We are leaving for our big trip to India in 2 weeks. My 16 month old son is going with us also. His pediatrician gave him Mefloquine 1/4 tablet once a week! I took this when I went to India about 5 years ago and I got really ill! In fact I was so ill the day of our flight that I had to see a doctor in emergency to give me a shot to make me feel good enough to get on the plane! Nuts! Anyhow needless to say I stopped taking them and I didn't take it 2 years ago when I went either. So this is my 3rd trip in 5 years.

Okay so now the question! I don't know what to do with my son!? Should I give it to him and risk the side effects or just do all the preventative stuff like long sleeves+DEET+hat and shoes at all times! So the only part that would be exposed would be his face and hands!

Anyhow have any experience with giving a child mefloquin? I'll be predominately in Punjab (Jullundhar) and we may go to Pakistan for 5 days and maybe stay in Delhi at the end of Nov for 4 days before coming back home! Any thoughts? So I'll be there from Oct 16-Dec1.

Thanks in advance,

CP

I am also going in that region, and am not taking any malaria pills for my kids. We got the necessary shots for typhoid and Hep A and some Ducerol for traveler's upset stomach. During the winter months malaria will be of less concern. Good luck

I would not suggest taking anything if you are going to India and staying at decent accomodations. Just bring about a bit of mosquito repellant.

Anti-malarial drugs often had side-effects .... including some of the nasty, near-term kind. I've seen plenty of 1 year to 12 year olds go from the US and UK to India and never have an issue due to such things. The bigger problem is related to what they eat/drink, heat stroke, or pollution/dust-related issues.

My wife and I have travelled to Delhi with our daughter twice-- once when she wasn five months and then when she was ten months (this was in May). Her Paed, who is also Indian, didn't recommend taking anything other than her regular shots, in order to avoid any side effects. Having grown up in India ourselves, both the wife and I don't really make too big a deal of these issues.

I've had malaria thrice living in Mumbai and still wont receommend taking anti-malarial as a preventive measure.

Why

*The side effects are bad. Your liver is under massive trauma when taking these
*If you child happens to catch malaria, it will go unnoticed and surface only later in a very late stage
*taking the usual precautions (proper clothing, moskito net at night, repellents both on usually effected parts and on in the room) is sufficient

How do you get it three times? My father-in-law has malaria - he got it during WWII - and has had it ever since. Just curious as I've always heard that you basically have it forever, although the frequency of symptoms lessens over time. Or is it that different strains effect one differently?? You've got me cuious.

As an aside, Tim Cahill wrote a very funny essay called "My Malaria", which details what having contracted the disease has done to him. Again, he writes about it as being a reoccurring illness that one doesn't get rid of.

Edited because I just did some reserach to answer my own question ... apparently there is a strain that can be cured. Some, however, can't be.

Still, as I said in the duplicate thread to this one, I encourage the OP to ask her pediatrician about Malarone. It has so far only be shown to cause liver damage when taken by dogs and rats in dosages far over what would be prescribed to a child or adult. It also has been shown in tests to have no more side effects than the placebo the other group was given, and it comes in pediatric doses. It's very expensive compared to the older malaria drugs, but everyone in my family certainly found it worth it as there were no side effects. I can put a link to a $20 off coupon if you'd be ordering more than 23 pills. Regular price is about $7-9 a pill, but purchased at Costco it's about $5 a pill and the rebate helps that much more. Off to pick up another prescription now ...

Well, this is an older thread, but... there are so many myths about malaria... ALL forms of malaria can be cured, but... (I've had recurrent vivax, as well as dengue and chikungunya fever over the years. Bleagh! is all I can say, and I hope I have learned better.)

Malaria is transmitted by mosquitoes of the genus Anopheles, most of which are night-biters, which is why bednets at night are important, as well as long sleeves and trousers, used with repellent* on exposed areas - but in some locations, such as Vanuatu and Papua - New Guinea, there are species of Anopheles that are active during cloudy days. Malaria is thought to be avian in origin (shades of avian flu HN51!) that mutated to infect humans; there are many varieties of avian malaria.

There are several kinds of malaria: Plasmodium vivax and and P. ovale are the recurrent ones, and they are not anywhere nearly as dangerous as the worst, chloroquine-resistant falciparum malaria (P. falciparum is the specific organism involved with this one, and infection with CRFM can be fatal.) CRFM is resistant to most common drugs used for malarial prophylaxis, and seems quite adept at mutating to deal with newer drugs - Mefloquine (Lariam) was recommended to me by a physician for a trip to PNG, for example, but when I was there I found that perhaps 30% of CRFM was occurring already to people using Mefloquine as prophylaxis. (I eschewed using it anyway, as Mefloquine has some nasty side effects - and sometimes mimics decompression illness, not good for divers.)

I used to get my Malarone (atovaquone/proguanil) in the UK, NZ or Australia before it was approved for US use. When traveling to places with CRFM during dry season, staying offshore on a liveaboard dive boat (PNG,) etc. and the risk is lower for contracting malaria, I take Malarone with me, and use it presumptively to treat malarial symptoms (no, I have never had to use it.) That way I have a very effective medication that has few side effects for most, yet I am not contributing to the problem of a rapidly mutating organism's resitance to this new and very effective drug.

Artemisin, first identified and long-used in China is a natural product of Artemisia annua, or sweet wormwood (absynthe makes the heart grow warmer? not really, that's A. absinthium...) is also supposed to be most effective, is being synthesized by several pharmaceutical firms and is in trials in several CRFM-infested part sof the world (such as East Africa.) If they pass tests and approval, there soon may be a low cost alternative to malarone and others.

*Repellents (the CDC information in the malaria section is not well updated yet.) DEET up to 30% (more is not better, and DEET has some problems of its own, especially with children and infants,) lemon eucalyptus oil (30% is good) and picaridin (not quite as long-lasting,) are all approved for use against mozzies. Avon skin-so-soft, citronella and the like are not recommended unless you want to be the Guinea pig - they seem to work against some biting insects, not others.

Useful sources for information include:

IAMAT - the International Association for Medical Assistance to Travellers in Canada has excellent information on malaria and other diseases, plus members get a booklet with screened worldwide physicians who also agree to set fees.

CDC malaria pages - Centers for Disease Control and Prevention. Similar information is available from UK, Australia, Canada and other countries' health organisations.

Caveat: I am not a physician, and I do not give medical advice. I do travel to CRFM areas including southern and east Africa, PNG, Vanuatu... and prefer to be informed and prevent malaria for me and mine.

I too am not a physician but married to one. There are also a lot of physicians in the family with some of them practising medicine in India. I have also traveled extensively with young kids in India and other mosquito infested areas. The following are solely my opinions and not from any authority.

Avoiding mosquite bites is still the best prevention. The under-rated solution is using mosquito nets in places such as India and Africa. If you're traveling with a small infant, there are travel ready nets that fits small cribs, hotel rollaways, etc. I would use them on an airplane as well. In addition to nets, we use long sleeved shirts and full length pants for our children. We buy soft, comfortable cotton or cotton blends specifically for this purposes. Our children have found them acceptable even in the warm climates of India, Africa and Mexico while being protected from mosquito bites. Despite being organic granola eating Californians, we've used DEET based repellants. We make sure that we spray on the clothes as recommended (avoiding exposure to eyes, face, and palms) and pay particular attention to neck and the areas behind the ears (mosquitos seem to like that). Our kids tolerate and actually prefer air currents, so we always use the airconditioner AND a ceiling or a table fan.

I feel guilty about the wasted resources, but to protect children, we make sure that the room is cold (mosquitos don't seem to care so much for the cold temp) and then cover them in full sheets (mosquitos can bite through light sheets).

Nowadays, for slightly older kids, malaria prevention is being recommended. Discuss with your physician and the recommendation on this has been updated extensively in recent years. I use my family physician as sometimes they are more up to date than pedeatricians on general infectious disease issues.

The preventive medications make the blood inhospitable for many parasites carried by the mosquitoes. It is important to take the medicine as recommended (starting before arrival, and in many cases for weeks after return).

Sometimes, when I am on a short trip, I don't take any medications. CDC site has a list of medications for different countries, side effects, FAQ, etc.

enjoystravel, you have some good ideas there - low temperatures inhibit activity in practically any ectothermic ("cold-blooded") species, whether they be insects, reptiles or amphibians.

Prevention is much easier, cheaper and less life-threatening than after-the-fact treatment. Clothing, heavier sheets, bednets serve well as physical barriers, and tested repellents for topical application (DEET, lemon oil eucalyptus and picaridin, according to the US Centers for Disease Control and Prevention, as of May 2005,) and permethrin for application to clothes, etc. (not topical!) are very useful.

Medical prophylaxis I have found one has to be a bit more circumspect about. Some physicians are very aware and well trained, but in places where diseases like arboviruses or insect-borne diseases are little known, it is best to check with qualified travel physicians, clinics or public health entities. I still see some prescribing outdated medications, or in developing nations those (like halofantrine / "Halfan") which are contraindicated completely by better trained health professionals. Others prescribe inappropriate medications (Mefloquine, for example, for people with some history of depression, divers, etc.) because they are not up to date, or because they are thinking of one location, not the one the traveler is headed (like the Peace Crops volunteer I met who had been in hospital three times with CRFM because he was prescribed Lariam, which is not very effective for those residing / working in lowland PNG.)

In a number of developing nations it is not uncommon to find physicians prescribing useless medications - multiple-antibiotics for colds or other viruses, for instance - or medications being sold without requirement for a prescription by "pharmacists" ("chemists," in most English-language speaking countries,) who do not meet training standards established for licensing in the US, Canada, the UK, Australia... (I have to admit when I was 12 and began working between and after school, I was charged with compounding medications in the pharmacy - not in the USA - where I worked, once I had been there long enough to become a known entity - think about that, folks, a pre-teen or teenager measuring, blending and packaging medications you would use to prevent or treat a significant disease, while his supervisor takes a break or is involved with other work! If that concept frightens you a little bit, good, it will wake you up.)

The CDC is indeed a good place to check - as well as the previously mentioned IAMAT. Talk to a qualified and up-to-date health professional - ignorancer or giving up is not a great idea; the owner of the The Ark in the Aberdares NP in Kenya died of cerebral CRFM malaria because he decided the risk wasn't high enough to use proper prophylaxis; he either became blas� or careless, the result was the same.

India is one of those places where location, climate and season make a big difference. Check it out before you go, fellow FTers, because as enjoystravel indicates, it's often not only you it's about. And follow instructions of whatever you and your health professional choose to the "T."

I love travel, but I like to manage my risks... see you there!

Okay since I posted the question about malaria awhile ago and have been and back from India with my son I thought I'd post an update for others that were in my situation.

I did end up giving him Mefloquine and he did absolutely fine. Not to mention it really gave me peace of mind. Mosquitos were very prevalent when we first got there in mid-october but then started to taper off as the weather got cooler...they were still there but not as many.

Things I learned...always used DEET or some other natural mosquito repellent, always wear long sleeve shirts, pants, socks and shoes while outdoors, wear light colored clothing. I took some bright shirts for my son such as red and yellow but I didn't end up wearing them since they would be a major attractant to the mosquitos. He did get bitten a few times when we first got there but the fact that he was on the meds really gave me peace of mind.

We also used the good night mosquito oils in every room in the house and since it was indoors it wasn't bad. I guess thats it! I hope that info can help someone please feel free to ask me any questions if you want more info.

CP

Thanks much for the update. That's exactly the kind of input/ feedback that makes this website such a great resource.

You are right that peace of mind is most important, so I am glad you could find it in the medication that you provided your son.

I am leaving for India tomorrow for our annual family visit, and my one and a half year old daughter will be making her third trip back to her parents' hometown. Concerns of potential ill-health are not utmost in my mind as India is not unchartered territory for me. Most of my daughter's cousins are now growing up in India and I can look forward to the best possible medical care, that they receive, for my child in case something afflicts her there. I do, at times feel a bit under-privileged, here in New York, when my daughter has, for instance, a bout of stomach flu and the best I can do is reach her doctor's messaging service or take instructions on what to do by her front desk person, based on whatever the latest bug is that is doing the circles. I take comfort in that I shall, when needed, speak to an experienced Paediatrician in case my daughter does need it, when in India.

While no doubt prevention is the best medicine, based on my own life experiences, I don't foresee any such concern for myself and the family-- and I shall be quite at peace without such precautions.

Glad to hear that you had a great trip to India. Thanks once again for your update.

I have used those mosquito coils in the Americas, Asia and Africa... without any ill effect. However, I do want to warn people about the "Fuma-Killa" tablets one puts on a mini-hotplate: these produce some very nasty fumes, and even those without notable allergies or respiratory challenges like asthma can have a nasty time with these. Fuma-Killa, indeed...