The question of malaria?

First some good news - after an initial failed attempt when the Indian High Comission returned our applications and we all had a slight panic, our six month multiple entry Indian visas finally arrived yesterday. Top banana! Tomorrow we're off to book the flights, arrival hotel and extended travel insurance.

Now back to less exciting planning...
Probably one of the greatest health risks we'll face while travelling in Asia is that of malaria. On previous trips to SE Asia (but not mefloquine resistant areas) we have taken the prevention route rather than the medical. After a dodgy experience with mefloquine in Sumatra 1994, Lee and I decided that covering up and using good quality repellants and nets, was a better option than psychotic dreams and vomiting. Apparently, children tolerate mefloquine better than adults with less propensity for showing loopy side-effects. But we still have several problems with anti-malarials:
1) They do not prevent malaria, and can reduce the efficacy and choice of treatment options. Yes, they reduce the severity of the infection but so does rapid treatment.
2) We are travelling for an extended period of time and taking anti-malarials for six months is a somewhat toxic prospect.
3) Our high risk areas (taking into account general risk and rainy seasons) appear to be Assam, central India, Yunnan, Laos, Cambodia, Vietnam, Northern Thailand and Sabah. Add to this that Northern Thailand, Cambodia and Vietnam have many areas of mefloquine resistance.
4) If not mefloquine nutty pills, then other options include doxycycline and malarone. The children are too young for doxy and malarone is ideally a choice of treatment if one of us is unlucky enough to catch malaria. Plus they are outrageously expensive so taking them for more than a few weeks is out of the question.

All this leads me to conclude that:
We can take over-the-counter chloroquine and proguanil with us, just in case we are going to be travelling through areas of malaria outbreaks in India (Assam already has an outbreak due to heavy rains, and I am little concerned about this happening around Mumbai due to the recent floodings - I'm also worried about cholera outbreaks because of this but lets not go there just now). We can also take malarone as an emergency treatment. We can take mefloquine for the children to take when we are in areas like Laos and Sabah.

Non-drug management of this problem includes changing the itinerary so that we don't travel in malarial areas in the rainy season. This is a perfectly reasonable option. The chances of being able to get a 30 day visa from India for China is fair to low. It is likely that we'll have to take a return trip into Tibet from Nepal on a short visa (hopefully 10 days at least) then fly from Khatmandu to Bangkok to continue the journey. So a malaria avoidance strategy could be that instead of heading back north slap bang into Laos' rainy season, we could travel south and avoid the bad weather, returning when its drier.

We've also acquired some pocket sized mosquito repellers. They emit a noise that the biting females don't like (apparently the males ;-) and Caroline & Johnny's recent field tests suggest they well work. Not that you'd want to rely solely on this. So permethrin soaked mossie nets and clothing, together with a range of repellants have been packed. DEET for high risk times, ankles and other favourite chomping areas together with some less scary sounding ones for general use. Our firm favourite is Mosi-guard. It's approved for tropical areas by the London School of Tropical Medicine and does not contain harmful poisins like DEET (and smells like lemons).

And just in case any of you were wondering about water risks, we have a fantastic Katadyn expedition water filter. Gotta be worth every penny for the environmental aspects (have you seen some of the plastic bottle mountains in Asia) and piece of mind (cos there ain't no guarantee that's clean water in that there plastic bottle). Now if only the mosquitoes were as manageable!