As a general rule we prefer not to take prophylactics against malaria; the side effects are such that we try to avoid them. However there are one or two areas where we think the risk of getting malaria warrants their use. The good news is that there aren't many places that fall into that category, and for most cruising, you can avoid taking medication.

Prevention

As a cruiser you are probably at greater risk of a mosquito (or sand fly/no-no fly) bite becoming infected and at worst causing a leg ulcer than you are of catching malaria. Mosquitoes also carry dengue fever and Ross River fever, both of which are unpleasant and can be dangerous for children or people with particular medical conditions. So prevention against bites is important whether you are in a malaria area or not.

Bug screens significantly reduce your risk. We use them all the time, wherever we are, because we simply do not like being bitten. They are fitted over all of our hatches and we have a bug screen that replaces the wash boards. As an added precaution you can wipe down the nets with Permethin or spray them with insect repellent. Mosquito sleeping nets work fine for when you are sleeping but do not protect you while you are awake, so we prefer our hatch covers. To protect us in the cockpit we burn citronella candles and use a bug spray. When ashore we use the bug spray, and if necessary, wear long trousers and long sleeved shirts.

The problem with bug sprays is that the most effective ingredient is diethylmethyl benzamide/diethytoluamide (DEET for short) and it is very harsh on your skin. It is particularly an issue with extended use. It is possible to buy products with a very high concentration of DEET and they are highly effective but very bad for your skin. (In a toiletries bag a leaky bottle of Bushman - a high concentrate DEET - melted a plastic disposable razor in the course of a few hours!) Alternatively, kinder products using lower concentrations of DEET or relying on citronella or eucalyptus are not as effective. So we carry more than one type and use whichever is appropriate. For example, if we want to visit a mangrove swamp at dawn or dusk to see the wildlife, we'll cover up with clothes and use a strong bug spray, washing it off as soon as possible.

Prophylactics

Whether or not to take prophylactics is entirely a personal decision. The two factors we take into account are:

1) Level of risk. Each area is graded high/med/low by the WHO and other medical organizations. Beware using information aimed at conventional tourists, as the assumption is that they will spend their time in specific areas that may have been sprayed, and will stay in air conditioned hotels. For example, Port Villa in Vanuatu is the capital and the location of all the hotels, and is considered risk-free. The outer islands and villages, however, are rated high risk.

2) Type of malaria. All malaria is bad, but some types are worse than others, by which we mean some can kill you. We take the latter more seriously and add that into the equation when deciding whether or not to take a prophylactic.

On the basis of these two factors, we did take malaria prophylactics (doxycycline) when we cruised Vanuatu (see our SetSail article dated 05 Oct 01) as did many cruisers, but some cruising friends who were taking Lariam felt so ill that they stopped and curtailed their time in the area.

To some extent the type of prophylactic you take is determined by the area you are cruising as mosquitoes have developed resistance to certain drugs. However where there is a choice we prefer to take low dosage (e.g. doxycycline) as the immediate side effects are usually less. The disadvantage is that you have to take one every day instead of one a week. Also some prophylactics (e.g. lariam) have side effects that mimic the effects of DCS (the bends), so you should not take it if you do any scuba diving.

Also bear in mind that none of the prophylactics are a 100 percent guarantee against malaria, so you still need to take preventative measures.

Information Sources

There are several excellent web sites that provide information on the malaria risk by location, including the type of malaria prevalent, and the prophylactics recommended for each area/malaria type. A few that we have found useful are:

www.cdc.gov/travel/diseases
www.expat.or.id/medical/malariaupdate.html
www.pol-it.org/malaria.htm

Most countries also have a tropical medicines advisory and they are worth contacting as they tend to have current information about areas within their geographical region (e.g. New Zealand is good on the Pacific islands, Australia on Asia etc.) Local doctors tend not to have sufficient depth of knowledge and rely upon guides for tourists, which are not necessarily appropriate to cruisers.

Detection and Cure

The symptoms of malaria are similar to the flu, so if you feel you have those symptoms, get to a doctor/hospital as fast as possible. The sooner you start treatment, the better.

The first part of the cure is to take a large dose of whatever prophylactic is recommended for that area, so it is important for the doctor to know if you are taking any already.

Whether or not we are taking prophylactics, we carry supplies on board. If one of us were to run a high fever, which we suspected of being malaria, we could then take a high dose of the medication, so as to start treatment immediately, while we hastened to proper medical services. We also carry quinine to take if we get malaria symptoms while taking doxycycline.

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