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Malaria risk in August/September

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Duke Ellieton
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Re: Malaria risk in August/September

Unread postby Duke Ellieton » Tue Sep 11, 2012 8:49 pm

The Guidelines for the Prevention of Malaria in South Africa were developed by the National Department of Health in close collaboration with several stakeholders and malaria experts:

• Mrs Lee Baker, Medicines information consultant, Amayeza Information Centre
• Dr Lucille Blumberg, National Institute for Communicable Diseases, National Health Laboratory Service
• Assoc Prof Karen Barnes, Division of Clinical Pharmacology, University of Cape Town
• Dr Frank Hansford, Department of Health (Chairperson)
• Dr Cornelia Duvenage, Department of Internal Medicine, 1 Military Hospital
• Dr Gerhard Swart, CDC, Mpumalanga Department of Health
• Dr Etienne Immelman, KwaZulu Natal Department of Health
• Dr Jan van den Ende, Drs Martin & Sim/Toga Laboratories Pty Ltd
• Dr Bonnie Maloba, Dr Eunice Misiani, Ms Tsakani Furumele and Dr Devanand Moonasar, National Department of Health

They identify KNP as a high risk area and recommend preventative measures.

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As a pharmacist with 30 years experience I support these guidelines and think it is irresponsible to say that the risk of contacting malaria in KNP is insignificant.

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Re: Malaria risk in August/September

Unread postby Graham_5000 » Tue Sep 11, 2012 8:54 pm

Thanks for the map Duke Ellieton (great name!). The map suggests what I thought - I visited in August and did not take anti-malarials which the guidance seems to support.

That doesn't mean I won't get bitten, nor does it mean that if I go to Mtunzini I can't contract it!
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Re: Malaria risk in August/September

Unread postby Crested Val » Tue Sep 11, 2012 8:56 pm

I totally agree with you Duke, and so would my friend Nicki, who's cousin came to "somewhere near Kruger" to work with the local communities, last year.

He apparently had decided not to take anti-malarials, contracted the disease, and sadly died.

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Re: Malaria risk in August/September

Unread postby MNEL » Wed Jun 05, 2013 11:04 am

I posted my initial question so long ago, I completely forgot about it! Anyway, we never went to Kruger with our son, who is now 1 year old. I also felt that at 3 months he was at high risk, not just of malaria, but if anything happens (tonsilitis etc..) I would be too far away from a doctor and would worry too much. We have consulted with several people/websites etc, and made the call toe visit the park en of June though. I agree that one should take precautions with the little ones, luckily he is bathed etc before sundown and would be in his babygrow, covered in anti-mozzi lotions by nightime. He will sleep in his camping cot underneat a treated net. HE WILL NOT GO OUTSIDE TO SIT AROUND THE FIRE....I guess what I am saying is that we will take all possible precautions, which are a bit easier in winter given the warmer, full body clothes etc. I will also check one final time with our pediatrician on drugs, but initial checks were NOT RECOMMENDED in the low risk season.
I am thankful for the many responses, I must be honest, in the past I've been quite naive on the risk of Malaria in the Kruger....we've been there MANY times in high risk season, and NEVER took drugs.....I realise we've been lucky on these occasions. I am however also the type of person who believes in taking calculated risks....as someone put it earlier, in SA your risk of being killed in an armed robbery or a car crash is MUCH higher than from getting malaria on a short June visit to the Kruger. Thanks again for the kind, well meant advice.

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Re: Malaria risk in August/September

Unread postby onewithnature » Wed Jun 05, 2013 7:00 pm

johanrebel wrote:Malaria was rife in Italy until well after WW2. Draining the Pontine Marshes was one of the measures taken to reduce the incidence. This also contributed to the demise of wild buffalo in the country, which used to occur in the tens of thousands. The US Army also sprayed just about the entire population of Naples and other cities with DDT (which, by the way, was also sprayed from huge trucks along packed New York City beaches in summer).

Last outbreak of malaria in Amsterdam, capital of the Netherlands, was in 1956. Malaria occured as recently as the early 20th century in Scandinavia. It only disappeared when peasants no longer spent the whole winter under the same roof as their domestic animals.

That malaria is now considered a tropical disease only proves how short memories people have.

The risk of contracting malaria in Kruger as a tourist is so insignificant that is not worth thinking about for a second. There are far greater risks in life, such as crossing a street or driving a car. Heck, even driving a car in Kruger is far more dangerous. Just off the top of my head I can think of seven people killed in road traffic accidents in Kruger in recent years. How many malaria deaths can you think of?

Johan


Wonderful information on areas of Europe little known to Africans, JohanRebel. :clap: :clap: :clap:

Your last paragraph, however, I cannot agree with in its entirety. Indeed there are many risks in life that will have a higher prevalence of death than malaria in South Africa; now, why then would one ignore the "lesser" ones in favour of the more-commonly published ones? That is like saying that one can drive through red traffic lights at high speed in the dead of night because the amount of cars on the road is so much less than during peak hour. If one thumbs one's nose at Death often enough, it may just prove itself more knowledgeable than you.

There are hundreds of thousands of people that visit Kruger - some many times each year - and very few ever contract malaria. However, speak to the families of those who did pass away from this dread disease and I have no doubt that almost all of them will tell you that, if they could advise the deceased to do things differently and so save his or her life, they would. The risk is always there - ALWAYS. Yes, sometimes lower, sometimes higher, almost never on a par with some of the notoriously dangerous malaria countries of the tropics. But, why risk it? I will never, and I will always advise others the same. We are given the blessing of one life on this planet - live it to the full, but do so sensibly and to the extent that you may not only be a role model to many others, but also preserve your health and vitality to maximise your enjoyment of it.
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Re: Malaria risk in August/September

Unread postby Bushbuddies » Thu Jun 06, 2013 9:40 am

Hear-hear! :thumbs_up:

I agree with OWN and Duke Ellieton. We do have scientific data on this. Risks have been determined and there are medical guidelines on this. Let's stick to that when advising others. Many people go to malaria areas for years without taking prophylaxis and never get malaria. Does this mean nobody is at risk and we should all just throw caution to the wind? Others, like the person Val knew, died of it. I have diagnosed a patient with malaria after visiting the park the first weekend in Sept 2 years ago. Luckily we diagnosed him early and he's fine - but he will never go without prophylaxis again. Other patients went for 10 years - never used anything - and advised others against it too! Year 11 both the husband and wife ended up in ICU with malaria. Luckily they are still alive and now recommending to all their friends and relatives not to go to KNP in summer without prophylaxis.

We all have opinions and our own experiences. But when giving advice on a life-threatening illness - I'd suggest we stick to the scientific facts (as outlined by Duke above). :thumbs_up:
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Re: Malaria risk in August/September

Unread postby cheetahlady » Thu Jun 06, 2013 8:06 pm

Hi there,

We have taken our son to KNP since he was 15 months old. Usually during winter (July-Sep). We have always given him malaria pills. Initially we used Larium - would have to cut the pills up, crush them and add to a spoon of ice cream or something like that. Taste terrible.

Now use Malarone. You can get a paediatric dose but not all places carry it. Bottom line- speak to your child's paediatrician and discuss your options.

Also use bug repellents, spray under beds, behind curtains etc.
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Re: Malaria risk in August/September

Unread postby onewithnature » Wed Jun 12, 2013 2:08 am

Well done, Cheetahlady. Better safe than sorry. :clap: :clap:
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Re: Malaria risk in August/September

Unread postby kite » Wed Jun 12, 2013 5:50 pm

Do we have any figures for people contracting malaria after or during holidays to Kruger?
Or perhaps even including staff who get malaria while working in Kruger.
I don't know if Sanparks will want to share what could be negative publicity?

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Re: Malaria risk in August/September

Unread postby onewithnature » Thu Jun 13, 2013 2:48 am

Not sure either, but one must remember that it would be pretty nigh impossible to determine the frequency of malaria infections contracted within Kruger for tourists visiting the park. The reasons for this would include: (i) people may only show malaria symptoms some time later and have been to other malaria areas either after or prior to their Kruger visit; (ii) many people visit while staying in malaria areas surrounding the Park; (iii) very few malaria cases potentially contracted while in Kruger will be reported back to the Park, especially if the visitors live far from it; and (iv) frequency of infection vary according to conditions.

As for employees actually living on Kruger's premises - and remember that many now live outside Kruger, but also in malaria areas - SANParks may have a better idea of infection rates. However, it is doubtful that accurate figures and/or extrapolations exist, again as the result of attendant problems with diagnosis, reporting, and length of time since malaria presents.

Perhaps Kruger and/or SANParks could kindly give further insight into the matter?
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Re: Malaria risk in August/September

Unread postby ctm7943 » Sat Mar 22, 2014 9:40 pm

We are visiting KNP & a private reserve in Sept 2014 for 1 week. I have read this entire thread. What I have gathered is that mossies are active/bite between dusk & dawn.
We plan on taking Malarone. And also using repellent on our person before we head out for sunset (dusk) guided game drives in KNP & reserve and also light candles in the room upon our return.

My qustion is: Do we need to re-apply repellent in the morning (dawn), before heading out for morning self drives (KNP) or guided game drives (reserve)? I am assumming that the temp will be quite cool/cold at that time of day.

Also we plan to shower @ mid-day, hopefully when they are not active.
This may be a silly question, but I am only used to the mossies in the US, which are not around/active in the winter, even if it rains.
Thanks

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Re: Malaria risk in August/September

Unread postby Elsa » Sat Mar 22, 2014 10:30 pm

I would advise to take the most precautions possible, one cannot be too careful so yes, do apply the repellant in the early mornings as well.
Rather be safe than sorry.
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Re: Malaria risk in August/September

Unread postby onewithnature » Sun Mar 23, 2014 1:55 am

Hi ctm7943. The female malaria-carrying mosquitoes here (the Anopheles genus) bite between dusk and dawn, even when it is colder (although the bite frequency generally decreases with temperature). That is, technically speaking, just before dusk until just after dawn. So, to be safe, begin applying mosquito repellant half to one hour before it gets dark and reapply anytime before the sun rises if you are out and about that time. (Of course, if you are active at night, you need to reapply repellants every few hours as well.) September in Kruger is on the cusp of high malaria risk, so you cannot go wrong using anti-malarial pills as well. (Your choice of Malarone is good if you're able to use it as it generally has a good side-effect profile.)

The malaria-carrying mossies here do not bite in the day, although there are other mosquitoes that may. ctm7943, I would not worry about showering during the daytime. I, personally, have no issue about showering in Kruger at night either, as I find that I seldom get bitten while in the bathroom. Also, I make sure that I apply mosquito repellant before dusk and then reapply immediately after showering.

The most important thing is to be diligent in malaria-prevention techniques, but most especially to enjoy your trip to Kruger (and elsewhere). :thumbs_up:
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Re: Malaria risk in August/September

Unread postby ctm7943 » Mon Mar 24, 2014 1:41 am

Onewithnature,
We appreciate the additional information & recommendations.
So, if Sept is on the cusp of the higher risk season, do the rains usually start then?
We were hoping to still catch the dry season.

Thanks

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Re: Malaria risk in August/September

Unread postby onewithnature » Mon Mar 24, 2014 2:22 am

Rains indeed usually coincide with the advent of Spring - or, they are supposed to: these days, with the global repositioning of weather processes, it is difficult to accurately predict when the rains will start in Kruger after winter. However, the area is in a wet cycle, so there may be significant rains a few weeks prior. Traditionally, the higher-risk season (which now is known as the moderate-risk reason - great news for everyone) in the area begins on the 1st of September and lasts until the 31st May each year. Earlier or later rains may affect the number of malaria-carrying mosquitoes and their life spans, but it is prudent to use the recommendations as is.

Disclaimer: My recommendations here - though based on some experience and some drug, and other, knowledge - are not absolute, and further consultation with suitable health-care professionals is suggested before a final decision is taken on whether to enter a malarial area, what prophylaxis to use, and any general factors and limitations that need to be taken into account. Furthermore, I only advise based on what information is given by the person(s) entering the malarial area, but I have no control on the information given to me, and so such information could possibly be incomplete or misleading. Moreover, people vary subjectively as to how they metabolise, and react to, drugs and other substances, which further accentuates that my suggestions here are only general suggestions, and therefore not to be taken as pertaining to every person alike.
Last edited by onewithnature on Mon Mar 24, 2014 3:00 am, edited 1 time in total.
EVERYBODY'S TR!
TR: A NEW DAY IS S-OWN
TR: NECTAREAN NICETIES OF THE NORTH
TR: PRIMEVAL PLEASURE

"Outside of a dog, a book is a man's best friend. Inside of a dog, it's too dark to read." (Groucho Marx)


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