Malaria Prophylaxis

[J.Ogilvie]

Hello AH,

Me and my younger brother are going to Namibia next year on our first safari. After hunting for plains game, we are spending a few days on the Okavango River fishing.

As it's a malaria risk area, we will both be taking Malarone. I have read that some people don't take malaria medicine due to the potential side effects.

It got me wondering how people on this forum feel.

 

[RedTag]

Don’t forget the Gin & Tonic
https://pmc.ncbi.nlm.nih.gov/articles/PMC9714995/

 

[Trogon]

Malarone was recommended by personal physician but not easily obtained earlier this year, easier to obtain Doxycycline? and take a pill a day a week prior to traveling. Not good for dealing with sun exposure in Angola for fishing. Sunburned very readily.

 

[375Fox]

I wouldn’t consider not taking it. The risk is too high. Possible interference with trip, losing work after returning home, or worse doctors not recognizing what it is after returning. I take doxycycline because I know I have no side effects. I put sunscreen on in morning and have never had issues with sunburn.

 

[RichieG]

Hello AH,

Me and my younger brother are going to Namibia next year on our first safari. After hunting for plains game, we are spending a few days on the Okavango River fishing.

As it's a malaria risk area, we will both be taking Malarone. I have read that some people don't take malaria medicine due to the potential side effects.

It got me wondering how people on this forum feel.

A good friend who specializes in travel medicine says you really want to avoid getting malaria. Even though I hunt in winter in remote areas she says malaria is a lifetime disease and is insidious. She is African btw. Malarone (locally in SA under the brand Malatec and Mozitec) is the current gold standard. It is available without prescription in SA and Namibia I believe and the daily regime starts 1 day before travel and ends a week after. Cover up at night and spray your room when you arrive. Safe travels and good hunting.

 

[Mark Biggerstaff]

If I need to take I use Doxy as I know I can take without any side effects. Only thing is it’s a longer treatment, reccomended take 28 days after leaving area. But it’s one pill every morning after breakfast.

 

[mark-hunter]

I went to Zimbabwe and Namibia Caprivi, in prime time when there is no mosquitos.
But nevertheless I took Malarone. Not a big deal.

 

[Wildwillalaska]

Same here. Didn’t see a single mosquito in Omay last month, but took Malarone as well. Was nervous first one hearing about sides…fortunately I didn’t have any, so will stick to it for future hunts.

 

[RichieG]

There was an outbreak in Northern Namibia this year where cases were 8x higher than previous years because of good rains last summer. So while season is important and risk is higher where there are large local populations because humans are the host, on that evidence I’d take it. If you get malaria (and survive) you will regret not taking the prophylaxis which is available locally, cheap and effective. As some of my country mates say it is a very kak disease.

 

[uplander01]

Not worth the risk to NOT protect yourself. The side effects on the different options are real. I'm pretty sensitive to the sun anyway and the one time I took doxy even with sunblock was a horrible experience. Malarone worked for me but did not work for my wife at all, she had to stop taking it 3 days into the trip.....her brain was not working right.

 

[Flipper Dude]

Don’t mix malarone and booze. At least that’s been our experience. Vivid, disturbing dreams. We take it, but make it a part of our morning routine. No issues.

 

[375 Ruger Fan]

Prophylaxis will not prevent you from getting malaria, it simply reduces the severity of malaria and makes it more treatable if you get it.

Take Malarone, get enough to start taking it a week ahead of your trip and take it for two weeks after you return home. Malarone is a daily pill.

I worked in Angola for 5+ years and took Larium (weekly pill) during that time. A lot of people complain about the side effects (sleeplessness, vivid dreams and suicidal thoughts) but I didn't have any of these.

I worked in Lagos, Nigeria for 6 years and didn't regularly take anything for malaria. I worked and lived in a company gated neighborhood and it was fogged at night on a regular basis. The mosquito that transmits malaria is the female Anopheles and is nocturnal. We use to joke that we might die from whatever chemical they were fogging with. When I traveled during this time, I always would either carry Malarone or start using it before, during and after the trip.

I was in Namibia for most of July this year and took Malarone the entire time, plus a couple weeks after I returned home.

In my 11+ years in Africa, I never had malaria. However, quite a few people I worked with did. A quick diagnosis and treatment is essential for a quick recovery. The worst scenario is when people go to Africa, then return home and develop symptoms. Doctors and clinics in non-African countries are not use to seeing malaria cases and may not even have the means to test for it.

 

[Doug3006]

Is there really a physician so dense that when presented with a patient with fever, body aches and severe fatigue WHO JUST RETURNED FROM AFRICA doesn’t think “hey, I wonder if he got malaria? “

 

[Red Leg]

If I can offer something other than just personal experiences. While in the military, I deployed to malarial areas numerous times and often for relatively long periods in elements up to Artillery Brigade size. We all took a prophylaxis (normally Larium, but also malorone), and I know of none of my fellow troops who came down with malaria. In virtually all of those deployments, I was in position to have been informed if we had cases.

A PROPHYLAXIS WILL PREVENT MALARIA, AND MALARONE HAS A 95% SUCCESS RATE IN DOING SO - particularly the most serious and deadly variant of the parasite. It doesn't simply result in less severe cases. There are some breakthrough cases, but even most of those were most likely due to missed doses. I do not know any doctors who attempt to prescribe it any longer, but do not use chloroquine. The parasite has developed resistance to it in much of its range.

It is very easy to do your own research on the subject. Below, I'll offer an AI summation.

In all those deployments, and all of my, family members, and friends subsequently, I know of no serious reaction to malarone. A handful of those individuals remarked that they had vivid dreams (perhaps 2%). I have personally never had a reaction to either drug, and taking it has never inhibited my enjoyment of a sundowner.

Finally, at the age most of us are during our expeditions to Africa and beyond, one is playing with what can be a lethal fire by not taking a preventative. Malaria can kill you, and the older the victim the greater the danger.

From Grok

Malarone (atovaquone/proguanil) is classified as a causal prophylactic and suppressive prophylactic, meaning it can both prevent malaria prevention and, in most cases, completely prevent clinical malaria when taken correctly. Here's how it works and what the evidence shows:

• Kills liver-stage parasites (causal prophylaxis): Unlike older drugs like chloroquine or mefloquine that only suppress the blood stages, Malarone attacks Plasmodium parasites while they are still in the liver (before they reach the bloodstream and cause symptoms). This is especially effective against Plasmodium falciparum, the most dangerous species.
• Also kills blood-stage parasites: If any parasites escape the liver, the proguanil component helps clear them from the blood.

Because of this dual action, Malarone can stop infection entirely if drug levels are maintained throughout exposure and for 7 days after leaving a malaria area.

• Clinical trials and post-marketing data show 95–100% protective efficacy against P. falciparum when taken daily as directed (start 1–2 days before entering a malaria area, continue daily while there, and for 7 days after leaving).
• Against P. vivax, efficacy is lower (~84–90%) because Malarone does not kill hypnozoites (dormant liver forms of P. vivax and P. ovale). This means delayed (relapsing) malaria can still occur months later, but the initial infection is usually prevented or markedly suppressed.

Does It "Just Make Malaria Less Severe"?No — in the vast majority of compliant users, Malarone prevents symptomatic malaria altogether, not merely attenuates it. Breakthrough infections are rare and usually due to:

• Non-compliance (missed doses)
• Vomiting the tablet shortly after taking it
• Very rarely, true drug resistance (documented but uncommon with Malarone so far)

Summary

• For P. falciparum (the potentially deadly one): Malarone almost always fully prevents malaria if taken correctly.
• For P. vivax/P. ovale: It prevents the initial illness in most cases, but a 14-day course of primaquine is later needed to prevent relapses (if exposure was significant).

So Malarone is one of the most reliable drugs available for actually preventing malaria, not just reducing severity.

 

[mdwest]

Prophylaxis will not prevent you from getting malaria, it simply reduces the severity of malaria and makes it more treatable if you get it.

Take Malarone, get enough to start taking it a week ahead of your trip and take it for two weeks after you return home. Malarone is a daily pill.

I worked in Angola for 5+ years and took Larium (weekly pill) during that time. A lot of people complain about the side effects (sleeplessness, vivid dreams and suicidal thoughts) but I didn't have any of these.

I worked in Lagos, Nigeria for 6 years and didn't regularly take anything for malaria. I worked and lived in a company gated neighborhood and it was fogged at night on a regular basis. The mosquito that transmits malaria is the female Anopheles and is nocturnal. We use to joke that we might die from whatever chemical they were fogging with. When I traveled during this time, I always would either carry Malarone or start using it before, during and after the trip.

I was in Namibia for most of July this year and took Malarone the entire time, plus a couple weeks after I returned home.

In my 11+ years in Africa, I never had malaria. However, quite a few people I worked with did. A quick diagnosis and treatment is essential for a quick recovery. The worst scenario is when people go to Africa, then return home and develop symptoms. Doctors and clinics in non-African countries are not use to seeing malaria cases and may not even have the means to test for it.

This is spot on. The only exception I’d add is my physicians have told me that proper meds can prevent getting malaria to a certain degree (varying degrees for varying meds) but that none are a 100% guarantee…

I’ve been traveling around the African continent for 25+ years at this point… and have spent lengthy periods of time in several very bad malaria risk areas… by the grace of God alone I’ve never gotten it, but several of the people that i worked with and that worked for me did… and we all took prophylaxis meds (different meds on different trips st different times)…

Malaria is definitely something you don’t want.. and is something you want to take as much precaution as possible to avoid…

I’ve got one former employee that got it twice in South Sudan… he left Juba in 2012… I just talked to him a couple of months ago.. he still suffers occasional effects of getting the disease 13 years ago… it will follow him to his grave…

​

 

[375 Ruger Fan]

Is there really a physician so dense that when presented with a patient with fever, body aches and severe fatigue WHO JUST RETURNED FROM AFRICA doesn’t think “hey, I wonder if he got malaria? “

That information, "BTW, I just returned from Africa," would need to be communicated to the doctor. Malaria is very rare in the US and most other non-African countries.

"When you hear hoofbeats, think horses, not zebras" is a medical maxim that means you should first consider common diagnoses before thinking of rare ones. The phrase, attributed to Dr. Theodore Woodward, is a reminder to use Occam's Razor—the simplest explanation is usually the correct one—when evaluating a patient's symptoms

 

[Hunt anything]

Is there really a physician so dense that when presented with a patient with fever, body aches and severe fatigue WHO JUST RETURNED FROM AFRICA doesn’t think “hey, I wonder if he got malaria? “

Yes, when we returned from South Africa in August my daughter came down with fever, chills and horrible body aches. We had been to Kruger and spent a couple of nights just across the river from Mozambique. Extreme northern Kruger does have a few cases of malaria every year. When Caitlin went to the doctor she told her she had been in a malarial area but refused to test her. Gave her some antibiotics and sent her on her way.

Caitlin used to work at the CDC so she called some friends and was able to be tested there and was negative. Our trip to Kruger was somewhat of a spur of the moment thing so we were not prepared to take a preventive regimen of medicine. One night in our cabin I did see a couple of anopheles mosquitoes and hunted them down like a 45” buffalo!

I’ve taken malarone and the only side effect was some very unusual dreams!

 

[SFRanger7GP]

I have had malaria, and dengue and a wide variety of other tropical illnesses. I did not take any prophylaxis but I would take mefloquine with booze from time to time for the freakish dreams. Disclaimer: I do not recommend that foolishness. It was what we did in those days. If you had not suffered from a tropical illness or disease, you obviously weren’t deploying to the “good” areas.

There is a vaccination for malaria available in Colombia. The Red Cross offers it and says it is highly effective.

Safe travels.

 

[Rare Breed]

Hello AH,

Me and my younger brother are going to Namibia next year on our first safari. After hunting for plains game, we are spending a few days on the Okavango River fishing.

As it's a malaria risk area, we will both be taking Malarone. I have read that some people don't take malaria medicine due to the potential side effects.

It got me wondering how people on this forum feel.

Here is what I know from my experience. 1. Yes Malorone taken 3 days before you go and up to 7 days after. Always take it in the mornings. I have two friends who I will not name who took it at night then had alcohol and both had horrible very real dreams. It upsets my stomach for the first two days then I notice nothing. just me

 

[zephyr]

Have always taken Doxy