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Graham, mosquitoes need sufficient stagnant water to breed which usually only comes with the rains from September onwards.
We never use anti malarial medication, summer or winter but we make sure to take all the other necessary precautions and we've been fine so far (touching wood!).
Not saying one should not take medication, if your doctor thinks you should or it's that time of year, you should.

The main thing to remember is to see your doctor immediately should you have any cold or flue like symptoms after your trip and I know of people who took medication and contracted malaria. Take all the precautions you can, long sleeves and trousers from sunset, liberally spray exposed areas with repellent, watch carefully when you are in the shower and enjoy the trip!

Looking forward to a nice trip report from you!

Just to be safe ...
Eat garlic bread and drink rum

On a more serious note however.......we have a problem this year.

We have always taken anti-malarials (more recently Doxycycline, which suits us well) but this year we are staying in Phala for 18 weeks, so wonder where that leaves us!!

It seems a long time to be "taking the tablets"!!!

Surely people who live in malarial areas, don't permanently take anti malarials?

We will obviously, follow the other rules............. spray regularly, plug in machines, fans, cover up. etc, but should we also take the anti malarials for that long?

Advice welcome please!!

then you should be fine

Little cheetah......you crack me up!!!

Cheetah2111 - hi there

You got something there - but isn't it gin and tonic I have read somewhere that the earlier visitors to malaria areas like Vic Falls used to drink something - but I am not sure whether it is gin and tonic.

Graham - sorry to hear about Malarone and Doxy's - then you must take all the other precautions and use the cream or stick for neck and ears, face, while you braai outside at night. You mentioned the LST2U unit, my favourite accom in Kruger. I have also read once that the mozzies are everywhere in the bush because of standing water in the veld, not only near rivers. I have spent many visits for a week or even longer in July in the LST2U's at LS and never saw a mozzie You must enjoy the LST2U the braai is on the deck and you can burn some romantic citronella candles

Crested Val - No I do not think you can take the doxy's for so long - but ask your doctor or you can phone the doctor at Skukuza - I think that they are on top of the newest meds on malaria. Another substitute for spray (that can cause allergy sometimes) is Citronella Oil itself - you can buy it at any chemist or Clicks - but beware - it has a STRONG smell - but is works, I grew up with it and here in the Karoo we do not have malaria, but many mozzies. And sleep under a net.

Leana

Yes Leana you are quite right, it is the quinine in tonic that helps against malaria (I just think they added gin to make it more drinkable!!)

Doxytabs has the active ingredient doxycycline, which, in different dosages, is used either for certain bacterial infections of the body, as well as for malaria prevention. Most malaria sites will show that it is contra-indicated (cannot be prescribed) for children less than eight years old. As to side-effect profile, many people respond negatively with gastro-intestinal effects (usually diarrhoea, nausea/vomiting, or stomach cramps) and an increase in sunburn potential. Each person differs in their response to any medication - for example, I can take doxycycline with very few gastrointestinal side-effects, but my skin burns quickly when in the sun; while my teenage daughter gets limiting gastro-intestinal effects as well as increased sunburn, and so uses another antimalarial drug.

The atovaquone/proguanil combination (Malanil or Malarone) generally seems to have a better side-effect profile than the older antimalarial drugs (although side-effects like gastro-intestinal disturbances and headache area are also reported), and it may be used in children from 5kg and upwards.

However, because of the difficulty of promptly recognising malaria signs and symptoms, as well as the rapid progression of the disease to death, in young children, most competent malaria sites will warn against taking children under five years of age to a malaria area.

The atovaquone/proguanil combination (e.g. Malanil or Malarone) is increasingly also being recommended, as it seems to have a better side-effect profile than the older drugs, and dosing is suggested only until seven days after exiting a malarial area. (Mefloquine and doxyxyline need prophylaxis until four to six weeks after exiting a malarial area).



Many people report uncomfortable (and sometimes debilitating) side-effects when on mefloquine (e.g. Mefliam or Lariam), but this is not universal and some people are quite happy to use the drug as an antimalarial, especially as dosing is quite easy - once weekly. Malanil (atovaquone/proguanil) seems to be well-tolerated in most people, but some do find it expensive. Doxycycline is generally the cheapest of the effective antimalarials in southern Africa, but many people find gastro-intestinal disturbances (dyspepsia, nausea, or diarrhoea) and sun-sensitivity while on it; also, it needs to be used every day from one to two days before entering a malarial area until four to six weeks after exiting a malarial area.



Daytime repellants are not necessary to prevent malaria, as the female anopheles mosquito only bites from (just before) dusk until (just after) dawn. However, pre-spraying certain areas with substances like Doom, or pre-treating antimalarial nets with a suitable antimalarial spray is certainly recommended. So that I don't forget, I usually apply my Tabard or Peaceful Sleep an hour before sunset, and then again just before bedtime; if I awake early (before dawn), I apply it to my body again.

Citronella candles have their uses, but other non-drug measures (such as covering biting areas on the body with suitable clothing, burning antimalarial coils before going to bed, using antimalarial netting, etc.) should be used along with it.




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.

People respond differently to medication; I'm sure you're no Sissie, Graham!

The official recommendations from the WHO and South African Department of Health is that August in South Africa (I assume that is the area you're talking about; not India?) is a low-risk area and that correctly- and diligently-applied non-drug measures should be sufficient. High-risk people should still be assessed to determine if they should not go to the area at all (it IS still low-risk, not no-risk!), or if they need to add antimalarial drugs to their non-drug-measures regimen.

As long as there are pools of stagnant water close by, the risk of mosquito bites, and therefore contracting malaria, still exists. All camps near water (and I'm trying to think of one that isn't!) have that risk; in fact, all of Kruger (and other areas of southern Africa - see a competent malaria-areas map) is at risk all year round, although the risk moves from low to high officially from October until May (which is around about the time of higher ambient temperatures and increased rainfall).


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.

I know you're joking, Cheetah, but seriously, people need to know that garlic, rum (and other alcohols), quinine-based drinks, vitamin BCo, and the like, are not officially recommended as suitable antimalarials!! The reasons for these are varied, but generally there are insufficient trials that conclude that such substances are suitably effective against malarial prevention that these substances can become part of the official arsenal of preventatives. This does not mean that there is no truth behind these substances lowering mossie bites (sometimes those proverbial old housewives had a lot of wisdom), but that there is insufficient proof that they will effectively help people not to get malaria.

On a personal note, however, garlic oozing from my pores not only seems to keep away some of the mossies and other goggas that bite, but unwelcome human visitors! Other people that I have spoken to, however, tell me that eating a clove of garlic every day (thank goodness I don't live in a closed area with those people ) have done nothing to prevent them getting bitten by mosquitoes. So, the case rests.

And, more seriously, I remember several years ago receiving many calls on a malaria hotline from British people wanting to visit malaria areas in Southern Africa, and who had heard from or read in their media that vitamin BCo tablets were sufficient to use as antimalarials because they supposedly change the smell of human skin enough that the female anopheles mosquitoes prefer to go somewhere else for their nightly blood fix!! We had to explain to these people in great detail the risks of malaria and what non-drug and (if required) antimalarial medicines are recommended for southern Africa.

The moral is that one must never go solely on the advice of quasi- or pseudo-experts on malaria prevention and treatment, as that may be the last "advice" you ever receive!!! Rather visit competent websites on malaria, speak to competent and knowledgeable health professionals on the subject, and do whatever you need to in order that you never become one of those (unlucky) people to contract the disease. I assure you that it is NOT a pleasant disease to contend with!


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.

CV, both Phalaborwa and Kruger are seasonal high-risk malarial areas, such that the official recommendations are that antimalarial medications, in addition to non-drug measures, is suggested from October until, and including, May. The rest of the year, both places are considered a low-risk areas, whereby non-drug measures, correctly-and sufficiently-applied, are suggested to be sufficient.

I assume that you're staying in Phalaborwa continuously for eighteen weeks, and in the summer months? If that is the case, it is difficult to decide whether to use antimalarials for the full four months or to only use non-drug measures; recommendations are based on weighing up risk of contracting malaria versus side-effects and costs of antimalarials, and you should consult a knowledgeable (and preferebly) local doctor as to the decision.

Personally, if I had been comfortable taking the doxycycline for extended periods, and am able to do so from a medical perspective, I would probably use this option for the full four months plus an additional six weeks after exiting the malarial area. For me, though, it increases sun sensitivity, so when I have used doxycycline, I use extra sun protection. Some women can get vaginal thrush from its use, so concomitantly using a probiotic (taken at least an hour after the doxycycline) is certainly recommended to prevent this. It sounds like you have little problems when using doxycycline, and it is indeed also cheap.

Whatever you decide to do, if you get flu-like symptoms, always test immediately for malaria, and if necessary, follow-up with tests several times thereafter! Always seek competent medical advice, and insist on immediate medical treatment if the tests are positive.


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.

Having been one of those unlucky people, I can assure all of you that OWN is 100% correct. Having lived for several years in high risk malarial areas with no problem, we do not take anything when we visit KNP but just take precautions such as long sleeves, spray etc. Two years ago I contracted Malaria in May in Northern KNP - which took my doctor 3 weeks to get a correct diagnosis (despite being told that I had just returned from KNP!) this was due to the fact that we were not lving in a malaria area and the doctors there did not have experience in treating or diagnosing the disease. It is possible to contract malaria even if you are taking the drugs - I know of people who have done so.
As far as I am aware, the KNP personnel, like those who live on the borders of KNP in Nelspruit, Phala etc. do not take any tablets as there is a limited time period in which one can take them.
If you are visiting for a couple of weeks or so - take them IF your doctor is happy to prescribe them. Otherwise, like CV - take all other precautions.

F

Tonic water contains quinine, which was once believed to be suitable against malaria prevention. Today, it is still used for treating certain strains of malaria and under certain conditions; however it is generally no longer recommended for malaria prophylaxis anymore. Even if it was, the problem is that the amount of quinine in tonic water is so little that you would have to drink litres of the stuff every day to have a high-enough quinine concentration in the body to minimise contracting malaria! And, because that has most probably almost never been accomplished (tonic water is bitter), the small amounts of quinine in the body that are consumed may speed up malarial resistance to the substance.

Gin, I'm sure, was indeed added to tonic water to make the latter's palatability tolerable. Or, maybe, it was just an excuse to drink more alcohol? Either way, I don't know of any competent person who would recommend drinking litres of gin and tonic just to lower malaria risk!!


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.

I'm sorry to hear that you contracted malaria, PNF. And sadder that the diagnosis took so long to confirm. However, I presume that you have fully recovered and back to your eloquent, insightful self?

It IS indeed possible to get malaria even if you take the antimalarial drugs, which is why non-drug measures are as important to use! However, concomitantly using suitable antimalarial drugs and non-drug measures correctly lowers the risk of contracting malaria to a very low level.

Most areas bordering Kruger (consult a suitable and accurate malaria map) are considered seasonal-risk malarial areas, with antimalarial drugs plus non-drug measures suggested from October until, and including, May; and correctly- and sufficiently-applied non-drug measures on their own recommended as sufficient during low-risk season (June until, and including, September).

As far as I am aware, and based on years of talking with staff, most personnel that live within a seasonal-risk malarial area in Southern Africa do not take antimalarial drug prophylaxis for protracted time periods, rather preferring to weigh up the risk of contracting malaria versus the side-effects and cost of the drugs. I would love to know what the official policy on this is from SANParks, and have contacted suitable people to find out; will let you know as soon as I have heard something in this regard.


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.