Avoiding Mosquitoes And The Diseases They Transmit

Don’t be their next meal!

Mosquitoes are not only annoying, they can be dangerous to your health!  When we got back from Indonesia, my husband got really sick and had to be hospitialized with malaria for 5 days.  I was even more surprised to find out he also had dengue fever on top!  Thankfully he is fine now, the malaria was cured with proper treatment and the dengue went away in due course.  Oddly enough, I managed to get off practically scot-free with only a cold and a cough that lingered a few weeks and went away eventually.  Yesterday, another blogger, Stacy of Very Good Points reported getting dengue after a trip to Thailand.  For those who can see Australian TV, there was a segment on Today Tonight yesterday about mosquito-borne diseases in Australia.  In many cases, the victims tend to mistake these mosquito-borne diseases for the flu and only find out it’s something worse when they get tested by the doctor/hospital.  Dengue is also present in northern Queensland.

AVOIDING MOSQUITOES

The best thing to do is to avoid being bitten.  Here are some suggestions on how to do that.

  • Cover up with long, loose fitting clothing of sufficient thickness to prevent mosquitoes biting through the fabric. (This is what my husband did wrong, he insisted on wearing shorts and a singlet because West Papua is hot.  I covered up.)
  • Avoid exposure outdoors when mosquitoes are most active. (This one is hard to do if you are a birder as you pretty much have to be outdoors at dusk and dawn.)
  • Use an insect repellent containing DEET or Picaridin (the most effective repellents contain 5-20% di-ethyl-N-toluamide or DEET) on exposed skin. Apply in accordance with the manufacturer’s instructions. Avoid using on babies and toddlers.
  • Use flyscreens and mosquito nets in accommodation where there are no flyscreens, especially for babies. (This is particularly important when camping out, as repellents are only effective for around four hours.)

EXTRA PRECAUTIONS TO PREVENT MOSQUITO-BORNE DISEASES

Dengue – there are no vaccinations or pills you can take to prevent this.  The best thing to do is avoid being bitten.  For more information, see the CDC page on Dengue.

Malaria – Malaria in humans is caused by 1 of 4 protozoan species of the genus Plasmodium: Plasmodium falciparum, P. vivax, P. ovale, or P. malariae.  My husband had the P.vivax one.  For more information, see the CDC page on Malaria.

There are several different pills you can take, and also follow the advice to avoid being bitten.  You will need different pills for different geographical regions depending on which strains of malaria are present so check on the CDC page to see which ones you will need.

Drug Reasons that might make you consider using this drug Reasons that might make you avoid using this drug
Atovaquone/Proguanil (Malarone)
  • Good for last-minute travelers because the drug is started 1-2 days before traveling to an area where malaria transmission occurs
  • Some people prefer to take a daily medicine
  • Good choice for shorter trips because you only have to take the medicine for 7 days after traveling rather than 4 weeks
  • Very well tolerated medicine – side effects uncommon
  • Pediatric tablets are available and may be more convenient
  • Cannot be used by women who are pregnant or breastfeeding a child less than 5 kg
  • Cannot be taken by people with severe renal impairment
  • Tends to be more expensive than some of the other options (especially for trips of long duration)
  • Some people (including children) would rather not take a medicine every day
Chloroquine
  • Some people would rather take medicine weekly
  • Good choice for long trips because it is taken only weekly
  • Some people are already taking hydroxychloroquine chronically for rheumatologic conditions. In those instances, they may not have to take an additional medicine
  • Can be used in all trimesters of pregnancy
  • Cannot be used in areas with chloroquine or mefloquine resistance
  • May exacerbate psoriasis
  • Some people would rather not take a weekly medication
  • For trips of short duration, some people would rather not take medication for 4 weeks after travel
  • Not a good choice for last-minute travelers because drug needs to be started 1-2 weeks prior to travel
Doxycycline
  • Some people prefer to take a daily medicine
  • Good for last-minute travelers because the drug is started 1-2 days before traveling to an area where malaria transmission occurs
  • Tends to be the least expensive antimalarial
  • Some people are already taking doxycycline chronically for prevention of acne. In those instances, they do not have to take an additional medicine
  • Doxycycline also can prevent some additional infections (e.g., Rickettsiae and leptospirosis) and so it may be preferred by people planning to do lots of hiking, camping, and wading and swimming in fresh water
  • Cannot be used by pregnant women and children <8 years old
  • Some people would rather not take a medicine every day
  • For trips of short duration, some people would rather not take medication for 4 weeks after travel
  • Women prone to getting vaginal yeast infections when taking antibiotics may prefer taking a different medicine
  • Persons planning on considerable sun exposure may want to avoid the increased risk of sun sensitivity
  • Some people are concerned about the potential of getting an upset stomach from doxycycline
Mefloquine
(Lariam)
  • Some people would rather take medicine weekly
  • Good choice for long trips because it is taken only weekly
  • Can be used during pregnancy
  • Cannot be used in areas with mefloquine resistance
  • Cannot be used in patients with certain psychiatric conditions
  • Cannot be used in patients with a seizure disorder
  • Not recommended for persons with cardiac conduction abnormalities
  • Not a good choice for last-minute travelers because drug needs to be started at least 2 weeks prior to travel
  • Some people would rather not take a weekly medication
  • For trips of short duration, some people would rather not take medication for 4 weeks after travel
Primaquine
  • It is the most effective medicine for preventing P. vivax and so it is a good choice for travel to places with > 90% P. vivax
  • Good choice for shorter trips because you only have to take the medicine for 7 days after traveling rather than 4 weeks
  • Good for last-minute travelers because the drug is started 1-2 days before traveling to an area where malaria transmission occurs
  • Some people prefer to take a daily medicine
  • Cannot be used in patients with glucose-6-phosphatase dehydrogenase (G6PD) deficiency
  • Cannot be used in patients who have not been tested for G6PD deficiency
  • There are costs and delays associated with getting a G6PD test done; however, it only has to be done once. Once a normal G6PD level is verified and documented, the test does not have to be repeated the next time primaquine is considered
  • Cannot be used by pregnant women
  • Cannot be used by women who are breastfeeding unless the infant has also been tested for G6PD deficiency
  • Some people (including children) would rather not take a medicine every day
  • Some people are concerned about the potential of getting an upset stomach from primaquine

 

  • For Americans: Malarone is pricey, but worth it. If you have a Flexible Spending Account for health expenses, you can use your FSA for Malarone purchases. Also, it makes sense to research the price online since there’s a lot of variation. I actually found an online coupon for Malarone last time I needed to buy it and saved a nice chunk of change.

    • Malarone is crazy expensive in Australia. $62 for 12 tablets (no concession)! Doxycycline is $14 ($6 concession) for 28 tablets so big difference! We will be in Central America for 16 days so we need either 24-25 Malarone (7 days after trip) so $124 or 46 Doxycycline (28 days after trip) so since we get concessions it’s $12.

      • The Larium makes gives me vivid dreams which I don’t enjoy (some people do). I’ve never tried doxy, but I’ve always been worried about the increased sun sensitivity side effect. So it’s Malarone for me… I do have to budget for the expense.

        • Vivid dreams, huh? 😉 Just kidding!