Malaria in Roatan

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bjeanneb - 03 Jul 2004 20:24 GMT

Anyone have experience with or an opinion about the risk of malaria in
Roatan?

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Jeanne

"Laugh at yourself first, before anyone else can." --Elsa Maxwell

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Greg Mossman - 03 Jul 2004 21:59 GMT

> Anyone have experience with or an opinion about the risk of malaria in
> Roatan?

Yep.

www.cdc.gov

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Ron T - 04 Jul 2004 02:25 GMT

> www.cdc.gov

stands for Can't Diagnose Crap....

at least when it comes to tropical deseases. They still recommend Lariam
and Chloroquine, both of which have been shown to be ineffective in most
parts of the world. You would do just about as well drinking quinine
laced tonic water (and some Gin and it would be better).

Latest studies suggest artemisin derivatives, which of course the other
bastion of ineffective government buracracy, the FDA has not approved
despite worldwide testing lasting more than a decade.

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C. Josef - 07 Jul 2004 06:29 GMT

for Can't Diagnose Crap....

> They still recommend Lariam

Lariam is usually not recommended for scuba divers because of its
neuropsychiatric side-effects.

> and Chloroquine, both of which have been shown to be ineffective in most
> parts of the world.

There is no drug resistant malaria in Honduras and the overall malaria
risk is considered as relatively low. Several official European
recommendations suggest no prophylaxis for this part of the world, but
just an emergency treatment (usually chloroquine) in case people catch
malaria. However, since we're talking about prescription drugs, this
should be discussed with a well experienced M.D.

> Latest studies suggest artemisin derivatives, which of course the other
> bastion of ineffective government buracracy, the FDA has not approved
> despite worldwide testing lasting more than a decade.

Artemisinin derivatives are definetly NOT recommended first choice
treatment drugs in Honduras. They're frequently used in Southeast Asia
and subsaharan Africa, but not in Honduras where the older drugs still
work.

C.

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nospam@all.please.net - 03 Jul 2004 22:18 GMT

> Anyone have experience with or an opinion about the risk of malaria in
> Roatan?

I used an anti-malarial the first time I went. It made my skin very
photo reactive and I felt...constipated for days. The left side of my
forehead was darkened for so long you could easily see the progress of my
hairline receding.

I haven't used it on subsequent trips to Roatan, and I haven't contracted
malaria (yet).

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Randy Buckner - 04 Jul 2004 05:24 GMT

> Anyone have experience with or an opinion about the risk of malaria in
> Roatan?

Rural areas, including resort areas on Roat?n and other Bay Islands are
areas of risk for malaria.

Chloroquine is the recommended Rx. The adult dose is 500 mg chloroquine
phosphate once a week. You should take the first dose of chloroquine 1 week
before arrival in the malaria-risk area, take your dose once a week while in
the risk area, and take your dose once a week for 4 weeks after leaving the
risk area.

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C. Josef - 07 Jul 2004 06:34 GMT

> Rural areas, including resort areas on Roatán and other Bay Islands are
> areas of risk for malaria.

I agree, but is the malaria risk big enough to outweigh the risk of
side-effects (especially in scuba divers)?

C.

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Randy Buckner - 08 Jul 2004 18:58 GMT

> x-no-archive: yes
>
[quoted text clipped - 5 lines]
>
> C.

Excellent question, but no satisfactory answer. Everyone has to weigh the
decision for themselves. I can't take the risk because I don't have sick
leave -- if I don't work I don't have income, being self-employed, plus my
patients lose a doc. If a person uses DEET repellants and limits night time
exposure, I'd think the risk would be very low indeed. Anecdotally, I have
never have any side-effects from the meds.

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Dillon Pyron - 08 Jul 2004 23:38 GMT

>> x-no-archive: yes
>>
[quoted text clipped - 15 lines]
>exposure, I'd think the risk would be very low indeed. Anecdotally, I have
>never have any side-effects from the meds.

Haven't there been reports of psychosis with laramine? Now THAT would
be an adverse side effect. I know I saw something in an Alert Diver a
while back that talked about some of the sides with the various
malaria meds.

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dillon

When I was a kid, I thought the angel's name was Hark
and the horse's name was Bob.

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C. Josef - 09 Jul 2004 07:04 GMT

> Haven't there been reports of psychosis with laramine?

Lariam frequently causes neuropsychiatric side-effects:
http://www.journals.uchicago.edu/CID/journal/issues/v33n7/010125/010125.html
http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=14604928

It's considered unsafe for divers by the Divers' Alert Network (South
Africa):
http://www.dansa.org/medical/medication.html

"4 divers (on four separate occasions) report symptoms to DAN's
hotline that are indistinguishable from decompression illness after
taking Lariam (mefloquine) for malaria prophylaxis. Symptoms ranged
from muscle aches, dizziness and pins and needles to personality
changes and psychosis. Two divers actually received unsuccessful
recompression therapy before the association with Lariam was made."

http://www.dansa.org/medical/malaria_prev.htm

"Lariam is considered unsafe for divers & pilots. It is
contra-indicated in Epilepsy but is a good first choice for other
travellers."

The New Zealand Medical Journal points out:

"As diving medical physicians at the Royal New Zealand Naval
hyperbaric medicine unit we would strongly advise that mefloquine
should not be used as chemoprophylaxis for [...] scuba diving [...]."
(Dr. David Wright, New Zealand Medical Journal, Dec 8, 1995, p. 514)

The product information by the manufacturer points out:
"Caution should be exercised with regard to activities requiring
alertness and
fine motor coordination such as driving, piloting aircraft, operating
machinery, and deep-sea diving, as dizziness, a loss of balance, or
other
disorders of the central or peripheral nervous system have been
reported
during and following the use of Lariam. These effects may occur after
therapy
is discontinued due to the long half-life of the drug."

>Now THAT would
> be an adverse side effect.

I'm not intending to problematize chloroquine more than necessary, but
as a matter of fact it can cause side-effects, too. And in some cases
they can be neuropsychiatric side-effects just like mefloquine
(Lariam):
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstra
ct&list_uids=15235536

Of course any risk of side-effects has to be weighed out against the
risk of malaria. But how big is the malaria risk in Honduras? It's a
fact that it's considered as smaller than the risk of serious
side-effects by both the Swiss, German and Austrian guidelines for the
prevention of malaria:
http://www.bag.admin.ch/infekt/publ/bulletin/f/malaria_bu14_03.pdf
[French]

Personally I would not take prophylactic malaria drugs for Honduras.
However, I would definetly take prophylactic pills for a similar trip
to Kenya.

C.

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C. Josef - 09 Jul 2004 07:13 GMT

> Excellent question, but no satisfactory answer. Everyone has to weigh the
> decision for themselves.

I agree, but you also have to rely on statistics.

>I can't take the risk because I don't have sick
> leave -- if I don't work I don't have income, being self-employed, plus my
> patients lose a doc.

If you suffer serious side-effects from a malaria drug the situation
is similar. The same applies if you suffer milder side-effects that
nevertheless can cause a diving accident.

>If a person uses DEET repellants and limits night time
> exposure, I'd think the risk would be very low indeed.

Compared to a country such as Kenya, the risk is indeed very, very
low. In fact I'm unaware of a single case of malaria from Honduras
reported via Tropnet Europe even though doctors in Europe frequently
don't prescribe prophylactic medications for this part of the world:
http://www.tropnet.net

I'm unaware of any published statistics by the CDC, but I would very
much like to know how many travelers returned from Honduras to the
United States with malaria in recent years. Is there any such case at
all?

>Anecdotally, I have
> never have any side-effects from the meds.

If somebody has taken a medication several times before and hasn't
suffered any side-effects at all, the situation might become
different. But the statistics clearly show malaria drugs are not
always well tolerated. Therefore the risks and the benefits have to be
weighed out against each other. I strongly doubt prophylactic
medications for Honduras are based on a realistic risk-benefit ratio.

C.

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