We are planning a trip to SA in July and want to visit the private Kruger game parks, considering Lion Sands. Would it be compulsory to take malaria prophylaxis as I understand the nights are cold which is prime mosquito biting time. Though I am aware the SA Health Bureau recommends yearly protection, don't most SA natives omit medical prophylaxis during the winter, particularly July? Any thoughts?
We are going to Leopard Hills in April and not decided whether to take anti-malarials or not. What is putting me off is that I have read that they can cause nausea and as you do have to take them before you go and during the visit and afterwards, the thought of having nausea really is putting me off. I know the risk should be first and foremost in my decision, but just the thought of feeling nauseous is really puting me off. I have a good pain threshold but when it comes to nausea I just cannot cope with that.
Do any of the anti-malarial treatments not have any side effects?
Is Leopard Hills in a low or high risk malaria area?
I would strongly, strongly recommend taking anti-malarials. I travel to Africa annually and take them without fail. Malaria is not a trivial disease, and low risk (during the dry season -- from late June through the end of October in most Southern African countries) is not the same as no risk. You can (and most likely will) be bitten by mosquitos even if you travel during the dry season, so taking precautions is still important. Mary-J, the Sabi Sands is a high risk malarial region (this is actually one of the main reasons why the area was never turned into farmland) and as you will be there in April you are not travelling during the lowest risk time of year.
If you haven't already done so, I would recommend consulting a travel medicine specialist. The most important factor in determining which anti-malarial will suit you best is your medical history, so you need to sit down with an expert who can determine what will work best for you. If you are particularly worried about side effects you can arrange to have a medically supervised drug trial -- this means taking the drug while under a doctor's supervision so any side effects can be monitored. You should do this a few weeks before you travel so you can switch to another drug if the first one doesn't agree with you.
Whatever drug you take, make sure that you take the entire course (including the part which you need to take before and after you enter the malarial region). If you don't do this you won't be deriving the maximum protection from the drug.
Finally, don't forget that half of malaria prevention is trying to avoid being bitten in the first place. This means using insect repellent and covering up at dusk when the malaria-carrying mosquitoes come out to bite.
This is an important topic for travellers in Africa and other malaria-infested areas. Julian's comments are thoughtful and prudent. I would suggest that you make sure you meet with a tropical disease specialist to discuss your situation, background and needs as most family doctors are unfamiliar with the nuances of malarial drugs and areas of greatest need and cloroquine resistance.
As the director of my college's interntional development centre, I travelled to West Africa more than 25 times and, thankfully, never acquired malaria. Over those years I tried most mainstream prophylaxis and had to advise interns on their options. Here are a few notes from my experiece.
Avoid Lariam. Developed by the US Army during the first Guld War, it only has to be taken once a week, but the psychological side effects can be severe, ranging from anxiety and insomnia to outright psychosis. I used it several times before I began to react; the sleeplessness and anxiety were pretty awful. Colleagues had similar experiences, and the high percentage of patients experiencing moderate to severe psychological side effects has been pretty well documented.
Malarone is a newer drug and is my prohphylaxis of choice. The drawbacks are that it has to be taken daily and is quite expensive. I know of few side effects with this drug. In some cases where field workers are in malarial areas for long assignments, they are eschewing a regular prophylaxis and using a higher dose of Malarone at the first sign of malaria. A little risky, but it does eliminate the long-term side effects, and is an option where malaria is relatively uncommon.
Doxycycline, an older antibiotic, is cheap and often ignored as an alternative. Apparently the drug messes with the parasite's DNA so it cannot reproduce. Though taken daily, the only major side effect is increased sun sensitivity. (I once got a second degree burn on my neck after spending a day on a beach in Ghana.)
And don't forget the old chloroquine drugs. Cheap and effective where the parasite has not developed a resistance, it is still used as a treatment by most of my African friends. Check out the area you're going to before assuming it is a chloroquine resistant region.
I echo Julian's comments that the best prophylaxis is to avoid being bitten in the first place. Avoid going out in the evening, wear long sleeves, and use a good DEET insect repellent.
