MALARIA AND PREVENTION BY NAMRU

MALARIA AND PREVENTION
by
NAMRU (NAVAL MEDICAL RESEARCH UNIT)
(UNDER THE AMERICAN EMBASSY)
TEL.: 421 445763

NAMRU which among other diseases researches Malaria in Indonesia, confirms that there are risks of Malaria in most national parks an tourist destinations in Jambi Province, Indonesia, and it is therefore recommended to use either prophylaxis or other means of protection (long sleeved shirts, long pants, socks and lots of mosquito creams).

In most parts of Indonesia, the malaria mosquitoes are Chloroquine resistant, which means that Chloroquine drugs won’t give you enough protection.

The following prophylaxis have been recommended by NAMRU:

1. DOXYCYCLINE – 100 mg, also known under its short name DOXIN. This is a very strong antibiotics, that works well, and it is easily available at local pharmacies.
MUST be avoided if pregnant, If in doubt about pregnancy, please have a test made first. Also not recommended for children below 8 years of age.
When using Doxycycline make sure to apply appropriate sunscreen during day time to minimize the possibility of a photosensitivity reaction, which is a side effect of this medicine. As with other antibiotics, candida vaginitis is a frequent adverse effect.
This medicine should be taken with food for optimal effect. Take a tablet and eat immediately afterwards, and make sure to drink enough water to wash it down.

DOSE: The Doxycycline should be the 100 mg. per tablet. Take one tablet one day prior to travel, and then continue to take one tablet each day throughout the duration of stay in Malaria area. Continue for at least three weeks after returning to non-Malaria area. The official recommendation is four weeks after returning, but according to NAMRU three weeks should give you enough protection. MAKE SURE that you remember to eat this medicine each day, as a day of “not eating the medicine” will bring you right back to the start of the course. Doxycycline flushes out of your system very quickly, so for optimal protection, you just cannot skip a day. IT MUST BE TAKEN EVERY DAY!!

2. MEFLOQUINE:  This drug is generally not available in Jakarta drug stores, but major embassies hold stocks for their nationals. MUST be avoided if pregnant or in doubt about pregnancy. Not recommended for children weighing less than 15 kgs. Also not recommended for patients taking beta-blockers, calcium-channel blockers or other drugs that may prolong or otherwise alter cardiac conduction. Patients with a history of seizure or psychiatric disorders and those whose occupation requires fine co-ordination or spatial discrimination should avoid Mefloquine.

DOSE: One tablet on day one, one tablet on day two and one tablet on day three during the trip to Malaria area. Thereafter one tablet per week for four weeks after returning to non-Malaria area.

3. PRIMAQUINE:  30 mg per day. Most tablets contain 15 mg, so you must take two tablets per day. Make sure that you are able to take this medicine as some people won’t be able to take it. People should take a test for G6PP (blood encyme) to make sure that they can take the medicine. If urine turns dark (without testing for G6PP) STOP taking PRIMAQUINE. Try to get the PRIMAQUINE produced in Singapore.

DOSE: Take one tablet on the first day in Malaria area. Then one tablet each day spent in Malaria area. Continue to take 1 tablet each day for 3 days after leaving Malaria area.

4. MALARONE:

DOSE: Take one tablet one day before travel. One tablet per day during travel and  one tablet per day for 4 weeks after returning from travel to get protection also against the VIRAX Malaria, which is very prevalent in Papua.
   
Even though you protect yourself with one of the above  drugs and/or  repellents, there is always a risk of getting Malaria. Remember to protect yourself against mosquito bites by using long pants, long sleeves and mosquito repellent as well. The “Virax” Malaria can relapse several  months  after you return from a Malaria area, although it is quite rare. The medicine to cure this is Primaquine, but you need a test to be done first. If you have this problem, please contact NAMRU for evaluation.