rather than adopt a "cookbook" approach and a risk assessment model works well here. Basically the factors to be considered and discussed with a client enquiring about malaria tabs are:

- the country itself and overall level of risk which includes "official" recommendations from organisations e.g.. WHO
- areas travelled to within the country (esp urban or rural) as risks will vary here. This includes level of remoteness and access to medical care
- duration of travel
- season of travel i.e. wet / dry
- style of travel - on a spectrum of rock bottom to 5-star.
- the client's own compliance with mosquito avoidance measures
- the client's own wishes regarding what level of risk is acceptable -- some want to be "covered for everything" whilst some others don't want tablets even if they're going to a high risk area.

It's a moveable feast and not cast in stone. For example:

- Previous blanket recommendations for needing prophylaxis for anywhere in India were recently relaxed about one to two years ago. However a recent increase in cases amongst tourists in Goa forced a rethink.

- there is good evidence that due to climate change, malaria in Kenya is now occurring at higher altitudes (incl. Nairobi!) at areas and elevations previously considered malaria free.

I think the main message is that the decision to take or not take malaria prevention needs to be made by the client after consultation with a travel medicine provider."

Now here's some other points about the disease you should consider.

2) Malarials do not immunise you from malaria

This is a common misconception. To quote the WHO: "No antimalarial prophylactic regimen gives complete protection". Malarials do not protect you 100% from malaria, rather they give you more time to get to a medical centre where you will still need to seek further medical treatment. This is certainly the case with doxycycline -- one of the more commonly prescribed medications.

3) An ounce of prevention is worth a pound of cure

Listen to your Grandma -- An ounce of prevention is worth a pound of cure. The best way to avoid being afflicted by malaria is to avoid being bitten by mosquitos and there are a number of simple steps one can take to dramatically reduce the chances of being bitten. These include:

a) Use a permethrin impregnated mosquito net
b) Use mosquito repellent containing DEET
c) Dress sensibly -- wear long pants and sleeves at dawn and dusk.
d) Use mosquito coils or other anti-mosquito devices (e.g.., citronella) as a secondary control.
e) If you are prone to being bitten, lean towards accommodation that can be sealed up -- air-con with no slatted windows nor open eaves.
f) Watch out for rooms with bucket showers/toilets. These tend to have buckets of stagnant water -- a mozzie's beach resort -- in the bathroom.
g) Don't sleep naked in a swamp.

4) Prevention protects you from other nasties

Another potentially fatal disease spread by mosquitos is dengue fever. It should be a far bigger concern to travellers than malaria, but as there's no pills to sell to "protect" you from it, you hear far less about it from the medical industry. In following the steps outlined in point 3 above, you'll also protect yourself from dengue fever.

5) The need for malarials is dependent on where you are going

The US Centre for Disease Control (CDC), an organisation which tends to err on the cautious side, suggests the following areas have malaria risks:
Cambodia: Risk throughout the country, including risk in the temple complex at Angkor Wat. No risk in Phnom Penh and around Lake Tonle Sap.
Laos: Risk throughout the country, except no risk in the city of Vientiane.
Thailand: Risk in rural areas that border Cambodia, Laos, and Burma. Risk in Ko Pha Ngan. No risk in cities and no risk in major tourist resorts. No risk in Bangkok, Chiang Mai, Chiang Rai, Pattaya, Phuket and Ko Samui.
Vietnam: Rural only, except no risk in the Red River delta and the coastal plain north of the Nha Trang. No risk in Hanoi, Ho Chi Minh City, Da Nang, Nha Trang, Qui Nhon, and Haiphong.

The WHO makes the following recommendations:
Cambodia: Throughout the year in the whole country except in Phnom Penh and close around Tonle Sap. Risk within the tourist area of Angkor Wat is limited.
Laos: Throughout the year in the whole country except in Vientiane.
Thailand: Throughout the year in rural, especially forested and hilly, areas of the whole country, mainly towards the international borders. There is no risk in cities (e.g. Bangkok, Chiang Mai, Pattaya), Samui island and the main tourist resorts of Phuket island. However, there is a risk in some other areas and islands.
Vietnam: Malaria risk exists in the whole country, excluding urban centres, the Red River delta, and the coastal plain areas of central Vietnam. High-risk areas are the highland areas below 1 500 m. south of 18?N, notably in the 4 central highlands provinces Dak Lak, Dak Nong, Gia Lai and Kon Tum, Binh Phuoc province, and the western parts of the coastal provinces, Quang Tri, Quang Nam, Ninh Thuan and Khanh Hoa.

6) Malarials can have nasty side effects

There are four main types of malarials which are prescribed for travel to Asia. They are atovaquone/proguanil (brand name Malarone), doxycycline, mefloquine (brand name Larium) and primaquine. While the majority of travellers take these without problem, each of these can have serious side-effects, including:

Atovaquone/proguanil
Stomach pain, nausea, vomiting, and headache.

Doxycycline
Sun sensitivity, nausea, stomach pain and vaginal yeast infection. More inconvenient than a touch of sunburn is that doxycycline can render the birth-control pill ineffective. If you are using doxycycline and don't have plans for baby travellers on your immediate horizon, then you will need to use alternative birth control measures.

Mefloquine
The most common side effects include headache, nausea, dizziness, difficulty sleeping, anxiety, vivid dreams, and visual disturbances. Rarer, more serious side effects include seizures, depression, and psychosis. We've personally seen individuals bearing the brunt of these side effects and would never suggest anyone take this profilactic for travel in Asia.

Primaquine
Stomach cramps, nausea, and vomiting. Primaquine can also cause an hemolysis (bursting of the red blood cells) in G6PD deficient persons, which can be fatal.

That all sounds pretty terrible, but then there's the effects of catching malaria which you need to weight these against:
Shaking chills, headaches, muscle aches, tiredness, nausea, vomiting, and diarrhoea. May also cause anaemia and jaundice. Infection with one type of malaria, Plasmodium falciparum, if not promptly treated, may cause kidney failure, seizures, mental confusion, coma, and death.

7) Many mosquitos are malarial resistant

Malaria is an adapting disease and certain areas are resistant to some malarials. To again quote from the CDC:

Cambodia
The provinces of Preah Vihear, Siemreap, Oddar Meanchey, Banteay Meanchey, Battambang, Pailin, Koh Kong, and Pursat bordering Thailand are mefloquine resistant -- use only atovaquone/proguanil or doxycycline.
All other areas you can use atovaquone/proguanil, doxycycline, mefloquine or primaquine.
No risk in Phnom Penh and Tonle Sap.

Laos
The provinces of Bokeo, Luang Nam Tha, Salavan and Champassak, along with the areas along the Thai and Burmese borders are all mefloquine resistant -- use only atovaquone/proguanil or doxycycline.
All other areas you can use atovaquone/proguanil, doxycycline, mefloquine or primaquine.
No risk in Vientiane.

Thailand
All of Thailand is mefloquine resistant, use only atovaquone/proguanil or doxycycline.
No risk in cities and no risk in major tourist resorts. No risk in Bangkok, Chiang Mai, Chiang Rai, Pattaya, Phuket and Ko Samui.

Vietnam
The southern and central part of Vietnam, including rural areas of the provinces of Tay Ninh, Song Be, Lam Dong, Ninh Thuan, Khanh Hoa, Dak Lak, Gia Lai, and Kon Tum are all mefloquine resistant -- use only atovaquone/proguanil or doxycycline.
All other areas you can use atovaquone/proguanil, doxycycline, mefloquine or primaquine.
No risk in Hanoi, Ho Chi Minh City, Da Nang, Nha Trang, Qui Nhon, and Haiphong.

To boil all that down, if you are going to take malarials, don't take mefloquine as it doesn't cover the entirety of any one of the above countries.

8) Malarials are expensive

Purchased in the west, malarials can be very expensive. While we're not suggesting there's any profiteering going on (perish the thought), there is a definate financial incentive for the pharmaceutical industry to convince you to purchase the pills before you leave home. If you're comfortable using generic medication, malarials are far more affordable in Asia than in the west,so consider spending your money in Asia.

9) Chances are you'll be fine

You're far more likely to have a motorbike accident, have your bag stolen or contract dengue fever than you are to come into contact with malaria. While the local population has some degree of inherited resistance to the disease, there are thousands of foreigners living in Asia who have no such resistance. Very very few of these foreigners, who live in Asia for years, take malarials on a regular basis.

10) Our personal experience

For what it's worth, in our over ten years of living and travelling absolutely all over the region, we've:
Been involved in three motorcycle accidents
Had some piece of luggage stolen at least three times
Know of at least half a dozen people who have had dengue fever
Have known not a single person who has contracted malaria
Have seen two people (including a Travelfish staffer) totally freak out as a result of taking mefloquine.

In conclusion, if you're planning on stopping by just the main tourist hotspots, using repellent and a mosquito net, dressing sensibly and never sleeping naked in a swamp, then chances are you probably don't need to take malarials. On the other hand, if you're planning on spending a lot of time trekking in remote areas and hanging out in border zones, don't plan to use a mosquito net or repellent and almost certainly plan to sleep in a swamp in your birthday suit once or twice, then availing yourself of a course of malarials would be a prudent decision.

One last point -- if you do decide to take malarials, make sure you take the full course of pills. If you cut it short you're contributing to drug resistant strains of malaria and also endangering yourself.

Further reading

Start by contacting a travel doctor and getting their opinion, then try the following websites for more information:
CDC Malaria website
WHO malaria website


About the author:
Stuart McDonald co-founded Travelfish.org with Samantha Brown in 2004. He has lived in Thailand, Cambodia and Indonesia, where he worked as an under-paid, under-skilled language teacher, an embassy staffer, a newspaper web-site developer and various other stuff. His favourite read is The Art of Travel by Alain de Botton and he spends most of his time in Bali, Indonesia.


Read 50 comment(s)

  • Hi I'm Andrew from Australia. This info was great. Was good to have a laugh while reading up on this stuff (not sure I'll be sleeping naked in a swamp in vietnam, but hey....after a few beers who knows. I liked it that you guys were so clear and honest about malaria tablets. it seems like some of the medical companies scare you into thinking we need them. Thanks alot for the advice. If i get sick, I will be the first person you know that has been diagnosed with malaria!

    Posted by Andrew Bolton on 21st January, 2009

  • Thanks for that reasoned critique. I have just consulted my GP who contacted a travel medicine specialist regarding precautions in northern Vietnam, Laos and Cambodia. The consensus regarding malaria matched yours — I will probably not take malarials but observe precautions as the risk of dengue seems much worse than of malaria — indeed dengue is spreading in Australia!

    Posted by Ray Wood on 4th February, 2009

  • This article is excellent, mainly because it has probably saved me over £100 in malaria tablets!

    Nice to hear some honest advice. Also, I pretty much nearly died in Thailand last year as a first time motorcyclist so take it easy on the bikes people!

    Posted by Matthew on 26th March, 2009

  • Great info people i was thinking of taking these drugs but after reading all of what you have had to say;im not going to worry about them.So i think i should pretty much be fine....im of to vietnam in 1 month woohoo

    Posted by jcw on 23rd April, 2009

  • Enjoyed the info. However, I have had malaria, got it in VN many years ago despite taking choroquine and primaquine. Luckily it was p. vivax with no other complications. Cleared up in two weeks or so. If you're going to be rural at all, take the tablets. What's the big deal? Malarone has the fewest side effects. Malaria really sucks and I don't feel like getting it again, especially, p. falciparum.

    Posted by S. M. Nelson on 25th April, 2009

  • Thanks - I found this article really useful as I'm contemplating preparations for a trip to mountain bike in Vietnam. I've been in six countries in S-E Asia for over nine months over three times. With careful slip (on a shirt), slop (on some DEET repellent) slap (on a mosquito net) have been fine so far (despite the occasional lapse). I haven't tried sleeping in a swamp yet tho...

    Posted by Jet black on 28th May, 2009

  • Thanks for the article. Having previously traveled to South America, it was quite difficult to find anti-malarials and a good repellant with a high percentage of DEET. Do you think it easy in South East Asia to find these at a normal pharmacy?

    Posted by Ashni Shah on 24th June, 2009

  • Like SM Nelson, I've also had Malaria, but would NEVER now take a prophylactic drug 'just in case'.

    It seems few people read on this subject with an open mind. Either they want to take drugs 'just in case', and read into a story reasons to take it, or don't want to take drugs and don't bother doing more research.

    For me, I note the comment in the story:

    To quote the WHO: "No antimalarial prophylactic regimen gives complete protection". Malarials do not protect you 100% from malaria, ...This is certainly the case with doxycycline."

    An added 'problem' is that the malaria pathogen is such that it can quickly become resistant to drugs. The more a certain drug is used, the more likely the malaria pathogen will become resistant.

    Most drugs to which the malaria pathogen has become resistant are prophylactics (like quinine, then... through to doxycyclene)

    Some first world nations (especially the US) advance the issue of chemoprophylactis (taking prophylactic drugs) primarily to minimise the outbreak of malaria in their nation caused by malaria carrying travellers. This policy has been widely advanced by drug companies, and hence readily adopted in the medical field.

    The ethical issue that has NOT been considered is whether prophylactic use in humans is harmful: (IT IS). It appears the economic cost of malaria as a public health issue is more important than the personal cost to travellers.

    The drug industry (apparently) advocate a position that new and enhanced anti-malarial drugs can be developed. For the drug industry, the REAL AND PRESENT DANGER of resistance is not regarded as a sufficient precaution to chemoprophylactis.

    Cheers

    Posted by BruceMoon on 28th June, 2009

  • absolutely excellent article very straight n simple, going to SE asia for a month so think we're just going to wing it. On another note, someone suggested taking B vitamin supplements as apparently mosquitos dont like the smell of them. much much cheaper even though you start taking them 2 weeks before u go. hope they work!

    Posted by Linda on 2nd July, 2009

  • Recommended to take Vitamin B1 400mg per day. Like a native provention cause VitB is just supplement and no struck in your body.

    Malaria mosquitos, Dangi mosquitos, Bed Bags, all the insects are smelling and far from you, by the way in the same time when you go toilets it out with urine.

    Strong recommended cause not harm your bodys

    Regards,
    MiMi

    Posted by Khaosan Pharmacy on 10th July, 2009

  • Thanks I appreciate the honest information. I'm traveling to all 4 countries this week and weighing the pros and cons of taking an anti-malarial.

    Posted by Joanna on 13th September, 2009

  • My head feels completely baffled! I just cannot decide what to do at all, great advice given here though,im thinking of not taking them,as i would need malarone and its so expensive in U.K and unavailable in Bangkok. Im going to Thailand, Laos, Cambodia next Saturday, arghhh! Any advice much appreciated! Maybe other precautions and Vit B? Thanks

    Posted by Nicola on 1st October, 2009

  • Thanks for this - it makes a lot of sense. I was sceptical, and now I'm sure after this read. I won't be taking any drugs as an anti-malarial.
    Interesting about the Vitamin B.
    I was bitten by what seemed like an army of bedbugs in Brisbane a few months ago, and still have scars (JHave been to several countries and stayed in various budget and backpacker accomm previously, and had never come across them). The itch and subsequent healing was debilitating.

    What about immunisations (that aren't compulsory, but usually recommended by the medical 'industry'. (talking about SEAsia, and not particularly remote areas)
    How do Australians go generally if they haven't been immunised (and if they take sensible precautions).

    Michelle :)

    Posted by Michelle (Adelaide) on 2nd October, 2009

  • This article is an excellent summary of current recommendations by the top two medical organizations that deal with diseases, WHO and CDC. Having spent many years in SE Asia and Africa, I have found, as have most of my colleagues, that common sense ought to prevail. That is, if you plan to spend very much time in vulnerable areas, then it's better to take the pills than to risk the even more unpleasant effects of malaria.

    One cautionary note: if you purchase the pills in SE Asia, ask around for a reliable pharmacy, because there are a lot of counterfeit drugs out there, espec. the high priced and important ones like malarials.

    The psychological side effects, on some people, of Larium (mefloquine) are well documents and I personally have used and would never use it again. For SE Asia, my vote (and my usual choice) would be for doxycycline.

    The comment to stick with the pill routine and not terminate it early, or skip days here and there, is very well taken, and highly advised, in order to maximize the benefit of the malarial.

    Posted by RenoBill on 15th October, 2009

  • Malarial medication is expensive...except for Doxycline. I've used it in the past (to treat acne) and didn't get a yeast infection or other nasty side affects. Definitely wear sunscreen if you're going to use it.

    Concerning the side effects to Doxycline, everyone will react differently. If you take it for malaria prevention, you must continue using for one month after you leave the country so that might be a turnoff for some.

    Posted by erickabe on 6th November, 2009

  • I agree with Reno Bill about the counterfeit drugs - it's very risky to buy medicine there if you don't know what you're doing. Here's an excerpt from the CDC site (I don't work for them!):

    A Special Note about Antimalarial Drugs

    You should purchase your antimalarial drugs before travel. Drugs purchased overseas may not be manufactured according to United States standards and may not be effective. They also may be dangerous, contain counterfeit medications or contaminants, or be combinations of drugs that are not safe to use.

    Halofantrine (marketed as Halfan) is widely used overseas to treat malaria. CDC recommends that you do NOT use halofantrine because of serious heart-related side effects, including deaths. You should avoid using antimalarial drugs that are not recommended unless you have been diagnosed with life-threatening malaria and no other options are immediately available.

    Posted by erickabe on 6th November, 2009

  • Another link of maleria worth reading:http://travelmed.com.au/FactSheets/MalariaLongterm.pdf

    Posted by erickabe on 6th November, 2009

  • The funny thing about this article from Travel Fish is that they start off the article with "Malaria is a serious disease which kills over one million people every year..." Then they jokingly add that you don't need to use malaria medication unless you're "hanging out in border towns or plan to sleep in a swamp in your in your birthday suit." If you're gonna start out your article about the seriousness of malaria, why end it with advice that underplays the seriousness??? My recommendation to all who are wondering: Seek advice from a legitimate health professional.

    Concerning Michelle - WTF? I'd rather get a sore arm from a shot than come down with fucking Hep A (which is prevalent across the country). Don't be dumb when it comes to your health.

    Posted by erickabe on 6th November, 2009

  • erickabe,

    What is the very first point we make in this story?
    Talk to a travel doctor

    What do we follow that up with?
    An opinion from a doctor who has almost 20 years experience in tropical medicine.

    And what does he conclude with?
    "Go consult with a travel medicine provider"

    The story concludes with:
    "In conclusion, if you're planning on stopping by just the main tourist hotspots, using repellent and a mosquito net, dressing sensibly and never sleeping naked in a swamp, then chances are you probably don't need to take malarials. On the other hand, if you're planning on spending a lot of time trekking in remote areas and hanging out in border zones, don't plan to use a mosquito net or repellent and almost certainly plan to sleep in a swamp in your birthday suit once or twice, then availing yourself of a course of malarials would be a prudent decision."

    I fail to see what part of the above is bad advice?

    I'm struggling to see what your point is.

    Posted by somtam2000 on 6th November, 2009

  • I liked the article - blunt.
    I have travelled through SEA for a number of years. I haven't taken malaria meds in most of these countries but I have in some - the point is, its's your decision and base that on some research. Look where the hot spots are and what precautons you might require - the secret, cover up from dusk till dawn apply the DEET based protection regularly - If in doubt take the bloody things, It's your health, not someone elses responsibility.
    check - http://wwwnc.cdc.gov/travel/ for up to date information.
    Have a good trip now


    Posted by Hotchily on 16th December, 2009

  • Having grown up in the South Pacific and then moved to America, I've been on all sorts of meds (not fond of doxyclycline) and absolutely hate getting malaria. I've likely had it half a dozen times or mroe before I was eighteen, and my father (a linguist) has had that nearly triple that amount despite medications.
    However. They worked ina very rural area on an island well off the coast of Papua New Guinea right on the beach. If you're at a tourist resort or in a major city that's not in one of the high-risk areas, doublecheck with at licensed travel doctor, but it's not really all that necessary if you are practical about your health. (long sleeves at appropriate times, spray etc) If you're footing it through the jungle in high risk areas with no intention of using the various protections and you get malaria, I'm going to sit on my duff to point and laugh. Use common sense, talk to a travel doctor for practical suggestions.

    Posted by River on 1st January, 2010

  • We just bought some 95% DEET in Koh Lanta at a pharmacy. It seems like you should be able to find it all over the place.

    Posted by nick on 9th January, 2010

  • I find it ironic that people say they won't use anti-malarials because of the potential risk to their health, and then don't think of how potentially harmful DEET is both to a person's health and to the environment.

    Posted by Kim on 13th January, 2010

  • i feel so much more content after reading this great and sensible article. thankyou!:)

    Posted by susannah on 8th February, 2010

  • I travelled to India and vacationed there for 2 months traveling throughout Ragasthan and then to Goa. I also vacationed in Thialand - Bangkok and Ching Mai in the north.

    I did not take any drugs and was only concerned in Mumbai wher I encountered an etraordinary number of mosquitos. Obviously they were not malaria mosquitos.

    I am planning a trip to Vietnam, Cambodia and Laos in 2111.

    Thanks to this article I do not plan to take anti- malaria drugs

    Posted by Evelyn on 25th April, 2010


  • Re: my post 25th April 2010

    Just noticed that I said I am planning a trip 2111 - maybe in my next life!!.
    Seriously, I am going, God willing Jan-Feb 2011.
    I liked this light hearted article and don't mind intergecting my own humour
    Cheers

    Posted by Evelyn on 25th April, 2010

  • Is Atovaquone/proguanil available in Vietnam? Also, is malaria present in Sapa?

    Posted by Sharon L Stern on 2nd May, 2010

  • My 16 year old daughter will be traveling with a teen group to Cambodia in July. Conflicted as to what vaccines/meds she really should get and which we can skip. Typhoid and Malaria are recommended. She will be going to: Phnom Penh, Tonle Sap Waterway, Srey Prey, Batambang, AngkorWat adn Kampong Cham.
    Any advice would be much appreciated!

    Posted by Suzy on 24th June, 2010

  • Thanks for such a well balanced article.

    I'm surprised that people somehow miss the fact that the bottom line is go talk to a travel doctor. When I talked to mine we went through the details of trip and where the risks were.

    I'll be travelling for 6 weeks mainly in northern Cambodia. After seeing 2 friends go through malaria from "winging it" in Cambodia and Indonesia and that fact that the travel doctor highly recommended antimalarials (atovaquone/proguanil), that's what I'll be doing.

    Suzy - my own opinion is to definitely go for the typhoid vaccination. The antimalarial one may not be as clear cut...did the recommendation come from a travel doctor or the group she is travelling with?

    Posted by Faz on 29th June, 2010

  • This was a really helpful article. I'm going to Thailand for 2-3 weeks and Lao for 1-2. While I am worried about malaria and japanese encephalitis, I think I am just going to cover up, become a deet addict, or maybe think about buying the drugs over there!

    Posted by Neelia on 23rd August, 2010

  • This is really solid advice - I consulted a very reputable travel clinic before traveling to Vietnam, and this is pretty much exactly what they said.

    I'm surprised how little attention is focused on dengue; you are much more likely to contract dengue than you are malaria, at least in Vietnam. Maybe because the only prophylaxis is preventing the bite in the first place.

    Posted by Jessica on 19th September, 2010

  • Hi Jessica,
    Glad you found the story of help (I wrote it) -- amusing you mention dengue fever as I have that right now and when in better health will add a second piece better discussing dengue!

    Cheers
    Stuart

    Posted by Stuart on 20th September, 2010

  • I'm just back from a few weeks - Doxycycline is cheap in Boots-the-chemist in BKK at about 10Baht/tablet but after 3 weeks my skin became quite sensitive. Note that Maarone cots over £2 a tablet eve from discounters in the UK

    Posted by Graham Poole on 11th October, 2010

  • hey all, me and three friends are traveling over to SE asia and im debating about getting these(as we all are) im really turned off about the fact that it makes u sensitive (plus other side effects) to the sun. we are going in summer Jan to feb and it will be in like the 30's everyday and my bf is already a lilly! just wanted to know how it effected anyone else with regards to sensitivity?? cheers

    Posted by Kiah G on 16th October, 2010

  • Thank you for the information, it was really helpful. If you’re going to an Asian country I just think that you should be careful and aware of which areas is a hazard zone for malaria. But what are the most common signs of having malaria then? Is it like a normal flue at the beginning or what.

    Posted by Simon Coleman on 3rd December, 2010

  • Thank you, finally some good common sense advice rather than the certain death the doctor suggested! Much appreciated.

    Posted by adam roberts on 5th December, 2010

  • good info but still unsure whether to spend my hard earned cash on antimalarials! traveling to thailand on 28 th december visiting bangkok pattaya and sung sang (near nahkon rachasima )been to bkk and pattaya before never even seen a mosquito but sung sang is not exactly a tourist area any advice would be appreciated thanx please excuse the spelling

    Posted by livinitup on 11th December, 2010

  • Thank you very much for such excellent text!

    Posted by Pedro on 6th January, 2011

  • thank you -this is the best information I have come across after reading a gzillion page on Malarials , I will follow my grandmas advice !

    Posted by shelly graham on 2nd August, 2011


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    Posted by A DEE on 8th September, 2011

  • Well, my insurance requires a fairly large co-pay for Malarone (in the $12-$24 range), but the drug was recommended by a travel clinic for Cambodia (where I was traveling), and will certainly be recommended in Laos. The cost is pretty darned tiny. Dengue is evidently more prevalent, but that is no reason to ignore the risks of malaria, especially when I have had zero side effects of Malarone.

    I also soak clothes in permethrin (sp?), which kills and repels other bugs as well.

    Oh, and anyone who is not inoculated against Hep A & B for travel in Asia is crazy!

    Posted by srk052004 on 25th September, 2011

  • Thanks for this very clear and practical advice. Sounds sensible to me and it has made my job easier in deciding whether to take anti-malarials or not when I travel to Cambodia in the New Year. I felt extremely ill two years running, when I tried taking taking Proguanil during trips to Goa and my local Pharmacist says that if I take Doxycycline I should cover up or stay out of the sun!! So, mind made up, then. It's a mosquito net, repellent and coils for me! And no naked romps in the swamp!!!

    Posted by Suze Kelly on 3rd November, 2011

  • Firstly thanks for the great article and the varied comments...
    I tend to value the advice of seasoned travellers aswell as that of well meaning but often un-travelled travel clinic nurses.

    8 years ago i travelled with a friend extensivly in south africa for 6 weeks then for 8 weeks around thailand (bankok and south), Malaysia and Singapore. In all of these places we did not use the Doxycycline that we carried after being advised not to by most other westerners we met. I tend not to be bitten much (could beind pescitarian help?!) whilst my friend was munched, we were both fine.

    In a few weeks I will be travelling ( for 3 months) in Vietnam, Cambodia and Loas in a clockwise motion and intend to trek into remote areas less than i will be coastal or urban so i am thinking of taking 4 weeks worth of malarone with me (incase local advice advises) and using common sense as the main protection...

    As people say there is more chance of catching dengue fever and i am not keen on taking even paracetamol if a glass of water will suffice!...after surviving a rabid dog bite in ko phan nang, a white tip shark nibble in the Perinthian islands (Malasia) and a venomous northern death adder bite (big trip out!) in NE Australia am i right to be suspicious of over selling malarial drug companies?!

    Ps i had 3 rabies jab in 2003 and 2 in ko phan nang 2003 post bite and am now told i dont need a booster before travelling (there is a world shortage somehow?!)...anyone confirm this is ok?

    cheers and happy explorations x

    Posted by Benjammin on 22nd December, 2011

  • Thanks for the common-sense advice (especially about not sleeping naked in a swamp). I went to Thailand last month and everywhere else on the whole internet seemed to be more concerned with covering its collective backside by telling me to take the tablets just in case than on presenting me with a realistic picture of both options plus the level of risk in the specific areas I was visiting in order for me to make an informed decision.

    Obviously I wanted someone to tell me what I wanted to hear, and I did get bitten so in theory I could be incubating something nasty even as I type, but nonetheless, thank you for putting my mind at rest. Although you did replace it with a fear of dengue fever!

    I'm off to Cambodia and Vietnam in March and have, likewise, run the gamut of reports from "OMG Cambodia TOTALLY take all the tablets" to a much more sensible-sounding "actually, if you're only going to Angkor Wat and Phnom Penh you'll be fine".

    As for bite prevention, long sleeves and trousers did it for me all by itself although I was staying in nice hotels which I'm sure helps. The only day I got bitten was the day I found myself walking through the woods for an hour to some caves near Nam Tok having worn short sleeves (in the mistaken belief that I would be going straight from the hotel to the station in a taxi that day).

    I've got some Deet-wipes for my neck for next time, just to stop me flinching every time I hear that high-pitched zzzzz in my vicinity, but that's the only change I'm planning to make.

    Posted by Claire on 3rd January, 2012

  • Thanks for the great article. It balances the information out there about whether or not to take anti-malerials. I'm heading off to SE Asia, spending time across Thailand, Cambodia, Vietnam, Malasia and Indonesia for about 6 months.

    I just went to collect my scrips and was told Malerone would be $1,000 to cover me over that time - that's about 190 pills.

    Why am I being so suspicious of big pharma? I accept the risks, understand profilactics and preventative measures etc, but I just can't help feeling its an absolute rip-off. If it was such a public health hazard for western tourists to travel (even to remote areas) in SE Asia, I'm sure there'd be some counter measures put in place. Meaninig, if there's a risk of tourists (like me) bringing the pathogens back in the form of Malaria, I think there'd be more incentive to take anti-malarials.

    As it stands, there is a distinct disincentive, in the form of serious cost. There seems to be two main drivers for people to take anti-malarials - 1) butt-covering by the medical profession, and 2) persuasive information about the benefits, ostensibly peddled by big pharma. What are they doing about prevention in these at-risk areas for the local people? Something isn't adding up, at least for me.

    From some of the sites I've visited lately, it also seems a critical issue has emerged with resistance to some of the more widey-used anti-malerials. While this resistance is not wide-spread, its sill cause for some concern.

    Balancing all this information, my gut instinct, my previous track record for prevention (repellant, long-sleeved shirts, mozzie nets etc), I'm accepting the risks and opting not to take anti-malerials.

    Thanks again for the great post :)

    Posted by Wendy on 5th January, 2012

  • Nice article!

    I've travelled through S.E Asia Nov-Jan ish a few times and have taken Malaria tablets each time. That was on recommendation from Doctors ...who i feel were just covering their tracks and suggesting the sensible.

    I didn't need them in North Vietnam... was way too cold for mosquito's around New Years time & then when i was in Thauiland and Cambodia in January the dry season made it seem pointless.

    Both times i've taken them they've given me the most crazy dreams, far more powerful than even a hallucinogen ever has! This time i was going to not take them however i'll be trekking through Laos and Northern Cambodia so i believe for once that it might be worth it. Better safe than sorry? Hmm still unsure.

    My advice too people would be depending on when & where you're going when considering. If your travelling in the rainy season then for the love of god take them! But when in the dry season... it's probably not worth it, unless you like too participate in extreme naked mud wrestling in a stagnant pool of water.

    Posted by Jonny on 28th October, 2012

  • I travelled to the Thai Burma border (some years ago) and there was a 90 per cent malaria rate in the countryside (in Burma). Every single one of the Medecins Sans Frontieres doctors up there actually had malaria but heroicly continued to work. Someone I was travelling with died after that trip - 24 hours after getting her first symptoms of malaria. SO I have a slightly more skewed vision of the whole debate.

    However, what it taught me was that malaria is amazingly zone dependent. If you don't want to take the pills get good local information about the specific area you are travelling in. To have travelled in an area with 90 per cent rates of the disease (in the villages I visited this meant 90 per cent of the population actually HAD malaria) without taking anything would have been a bit silly.



    Posted by Tom Bertram on 9th December, 2012

  • Good Stuff! I was in South East Asia for 6 weeks, didn't take malarials and I'm glad I didn't. My friend had bad hallucinations and it ruined her trip.

    Posted by Meghan on 19th March, 2013

  • Great article, which is to be expected from this site. Invaluable information put forward in a simple way, which is exactly what I've been trawling for. Thanks

    Posted by Tom on 9th July, 2013

  • I am Travel to Thailand now for 24years, last year for example for 10weeks. In my first trips I have taken Lariam and have had all the nice and not so nice side effects, after the fourth trip I was stopping to sponsor the pharmacy industry and just use common sense. I never got malaria, even I was in the jungle or at very poor areas.
    Use the local sold repellent it works there, your home cocktail my be good for your home but not for your travel destination.
    Use thick long clothes who hanging around you rather than thigh on you even it might not necessary for the locals there. The most Asians in that area are resistant because the survived it as little kids. (Many do not)
    Have a air condition or use a mosquito net to sleep, these bites even sucks when they are harmless.
    Have a buddy with you who take care of you, when you can not do it yourself anymore. That mean keep yourself and your buddy informed where the next hospital is. And I mean hospital and not some town drug seller. If you suspicious that you are sick the Thai government run hospitals are very well able to make the right blood test and then you can get there what your body need. Off corse you need to pay then for it, but for me it was always the right deal.
    I got some very bad liquid shit with all the danger of dehydration at the border to Laos. The hospital gave me the right medication and instructed our local guides that they need to make sure I drink that bad tasting yellow liquid every hour or so even I spill it or piss it to my ass. They take care of it and i came back to normal soon.
    A good tip for that case of montezumas revenge is that banks and gold stores have toilettes we can use. If you ask friendly you will be allowed even to use the staff toilette at the biggest bank tower.
    If you walk into a hotel there are also always some place close to the reception, but there you should prevent to ask just try to use your eyes and walk strait into as it would be your everyday walk.
    What every traveller should do is to make that hepatitis immunization, it works is save and is worth the price. But be aware it works only if you make all refresh immunizations at the right time frame. Don't bend it.
    Again make sure you have a travel buddy who don't panic and take care of you, in the rare case that you get malaria or dengue he need to make the decision to move you to the next hospital because you will not be able to do it yourself when the fever hit you.

    Posted by Jan on 16th September, 2013

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