Do you need malaria tablets to travel Southeast Asia?

 

There’s only one thing I hate more than people who walk slow, and that’s mosquitoes.

If you’re in the planning process of a holiday, gap year or change of scenery you might be looking to visit Southeast Asia. After all, it’s a beautiful place with a relatively cheap cost of living and massive changes in culture for every few hundred kilometres travelled.

While I was going through the planning stages, one of the burning questions I had at the travel clinic was ‘Do you need malaria tablets to travel Southeast Asia?’.

Of course it’s not all as simple as that, the question is vague, but it can be further investigated by considering the following questions;

 

  • Where are you going?
  • What type of traveller are you?
  • How long are you going for?

 

Once you’ve answered these then it will become a little clearer for you and with any luck it won’t be as annoying a topic to research as it was for me. It’s not as scary a subject as it appears to be and it certainly isn’t all doom and gloom!

Before we dive into the questions and how to approach them I’ll show you a little table I made as a central point of information for myself, to prevent the need to have to individually look up country by country when I inevitably forget whether I needed tablets or not.

This guide covers malaria only, if you have concerns about other diseases and are wondering about vaccinations then I have a very detailed post just for you.

If you’re also planning on travelling South or Central America then I also have a malaria guide for you too! The information is largely the same, as is the nature of malaria, but it offers a different table with different climates and altitudes effecting the need for medication.

Some clarifications to help you understand the table

 

It’s obvious to most but this isn’t my own research into malaria, it’s a collection of information from trusted sources that I have simplified for the average person to get a handy guide to answer the question, ‘do you need malaria tablets to travel Southeast Asia?’.

My sources

A little bit about these sources for those who are interested;

CDC – They are the USA’s government health agency, working to prevent illness and advise people about risks abroad. They update their malaria section frequently and provide information on mosquito drug resistance, recommended chemoprophylaxis (malaria medication and the percentage of malaria species for an area.

NHS –  Fitfortravel is a free, interactive, public access website providing up to date health information for the UK public on avoiding illness and staying healthy when travelling abroad. NHS is the National Health of Scotland and the information provided is specific and targeted to zones within countries.

Travax – So this one you won’t be able to view at your leisure. This is a portal that is accessed by travel clinics and/or doctors that has very detailed information. It also uses google maps to display up to date information on trouble areas, with grid and colour overlays for each area depending on the severity of the risk.

I myself visited a travel clinic and was given printouts of all the countries I requested so I’d recommend you do similar if it is of interest to you. I found it to be very detailed. I have used these printouts as a resource.

With all that in mind, time to move on to the clarifications.

Here is an example of the maps provided by Travax, normally in colour so the different risk areas stand out, but this is all I have.

Table clarifications

 

Malaria Tablets needed column;
This column basically is the recommendation by travel clinics. They’re likely to give you one of these answers;

Yes – They will recommend you take them.
No – They will not recommend you take them.
Maybe – They will recommend you take them if you meet certain criteria or go to a specific location.
Unlikely – The chance that they recommend them is low unless you meet extreme criteria.

Now just because they recommend that you take them doesn’t mean you absolutely should. Your personal preference, for budget, health or just travel style always will be a deciding factor in whether you ultimately decide to do it. This will be explored below the table. They will only give you advice, their professional opinion, the rest is on you.

 

P. Falciparum % column;
This column isn’t to be confused with the percentage chance of you catching the disease with no protection. It is just a number outlining the percentage of malaria in the area that is P. Falciparum, in comparison to the other types of malaria.

So for example, in Cambodia, of all the mosquitos that do carry malaria, 60% of those carry the P. Falciparum strain, which is the most dangerous variety. For more information on the types of malaria see below the table, or read about it here.

 

The < and > symbols;
This shouldn’t need explaining but it just goes to show my lack of faith  in humanity 😉
< = Less than (it always points to the smaller number)

> = Greater than (like a crocodile’s mouth it always eats the biggest number)

That’s how it was explained to me in primary school so that is the explanation you will get.

Do you need malaria tablets to travel Southeast Asia? The quick table guide

The questions you need to ask yourself

 

There’s a certain order that you can answer these questions in, but that isn’t set in stone. I’ll explain the methodology behind the way I see it as I explore each question.

First things first and this will eliminate a lot of need for further research is…

 

Where are you going?

 

If you’re going to one of the following countries exclusively then you wont’ have any need to worry about getting medication:

  • Malaysia (Peninsular)
  • Singapore
  • Sri Lanka

 Now when you look at the rest of the places you’ll notice a common theme. Urban areas, capital cities and the like are usually such a low risk that it is not recommended you take medication. For example if you had a holiday to one of the above places as well as a 4 day stop in Siem Reap to visit Angkor Wat, it wouldn’t be advised that you took medication. All this is despite Cambodia being a location that is considered high risk.

This is where some common sense comes in to play, I can’t give a rundown of every traveller’s variations because I don’t have the time, hence the table above with the notes on areas of high or low risk.

Note that some areas are not “malaria free” but the the risk is so low that travel clinics will not recommend you use medication.

What type of traveller are you?

 

Now obviously you might think this would be the first question you ask yourself. If you are the type of traveller that just wants to run the risk and use bite prevention as your only means of protection then all these other questions are irrelevant to you.

There are people that travel the world without bothering with medication, and that’s perfectly ok. You can do this for any number of reasons, whether for budget, or to avoid side affects.

However this question assumes that if you’re that type of traveller isn’t reading this post. What I mean by ‘What type of traveller are you?’, is more about your travel style.

Below are some factors that increase the risk;

  • Adventure Travel
  • Vulnerable Travellers
  • Flexible Itineraries
  • Travelling 1 Month or Longer

 

Adventure Travel;
If you are likely to visit more remote jungle locations, go on overnight or multi-day hikes or be further away from medical help then you would fall into this category. As you can see from the table, urban areas are low risk, but if you are exploring remote areas then the risk increases as well as your proximity to medical aid.

This is where the “unlikely” and “maybe” suggestions come in to play, of course that depends specifically on your destination and activities.

 

Vulnerable Travellers;
People who are vulnerable tend to be children and pregnant women. Pregnant women have a decreased immunity during the pregnancy and children have yet to develop partial immunities.

These vulnerable travellers should seek extra help and possibly change travel plans until a later date.

 

Flexible Itineraries;
The main reason for this is simply because you could become someone who falls into the adventure traveller category or who stays for an extended period of time. The variable factor at play here needs to be considered.

 

Travelling 1 month or longer;
This essentially comes down to exposure over a certain amount of time. The longer you’re in an area with malaria, the more you are naturally exposed to it and therefore it only makes sense that the chances of catching it go up.

 

How long are you travelling for?

Essentially this has been covered in the above paragraph.

If you’re going somewhere for a long period of time then you risk increases through exposure and probability. This applies not only to countries but also areas within a country.

A two-week jungle expedition for example increases your exposure and decreases your means of protection at the same time.

Learn about Malaria

 

This is a quick guide only for some basic understanding.

Malaria is a potentially deadly disease that is transmitted through the bite of an Anopheles female mosquito. This mosquito is active from dusk until dawn, unlike the Aedes mosquito which is active during the day (and carry Dengue fever, Zika virus and Yellow fever).

So as you can see mosquito protection is required around the clock.

Mosquitoes pick up a single cell parasite from the blood when feeding and then transmit it when feeding on others. This virus is called Plasmodium. Once the parasite is in your bloodstream it travels to the liver where it matures, then it starts effecting red blood cells.

From here the disease spreads.

 

Types of malaria

 

There are four types of malaria that can infect humans;

  1. P. Falciparum
  2. P.Vivax
  3. P.Ovale
  4. P. Malariae

The “P” stands for Plasmodium.

While all of these types of malaria are bad, it is P. Falciparum that is the most dangerous and likely to cause death.

The disease is typically going to effect people from 10 days, to 4 weeks after the transferring bite takes place. It should be noted though that people can feel ill up to 1 year after being bitten.

P. Vivax and P. Ovale can even be dormant in the liver for up to 4 years before becoming active!

 

Symptoms of malaria

The symptoms of malaria can vary but include;

  • Shaking chills
  • Fever
  • Profuse sweating
  • Headache
  • Nausea
  • Vomiting
  • Abdominal pain
  • Diarrhea
  • Muscle pain
  • Convulsions

If you suffer from ANY of these symptoms after visiting an at risk area then go see a doctor immediately and get a blood test. This also applies to those who were on medication, because these medications are normally about 90% effective, they’re not guaranteed to protect you.

Malaria prevention

The best way to avoid getting malaria is by preventing yourself from getting bitten. Although the Anopheles mosquitoes are most active from dusk until dawn, you should avoid bites at all times to avoid other diseases as well such as Dengue fever.

To avoid getting bitten consider;

  • Long, loose clothing
  • Air conditioned accommodation
  • Using deet spray (40% recommended)
  • Sleeping under mosquito nets when air conditioning is unavailable
  • Avoiding the rainy season when mosquitoes are most active

Of course mosquitoes are active all year round, but the risk is higher during the rainy season due to the better breeding conditions for the mosquitoes. This is partially why Southeast Asia is a problem area, because the conditions are perfectly suited to mosquitoes.

Deet spray has been proven to be safe for humans. Yes it breaks down plastics so be careful not to put it on everything you have.

It is also proven that there’s no added benefit for using 100% deet spray, besides a slightly longer duration effect (up tp 9 hours), it is no stronger or more likely to keep mosquitoes away than it is at its maximum effectiveness of 30-40%.

However it will eat up plastics faster! Whereas a 30-40% concentration will be good for up to 7 hours of protection.

TIPS FOR APPLYING MOSQUITO REPELLENT;

  • Apply on exposed skin or on clothing, NOT under clothing
  • Apply sunscreen BEFORE applying repellent, wait 5 minutes after sunscreen application before applying deet
  • If you want to apply to your face, rub it in your hands then apply, don’t spray anywhere near your face
  • Wash your hands before eating

Note that sunscreen will have reduced effectiveness after applying deet, but it is still a more effective method than buying combined sunscreen/repellent combinations.

You take the red pill, you stay in Wonderland and I show you how deep the rabbit hole goes.

Malaria medication

 

If you’re interested in this you should see a travel clinic or your doctor. I won’t go into too much detail here but I will briefly touch on the 3 medications I think are quite common worldwide. The drug name is followed by common brand names in brackets.

 

Doxycycline (Vibramycin/Monodox/Doryx):


This is the medication that I ended up going with. It will more than likely be the number one recommendation for the majority of people who travel long term based purely on cost.

Administration: Take one tablet per day, with a meal. Start 2 days before entering the malarial zone and continue for 4 weeks after leaving the malarial zone. Don’t lie down after taking it. Take it with a full meal and then remain upright and active to gastronomic side effects.

Pros;

  • Cheap – Cost me $1/day (AUD)
  • Side effects are known and documented heavily, so they can be accounted for
  • Also an antibiotic that treats things such as lime disease and other bacterial diseases

Cons;

  • Can cause sensitivity to the sun in 1 in 20 people. A trial run is recommended in your home country before you go overseas.
  • Can effect birth control pills effectiveness

 

Atovaquone (Malarone/Promozio):

 

This medication is much more likely to be suggested for those who are travelling for a shorter period of time, because the side effects are less common than Doxycyline, but the price is also quite a bit higher.

Administration: Take one tablet per day, with a meal. Start 1 day before entering the at risk area and continue for 7 days upon leaving the area.

Pros;

  • Very little chance of side effects
  • Only needs to be taken for 7 days after leaving the malarial zone

Cons;

  • Cost is higher at about $7/day (AUD)
  • Rare cases of side effects still exist

 

Mefloquine (Larium)

 

This is an older drug and is less common these days and will probably only be recommended for pregnant women or people who suffer side effects from the previous two mentioned methods.

Administration: Take one per week, the same day of the week, with food and lots of fluid. Start the course 2-4 weeks before entering the malarial zone and continue for 4 weeks after leaving the area.

Pros;

  • Only needs to be taken once per week which can keep costs down
  • Can be taken by pregnant women if need be

Cons;

  • Side effects can include insomnia, lucid dreaming, psychotic episodes, it can be very bad
  • Can’t be taken by anyone with cardiac problems, depression or epilepsy
  • Generally a last resort method if other medications won’t work for you

 

Malaria treatment

 

There’s good news to be had. Malaria is treatable, the earlier you go see a doctor the better they will be able to treat it.

Treatment will be via medication, with surveillance to see how effective it is in case there’s resistance to the drug from the virus.

P. Vivax and P. Ovale can remain dormant for over a year and then become active, this will also be monitored and treatment provided accordingly. The most important thing is to get yourself checked if you don’t feel well.

So hopefully this has answered the question of ‘do you need malaria tablets to travel Southeast Asia?’ for you.

With any luck this will never be an issue for you, so happy travelling and best of luck!

 

ps: This one post alone took me over 9 hours to research, fact check, write and finalise. So if it has been helpful please consider buying me a coffee. If not, that’s all good too 🙂

If you notice something that I have missed feel free to get in touch and let me know.

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