Malaria Protection for Travel

Archived Q&A and reviews ▼

Archived Q&A and Reviews

Questions

Guatemala travel - malaria drugs needed?

April 2009

My 21 year old son is in Guatemala volunteering for 5 weeks. His campus health center fully vaccinated him for everything, including a prescription for malaria. My daughter(25) and I are going to visit for 9 days.Some websites recommend we take malaria medicine. The three of us have all been to Africa and fully protected against malaria, so I'm somewhat educated on these issues. EVERYONE takes it going to Africa! However, the travel doctor cost and malaria medicine is quite prohibitive (health ins. does not cover) & I know of no cheap ways around this. I know SO MANY people who have gone to Central America without this that I am not convinced it is necessary for a visit of 9 days. Any advice? Any info on getting a prescription that is a reasonable price? Is it really necessary for 9 days? trying to be safe but cost conscious too safety conscious but cost conscious too

Try the Overseas Medical Center in San Francisco for a low-cost option. This place is NOT fancy (read - hole in the wall) but I have gone there numerous times for vaccinations for overseas trips when my insurance didn't cover the costs.

49 Drumm St
San Francisco, CA 94111-4805
(415) 982-8380

I always err on the side of caution and did take malaria pills when I was in Guatemala and Belize - 9 days or 1 month, it only takes one mosquito infected with malaria.... I've had a very good friend here contract malaria on a trip and it was a nightmare to get treated here since it is not seen very often in this part of the world. anon

I've travelled extensively in Latin America (Central and South) and I spent two summers in Ecuador. I have sometimes taken anti-malarial meds. The travel clinics here ALWAYS recommend them, but I only took them if there was actual malaria in the areas I was traveling in. If there was little malaria, I didn't take the drugs. I say try to research the specific area(s) you will be in. If malaria is present, take the drugs, if not, you could skip them. I know many graduate students who got malaria in Africa, but only one in Latin America (in Belem, Brazil). Not a doctor

For Guatemala, it depends on what areas you plan to visit during your time there. If you're going to the lowland, coastal areas (at sea level or below 3000 ft) for an extended period of time, it's recommended that you take malaria medication. If you're staying in the cities, like Antigua, Guatemala City, or Quetzaltenango, you should be ok without medication. Have you checked the CDC website?

In the past, I've used a travel clinic on Telegraph Ave. in Berkeley. I can't remember its name, but you could try there if you want to buy the medication out of pocket. Lisa 

You're already paying for two excellent and official websites:

Center for Disease Control http://www.cdc.gov/malaria/

State Department http://travel.state.gov/travel/cis_pa_tw/cis/cis_1129.html

Just keep monitoring them, since things do change.

Don't Reinvent the Wheel 

Doxycycline is dirt cheap. Is your travel doctor telling you that it won't work in Guatemala? The fabulously expensive newer drug (malarone?) does have fewer side effects, but if doxycycline will work on the mosquitoes in that area, I would take it because it costs literally pennies per day. If you are going to be near good medical care, you might want to take your chances (just use really good preventative measures) and just go to the doctor at the first hint of anything wrong. One other hint, get your doctor to write the two prescriptions as if it is one prescription for one person (I am assuming you are paying out of pocket, I am NOT suggesting insurance fraud here). Then get it filled at Costco. By combining the two prescriptions, you can get a bulk discount. Better safe than sorry . . .

You need to worry about Malaria in Guatemala only once you 
leave specific areas. Guatemala City and Antigua are safe. I 
think Montericco and Tikal as well but you can check with your 
travel clinic to make sure.  (this is a reply posted to another question in 2004) 

Yucatan with a 1 year old - risk of malaria?

Sept 2004

Hi, we are planning to travel to Yucatan, Mexico (Merida, Playa Maya) in January with our 1 year old daughter. Her pediatrician says there is risk of malaria because of the jungly area (we will probably stay at the beach but are planning to visit some maya ruins). And she will not quite be 24lbs by then, which is the requirement for the malaria vaccine. Does anyone have experience travelling to this area with a 1 year old (without being vaccinated?). In addition, are there any other preventive measurements we can take (e.g. mosquito net)? Or would you recommend not taking her to this destination yet? Any additional information regarding this will be helpful. Thanks, Padminie

We just got back from one week in Merida and one week just north of Tulum with our two and three year old. We all took the malaria medicine, but here was our actual experience of the mosquitos, plus the feedback we got from people who live there. There is no malaria risk in Merida--however, there are mosquitos there that carry dengue fever, for which there is no vaccine. We all, but our son (2 year old) especially, got many mosquito bites in Merida, despite pretty vigilant efforts with the DEET spray, having them wear long pants, not going outside during dusk, etc. Once we where on the coast, though, we hardly got bitten at all. This may be because we were RIGHT on the water, so there was a fairly contant breeze coming from the ocean. We went to Chichen Itza, Tulum, and some smaller ruins in the area, which were not jungly, and we didn't get any mosquito bites. I think Coba is one that is fairly jungly, so there may be more mosquitos there. Most of the people we talked to on the coast side were surprised that we were told to take chloroquinine. Also, from the research I gathered, there are two kinds of malaria strains, and the more dangerous strain is rare in the mosquitos on the Cancun-Tulum corridor.

In terms of mosquito netting, we brought quite a bit in case our bungalow was not adequately screened in. We ended up not needing it because the place was very well-built and screened, but if you were planning on staying at all in the beach cabanas along Tulum, it would probably be worth bringing.

That's just my experience. Since we didn't have the issue of our kids not weighing enough for the quinine, I'm not sure how I would have felt about traveling with them to the Yucatan without it. But it was a great trip! Good luck! meli

We traveled to the Yucatan last year with our then 6-month-old and 3-year-old sons. We stayed at the beach (Playa del Carmen and Tulum) and went inland to ruins (Coba and Chichen Itza).

To protect against the incredibly small risk of malaria we used mosquito repellent and relied on my breastmilk protecting the baby. If you're interested, catnip-based mosquito repellents work great, even better than DEET. You can buy them online or make your own.

We're taking our now 4-year-old and 15-month-old sons back in November and will use the same strategy. Have a wonderful trip. DL

Well, I'll be interested to hear what any other medical professionals say. But I would say this: I have been to the Yucatan and can't imagine it presenting a particularly strong malaria risk. Seems a rather surprising concern to me, particularly the places you are talking about visiting. It's not all jungle out there! I think it's an ideal vacation spot for a young child -- they can waddle around ruins or squat on the beach. sabrina

My husband and I took our 8 month old twins to Merida last December. We stayed with my in-laws in Merida and did not even notice any mosquitos. In fact, my pediatrician did not even suggest the vaccination for malaria. We did take day trips to see some Mayan ruins and again had no issues with bugs. We only used bottled water and jarred baby food while we were there, and our twins did not have and intestinal issues either. I think you will be fine, but you need to do what makes you feel most comfortable. Karen

India trip with a 1 year old

May 2004

My best friend is getting married in Calcutta this December. I am considering going with my 1-year-old daughter, but my mother is worried about the health risk. Has anyone had experience taking an infant to India? I should note that we would be staying with family so we should be able to control food safety better than most tourists. On the other hand, my own mother took me when I was 2 and I got very sick, which is why she is concerned. Thanks!

I would not bring a one-year old to India, unless you and/or she is Indian and know the ropes. I think the chance of you enjoying your trip and the very exciting and beautiful Indian wedding experience will be extremely compromised by having to care for your small daughter. You may hear many divergent opinions on this. I've taken my daughter to Calcutta four times (first time she was 18 months.) Here are a few thoughts:

Malaria is real (most of my husband's relatives have gotten it several times). You will need to check with a travel medicine physician (reliable ones are tricky to find: here today, gone tomorrow) to determine if and how to handle travel meds. The CDC has a website, but I don't think it talks about how young children can handle the drugs. I think a one year old is too young for much of the immunizations we took. At one point, we had a pharmacy on Telegraph (can't remember the name), crush malaria tablets into capsules, which we poured into chocolate syrup for our toddler to take every day.

If I remember correctly, we took typhoid, Hep A (which needs a six month booster), malaria. You didn't have to worry about cholera in Calcutta, only in the North. Tetanus is critical to have before you go. Check with your doctor (who probably won't advise, but will refer you to a travel clinic; Kaiser has a good travel medicine department if you have Kaiser).

Unfortunately, there is the risk of malaria but the baby is too young to take medication; you need to prevent through clothes cover and repellent. Unfortunately, mosquitoes are a part of life in these areas and the kids usually get a bit swollen so also bring some sort of lotion; I use antisan (I get it in the UK). Also, make sure you are under a mosquito net at night. 

Ofcourse, take all the shots recommended, drink well boiled water (you and the baby), eat only thoroughly cooked food, try to have food cooked at someones home (if possible) for you. When food is cooked for large groups by cooks, the chances of contamination go up. Never eat raw food, salad etc. outside. Carry and constantly use a deet based insect repellant especially on your baby, and if in Delhi, use mosquito nets at night. If you eat fruit, wash it in boiled water, rinse your knife in boiled water and cut the fruit yourself. Take disposable plates from here to make life easier for you, won't have to worry about the cleanliness of the plates.

I carried all my daughters usual cold, fever, etc. other general medicines that I use here. Also tylenol etc. for me. Diarrhoea medicine (I think Bactrim?) for me. On the most recent trip she and I were both taking malaria meds (hers I gave followed by her favorite sweets, it tastes awful), when she was 8 months old, I was still nursing her so I took the malaria meds and her doc said that was enough of a dose for her.

I know I sound like I'm going overboard with this but I can happily say that with all my self-imposed restrictions I have managed to take my daughter to India twice and have brought her back with no more than a sore throat the second time, not even a sneeze the first time.

I am in India right now with my 16 month-old baby--actually we've been here for 3 months. My husband and I are here doing research. To tell you the truth our pediatrician did not give us any anxieties about coming here, much to my surprise. Our baby had all of her shots (up to 1 year) in Berkeley. We are returning to CA next week when she will get her 15 month shots (1 month late). We return to india again in novemeber. We have not had any problems here so far. We arrived right in the midst of the monsoons, when incidents of malaria are high. Since we were to stay in Delhi mostly (where I was told the mosquitos are not as bad--and they really weren't) baby's pediatrician told us not to worry. No malarial medicines can be given to babies that young, I was told. Baby has been in good health and so have we. I don't think December is a high malarial season, but I am not sure. I think the key is food and water. I would say that if you take care of your food and water situation, you should be alright. Our experience has been positive here, and our baby is thriving. 

Moving to Ghana with a toddler and concerned about malaria

May 2004

I was wondering if anyone has experience with living in West Africa with a child, especially a young child. My son Gabriel, 13 months, is Ghanaian-American. I would like to bring him to Ghana to meet that side of his family (his father is from Ghana), and introduce him to the culture, language, and music. I am thinking of starting a business there (in Accra) and living there long-term. I lived there for 6 months in 2001 when I was working there as a technology volunteer. My main concerns are malaria (I worry about side effects of anti-malarials too) and infectious disease. Any insight into life with children in Ghana would be appreciated.

My mother went to Africa with my brother when he was 9 months old. But he was young to take the Lariam (name of the drug to prevent malaria). So she had to be careful where she went with him; avoid the area were there is a lot of mosquito, she bought mosquito net (to protect him when he was a sleep) and lot of insecticide (there is also a lotion which you put on skin to prevent mosquito bite). Good luck, Myriam

I didn't see the original posting, so forgive me if the advice isn't on the mark. I have a friend who just moved to Tanzania, which is in E. Africa, but she could have some helpful advice for you. She and her son (5 yrs old) were on the latest malaria medication prescribed in the US when they first arrived in Africa, but they both had to stop taking it due to side effects (she became depressed and couldn't stop crying and her son developed nightmares and started grinding his teeth). She feels that US medical doctors are not the ones to consult about malaria in Africa. She mentioned that there is medication you can take once you get malaria that clears it up right away. It only costs about $8 per dose -- a full day's pay for many of the people where she is living -- which is why many Africans can't get treatment. She and her son haven't gotten malaria yet, and she lives at a higher elevation where there aren't as many mosquitoes, so I imagine the risks depend on where you are in Africa.

I would move to Ghana right now if I could. My parents take a two week trip to Ghana every year and I have been there for that and for other reasons. My husband is from Nigeria and we have taken our three children to Nigera and Ghana and stayed for some time. In fact, my 2 and 4 years old daughters lived in Nigeria for 6 months with my husband while I ''supposedly'' was working towards getting this doctorate completed. Anyway, regarding Malaria... there is a pill called Mefloquine that we are supposed to take weekly... many people call it the ''sunday sunday tab''. Kaiser reduced it into a powder for my youngest to take but I discovered it was easier to give to her in pill form and with COKE or FANTA!! They looked forward to drinking the soda... not taking the Mefloquine... on a side note, both of my daughters contracted Malaria and were treated easliy and quickly while in NIgeria and are wonderfully healthy now.

Furthermore, the schools in Nigeria and in Ghana are very strong academically. Many do not however have all of the financial resources that we take for granted over here ( computers, science equipment etc.)but the students are sharp as can be and able to compete and even surpass the students educated in the US public school system.

I find the children in that area to be extremely articulate, incredibly respectful and bi-lingual. In fact,my daughters came home speaking Yoruba and English with a NIgerian accent. Ghana to me is a very warm friendly place. It is a bit more laid back than Nigeria. In Ghana as well as Nigeria, you can find practically anything you would find in the US. I often found myself a bit disturbed by the over infatuation of America and all things American... But that can be relative to your locale as well. Accra is a very metropolitan place... great food, nightclubs(if you are so inclined)etc. The area is very safe and children are loved. I wish that I could raise my children in such a child friendly, human centered environment. Enjoy Africa

Zetha

Taking my 4-year-old to Senegal - malaria and carseat concerns

October 1998

I'm wondering if anyone has any new insights into safety while traveling/living with a young child (4.5 years old, still under 40 pounds) in a third world country. My son will be with me in Dakar, Senegal for 7 weeks and I'm mostly concerned about automobile safety given that most vehicles there won't have functioning seatbelts. I'm also trying to find some magic child safety seat that will work on the airplane, in whatever cars do have seatbelts AND is light enough to carry around airports and through a week of travel in Europe on trains in the middle of winter. I have a seat that works well on airplanes now, but it is very heavy and awkward to carry around. I've called around, but none of the stores seem to have much to offer. (By the way, I haven't found much of anything helpful on the web. There is a site, which is interesting, but basically repeats the less than satisfactory information given on the FAA site about child safety on airplanes, http://www.airsafe.com/kidsafe.htm)

I also have some concerns about health - particularly malaria (even tho' he seems to be especially sweet to mosquitos, I don't want my son to be taking prophylactic doses of Meflaquine/Larium) , and food-bourne illnesses. I am aware of all the standard precautions, have checked out the CDC page and am going to Senegal at a time of year when malaria isn't that prevalent, but any hints/advice would be greatly appreciated. Martha

I hate giving advice but I will share my experience. I was a Peace Corps volunteer in Cameroon, West Africa for 2.5 years, in the early 90's. During that time, I had malaria three times even though I was taking chloroquin and fansidar prophylactically. By the time I left Cameroon, there were resistant strains to both these drugs. While I was in Africa , three volunteers DIED of malaria in the continent. I used to be much more knowledgeable about the various strains than I am now, but PLEASE PLEASE do not take a child to sub-Saharan Africa without prophylactics. If you do not want to give him drugs, then I would say don't take him. No amount of separation anxiety can be as lethal as a bad case of malaria.

As far as car seat, I would say, take one anyway. I have traveled extensively in West Africa and I agree that transportation safety is nonexistent, but it cant hurt. Dysentery is sure to happen unless you really live in a vacuum and don't go near fresh fruit or produce. It does pass though. I am sure your doctor can prescribe something for it. All that said, I hope you have a good time! I love it there. Niloufar

I haven't been to Senegal, but if it's anything like Cameroon, you'll be lucky to get a SEAT on local transportation (private taxis, bus-like vans, etc), let alone a place for a carseat or a seatbelt. This varies by location, of course, but the further out in the bush you are, the more likely they will cram as many people as possible into the car, meaning your son will probably be on your lap. Also, the drivers in some areas will try to get you into their car by grabbing at anything you're carrying, so a clumsy carseat (on top of whatever luggage you have AND your small child) could be a real nightmare. I'm sure it varies by what you're doing there and who you're with. I was a Peace Corps volunteer, so we saw essentially what the local population saw. I'm sure it would be different if you have escorts or business companions or anything like that, or if you're spending a lot of money (a lot to them, not necessarily to you). As for the malaria, most of us got it at least once (in a roughly 2 yr period) even while on Mefloquine. I agree that you probably shouldn't give it to your child, especially if it's just for a short visit. Anopheles (the malaria mosquito) only bites at night (say 4:30 pm and later), so keep you and your child well-protected at those times (maybe mosquito repellent would do the trick when you're up and about; definitely nets over sleeping areas help cut down on problems). There's not really enough known on the effects of Mefloquine to feel good giving it to a growing child... even adults have reported some pretty bizarre problems. It doesn't sound like it's worth the risk in your case. If either of you DO get malaria (another problem is that Mefloquine can muffle the symptoms, causing misdiagnosis), there are treatments that seem to be pretty effective. The real problem is getting it and ignoring it, but I think it would be tough to miss the symptoms normally (fever that cycles is the prime one). Good luck!

I've read about an inflatable carseat that I think still meets safety regulations. I think it was in the book ``Baby Bargains.''

I've been to Dakar and elsewhere in Senegal myself. You may be right to fear the lacking seatbelt issue, though I wouldn't be so sure. Dakar is very cospmopolitan and there is huge population of professional foreigners. Many taxis are likely to be Mercedes, since those are common in Europe and Dakar's connection to France is significant. I took buses, so I can't be sure.

I realize the malaria medication is a tough choice, but I just wanted to encourage you to talk to as many people as possible before deciding to forgo malaria prophylaxis. There is most definitely quinine-resistant malaria in Senegal today, as is the case in many of the malaria-plagued places of the world today. You can get forms of malaria there that stick with you so that years later, suddenly, a person has malaria again. And if you come down with malaria, you have to take the same type of medicine but in very huge doses, plus you are suffering. Probably you know all this already and are making the best choice, but my own experience was that I didn't take medication before I went (as you're supposed to), largely because I was afraid of all the side effects I'd heard about. And while it wasn't very humid, I still got occasional mosquito bites and then would become very scared. What if this is the one? Finally, someone I met told me I was a nut not to take the drugs and I started right away and had no side effects, even taking two kinds. And I didn't get sick at all.

Have a great time! It's a fascinating place of gorgeous people - on every sidewalk there seems to be a parade of bright colors and beautiful clothes. Do be wary in the central market where things can easily be stolen off you. and do get out of the city! Monica

In 1984 I went with a male friend to Tanzania. We were both taking chloroquin and fansidar as malarial prophylactics, but get this -- we were on the same doses, even though he outweighed me by forty pounds or more. In travelling from Dar to Moshi, we were bitten extensively by mosquitos -- I counted 89 bites between the wrist and elbow of my left forearm (while waiting around the next afternoon in Moshi). I did not come down with malaria, but he DID. So, and here's the advice part so ignore it if you like... not only should you make sure your child has prophylaxis or leave him/her home, but you should make sure the dosages all of you get are appropriate for your own size. Also, get all recommended vaccinations, and never drink anything that has not been sterilized -- order your coffee as kahawa na maziwa moto (with boiled milk) if you can't take it black (but it's great in Tanzania and Kenya, so do try it ;-), order your coca cola sealed in the bottle -- if you have to have it cold, put the bottle into ice, and WIPE the opening thoroughly before drinking it. No orange squash if you value your health, no cut fruits, take water purification tablets along for the water in hotels, etc., and take along pepto bismol tablets or some other such to be chewed to prevent the runs. That worked well for us -- he only got malaria, and neither of us got anything else although we were in Tanzania and Kenya for eight weeks, and not staying in the fanciest hotels, either (well, except once in Nairobi!). Another friend of mine picked up some intestinal bug and has never gotten rid of it -- she still has an occasional bout. And, all that aside, have a GREAT time! The people are wonderful, despite often having to cope with difficult circumstances.  Heather

Regarding the use of prophylaxis for malaria: most European doctors do NOT prescribe prophylaxis, partly for the reason that if we rich foreigners keep on routinely using the drugs of last resort their efficacy will be destroyed for everyone. Rather, the strategy is to respond very quickly to symptoms. If you will be far from medical help, you should carry the medications with you. My impression is that Mefloquine/Lariam is NOT cleared for young kids (please check this), at least as a prophylactic. I think chloroquine is considered safe enough that you COULD give it to your son as a prophylactic. I would try to find out as much as you can (doctors there will know more than here) about the symptoms & treatments of malaria in young children. The best thing, of course, is, as suggested to protect against mosquitoes in the evening & night (though daytime species carry dengue fever! - don't know if this disease occurs in Senegal...) Good luck & please keep us posted w/ any new info you come across (I, too, am contemplating taking a small one to Sub-Saharan Africa) Melanie

Here are a few more suggestions for travel in Third World countries (these may sound a little paranoid, but it's probably worthwhile to be more safe than sorry):

Consider bringing your own hypdermic needles, sterile syringe, and a note from your doctor explaining why you have them. In case you or your child needs an injection while there, do NOT rely on the clinic or doctor traeting you having sterile supplies.

Know your blood types.

Bring oral rehydration powder with you, too. The packets are light, small, and fairly cheap. If you don't use it, you can give it to people who live there, who probably will. (Dehydration from diarrhea is a very serious problem in children in 3rd world nations.)

PeptoBismol was mentioned before... it should be on your must bring list.

If you are going to be WAY out in the wilds and want to be as utterly safe as you can be, think about a few sterile hospital gloves and maybe even an IV drip.

There's a great book called Travel with Children by Maureen Wheeler. It's part of the Lonely Planet series, and I highly recommended it for adventure travelers. She's been amazing places with her kids, and her suggestions are quite detailed and useful. (BTW, I'm the author of a book on traveling with babies and small children called Baby Maneuvers. It's for parents whose kids are under five. And... there's one chapter focusing on overseas and adventure travel.)

A note: all this preparation sounds really scary, but once it's done, you'll be free to enjoy and experience. I think it sounds terrific! 

Ericka

I have travelled to the Senegal in July/August eight years ago. So, all I know refers to the transportation and living conditions at that time. The situation might have changed since then. Generally, there was a big difference in the standard of life between Dakar and the rest of the country particularly the inland. After having travelled around in Mali and the Senegal I did not find that Dakar was really a third world place.

Sanitary conditions: were great, water was treated and drinkable (outside of Dakkar nothing was guaranteed).

Mosquitos: I took Lariam. Good is however to avoid Mosquitos, dress accordingly in the evening, close windows, no lights, spray if neccessary. In Dakar I stayed in a house near the Medina with windows and everything. I do not recall any Mosquito problems there. To my view, in the City itself the risk is relatively low.

Transportation: Regular buses were fairly safe in Dakar. They were not less reliable as most busses that I have seen running in the Bay area. The same was true for taxis. You may want to avoid the colorful and funny-looking minibusses in the City (I forgot their name). They were fast, but very unsafe, badly maintained, e.g. brakes didn't work well, and frequently involved in accidents. Also local people often avoided them. For longer trips in the inside country I recommend checking over the taxi and choosing the most reliable one. It happened several times to me that the taxi broke down somewhere on a road, and we had to wait a couple of hours until the driver had finally managed to self-repair his vehicle. The drivers are also able to pile up people in the car to a point that it gets extremely uncomfortable. Also, try to avoid any Peugeot 4 x 4 without closable windows, or for else dress well. I got once in a violent sand wind and another time I got a terrible sore throat. I read somewhere that colds are the most common illnesses of tourists in Africa. Anyhow, as long as you are staying in Dakar, I don't think there is much to worry. There are a lot of Frenchmen who are really fond of living there. --Petra