Malaria and bowel disease

[pebbles22]

Hi Doctor,

I am a 35 year old female,  who for the past 5 years has suffered with mild proctitis and IBS and upper GI discomfort (dyspepsia).  My proctitis has improved significantly throught careful diet and keeping my stress levels low. However I still have regular daily bouts of tummy pain. My  question is this:  I am travelling to the Kruger National Park (SA) in July for one month to work alongside a wildlife ranger, I am a bit concerned about the malaria vaccine and if/how it might affect my gut, if it is absolutely necessary to take it, and if so what would be the most suitable one for  me?I also might addthat I am a bit anxious about taking as I have heard of someone hallucinating on it!. and I can get quite anxious.  What would you advise?

Many thanks

Joan

[Philip D Parks, MD, MPH, MOccH, FACOEM]

Great comments Sarikate!

Like Sarikate mentioned, there is currently no FDA approved malaria vaccination for travelers. There are malaria vaccinations that are being investigated in clinical trials but these vaccinations are not available and are only used in clinical trial settings.

That being said, you have several options for malaria "prophylaxis" - or prevention. A couple important facts: No malaria prophylactic medication is 100% effective and it is extremely important that you try to minimize insect bites by covering up with clothes and by applying insect repellent that contains at least 30% DEET (you can purchase this at any outdoor store--REI, EMS, Bass Pro Shops, ****'s, etc).

As for malaria prophylaxis, you have three choices of the usual four choices. You have three choices because there is resistance to one of the medication options--chloroquine is not considered to be an effective anti-malarial for South Africa.

Based on your history of gastrointestinal problems, I would not recommend doxycycline. Doxycycline works well but can cause sun sensitivity and can cause esophageal reflux (~ heart burn or indigestion). Now, we are down to two choices. First, malarone (atovaquone + proguanil). Malarone is taken daily, begun one day prior to arriving in a malarious area, taken every day while exposed to malaria, and then for one week after you leave the malarious region. Malarone is very well tolerated and generally does not cause gastrointestinal problems. Second, Mefloquine (or Larium) is a once weekly medication. Mefloquine has received some attention because of "psychiatric" side effects and also has been associated with vivid or potentially frightening dreams. Mefloquine is taken 1 week prior to arriving in a malarious region, every day while in a malarious region, and then for four weeks after you leave the area.
In general, Mefloquine is usually well-tolerated but can cause mild gastrointestinal side effects (upset stomack, abdominal pain, etc) according to the patient information package insert. With regard to the psychiatric side effects and possible effects on sleep and dreams, the usual guidance is that people with anxiety, depression, other types of mental illness, and those that have frequent nightmare should consider alternatives to mefloquine.

I recommend that you be seen by a travel medicine specialist about 8 weeks prior to your trip so that you can make the best choices on how to be as safe and healthy as is possible on your trip. You should ask specifically about self-care for traveler's diarrhea in the context of your on-going gastrointestinal symptoms.

Other recommended vaccinations: Hepatitis A, Typhoid, MMR, Tetanus, and consideration of Rabies vaccination, Polio Booster.

You should not need Yellow Fever vaccination for entry into South Africa as long as you are entering from a country that does not have Yellow Fever as an endemic disease. The CDC website is useful for checking if you will need proof of the Yellow Fever vaccination depending on what country you will be arriving from.

I hope that this is helpful.

Links:
1. http://www.sanparks.org/parks/kruger/tourism/malaria.php
2. http://www.mdtravelhealth.com/destinations/africa/south_africa.html
3. http://wwwn.cdc.gov/travel/destinationSouthAfrica.aspx

~•~ Dr. Parks

This answer is not intended as and does not substitute for medical advice. The information presented in this posting is for patients’ education only. As always, I encourage you to see your personal physician for further evaluation of your individual case.

[sarikate]

I am a fellow member on this board and have traveled in Africa doing wildlife studies, so I thought I'd chime in - there is currently no malaria vaccine, so you must be talking about malaria prophylaxis.  One of the drugs used is called mefloquine, also called Larium.  It is pretty effective but does cause some psychiatric side effects in people.  There's another, newer drug called Malarone, which is a combination of atovaquone and proguanil.  Malarone reportedly has fewer side effects than Larium.  Hopefully Dr. Parks will be able to further expound on this.  Just as an aside, you might want to consider taking a strain of probiotics (such as Bifidobacteria and Lactobacillus species) while you are traveling, especially with your history of IBS, because this can reduce the incidence of traveler's diarrhea.  Good luck.