Date: Wed, 12 Feb 1997 20:18:16 GMT-5
John, Here are the H-AFRICA postings. Dr. K.
----------------------------Original message----------------------------
[1]
Date: Tue, 11 Feb 1997
This discussion is making me very curious about Larium,
its effects and "side" effects. Could someone explain?
What symptoms does it cause that could be confused with
culture shock, "travel stress," etc.?
[2]
Date: Wed, 12 Feb 1997
I would like to query Judith Krieger what she includes
among her old fashioned remedies for malaria. I am
currently working with two students who will be overseas
next year: one in Mali, the other in Tanzania. If there
are ones she would recommend as "supplements" or in lieu
of the others, please advise. . .at least for discussion
with medical advisors.
[3]
From: Cecil Blake, Indiana University, Northwest, CBLAKE@iunhaw1.iun.indiana.edu
This drug has been known to cause serious side effects for
several years. I recall being advised about the side
effects many years ago when I was about to undertake a six
nation tour in countries that are malaria-infested. The
extent to which information about the drug and its effect
are widely distributed is uncertain. You have provided an
excellent service by posting this on the net.
[4]
Date: Wed, 12 Feb 1997
I think western paranoia of African illnesses and their
general belief that African medicine/doctors etc. are
inferior is a major part of what makes it so hard for them
to physically deal with being on the continent.
[5]
From: Don Gordon, Furman University, Gordon_Don/furman@furman.edu
The problem of doxycyline as a substitute for mefloquine
is that for women yeast infections often result. Further,
doxycycline must be taken daily and has a limited span of
protection. If one misses two pills (or perhaps just one) a
possible "window of opportunity" for infection is created.
It would be interesting to know the experiences of PCVs
and of state department personnel (especially in plasmodium
falciprum areas such as coastal Tanzania and Kenya) with
mefloquine.
Also, is length of use of mefloquine a factor for those
experiencing significant side effects? I have taken 120
students on three foreign study programs to east Africa
over the last four years. All were on Larium as the malaria
prophylactic. The exposure period was four weeks. No
students experienced what would be considered significant
side effects. On each trip two or three women complained of
"bad dreams" after taking the tablet at times other than
with meals. When taken with food, as is suggested, such
dreams ceased or became "less bothersome".
I am interested in the experiences of others with study abroad programs
in east Africa.
----------------------------Original message----------------------------
H-AFRICA's Editor's Note:
As issues about anti-malarial drugs
began to be discussed on H-Africa, I
sent copies to the editor of a new
H-Net list on the history of science,
medicine, and technology, Harry Marks.
Responding to my concern that much of
what was appearing on H-Africa was
anecdotal information, Professor Marks
kindly provided the following. Please
take note of his caveats, some of which
have already been a part of our
discussion here. mep
Date: Mon, 10 Feb 1997
I promised to send some citations from the medical
literature re: mefloquin. These should be available from
any good medical library. If you post them, will you
please also post the following caveats:
1) I am not a physician, nor have I even read the
articles, though I looked at the abstracts and these
seemed informative overviews;
2) medical studies (and authors) disagree about the
strengths and implications of medical advice, and
reading journal articles is a poor substitute for
getting that advice directly;
3) the idea of a SAFE drug, to which your discussions
allude, is an oxymoron. NO drug is safe--think of the
nasty things aspirin can do to your gut or your
clotting ability. Whether mefloquin is nastier than the
alternatives (or than malaria) is a complex question.
FYI the last item on the list comes from Hoffman LaRoche,
the drug manufacturer.
References:
[1] Kuile, FO. Nosten F. Luxemburger C. Kyle D.
Teja-Isavatharm P. Phapun L. PriceR. Chongsuphajaisidhi
T. White NJ.
Mefloquine treatment of acute falciparum malaria: a
prospective study of non-serious adverse effects in 3673
patients.
_Bulletin of the World Health Organization_. 73(5):631-42,
1995.
[2] Barett PJ. Emmins PD. Clarke PD. Bradley DJ.
Comparison of adverse events associated with use of
mefloquine and combination of chloroquine and proguanil as
antimalarial prophylaxis: postal and telephone survey of
travellers.
_British Medical Journal_. 313:525-8, 1996 Aug 31
[3] Phillips-Howard PA. terKuile FO.
CNS adverse events associated with antimalarial agents.
Fact or fiction?. [Review]
_Drug Safety_. 12(6):370-83, 1995 Jun.
[4] Luzzi GA. Peto TE
Adverse effects of antimalarials. An update. [Review]
_Drug Safety_. 8(4):295-311, 1993 Ap.
[5] Bem JL. Kerr L. Stuerchler D.
Mefloquine prophylaxis: an overview of spontaneus reports
of severe psychiatric actions and convulsion.
_Journal of Tropical Medicine & Hygiene_. 95(3):167-79,
1992 Jun.
123
---------------------------Original message----------------------------
[1]
From: Scott MacEachern, Bowdoin College, smaceach@polar.Bowdoin.EDU
This discussion of Lariam is very interesting, and I
thought that I'd put in my two cents worth. After four
seasons of archaeology in northern Cameroon, I've come to
the following conclusions:
(1) Lariam is a lot more toxic than its makers and most
North American doctors will admit.
(2) Larium has very different effects on different people.
About half my crew (including me) take alternative
prophylactics because of bad reactions to Larium; the other
half wonder what all of the fuss is about.
(3) Larium is more effective against chloroquine-resistant
malaria than other prophylactics are, but you can still get
malaria while taking it (we've had two cases, of about 10
people who have used it).
Personally, this whole thing reminds me of my second
season of archaeology in Africa, in 1983. I was told about
this new wonder-prophylactic called Fansidar, and took it
regularly for 3.5 months. Doctors aren't too happy to hear
that now.
[2]
Date: Wed, 12 Feb 1997
From: Pier Larson, Pennsylvania State University, PML9@psu.edu
Persons of wealth with access to anti-malarial drugs do
not die of malaria. Therefore it has always been my
philosophy (20 years living in Madagascar) to take
chloroquin or nothing as a prophylactic and to have two or
three curative doses of various drugs at my disposal,
including Larium, should I contract malaria.
I wait until I arrive in Antananarivo to walk into the
local pharmacy and purchase chloroquin over the counter for
cents a pill, rather than deal with the hassles of seeing a
physician and receiving a prescription for the same drug in
North America.
The doctor's advisory books in North America tell you that
Madagascar is notoriously chloroquin resistant, but most
Malagasy (who do not take prophylactic) still effectively
cure their malaria with cheap doses of the drug. The cost
differential between the two systems is astounding.
Fortunately I have never succumbed to malaria, but I have
numerous friends in Madagascar and other malaria endemic
regions who do well by this philosophy. Getting sick with
malaria is not pleasant, but hitting it early on with
curative drugs often has one back to work within a week.
I think Larium as prophylactic is symptomatic of our overly
aggressive biomedical ethic and practice and, ultimately,
our worst fears about tropical disease.
[3]
From: Stephen Rockel, University of Toronto, srockel@chass.utoronto.ca
I took mefloquine/Larium for 5 months in Tanzania during
1992-3, and subsequently used the chloroquine/paludrine
combination for another 3 months. I did not get malaria.
I was extremely careful to avoid getting bitten. This is
ultimately the best defense against malaria, as no drug is
100% effective as a prophylactic. Nor did I experience any
of the serious side effects sometimes associated with
mefloquine.
However, I did have problems in another respect. One of
the side effects is insomnia. For 5 months I did not get
enough sleep. After switching drugs I slept better. But
in the meantime I experienced many small illnesses of
various types which interfered to some degree with my
research programme. I am convinced that 5 months of
insufficient sleep reduced my immune defences to the point
that I could not ward off other illnesses. I think this
should be an important consideration for some people. I
would have to think carefully about using mefloquine again.
Does anyone know the state of the Colombian developed
vaccine tested in Tanzania and Columbia in 1993/4?
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100
----------------------------Original message----------------------------
Date: Wed, 12 Feb 1997
As long as anecdotal evidence seems to be the only type
available for this thread, due to a distinct lack of public
health types on this list, I will add my two cents worth.
My wife and I did a 28 month stint as Peace Corps
Volunteers in Mali from 1989-91, we have returned to Mali
for research, the most recent trip being an 11 month stay
during 95-96 academic year. Early in our Peace Corps
service we were switched, (voluntarily) from a malaria
prophylaxis regime of chloroquine and Paludrine to
mefloquine tablets (Larium).
This was done after I had contracted a not too serious case
of malaria. (Serious enough though to convince me that I
was not interested in getting it ever again.) We were on
mefloquine for at least 18 months with no serious side
effects and no reoccurrence of malaria (I experienced
occasional dizziness when lying down and the usual vivid
dream). My wife did not get malaria at all and also never
had serious side effects from the prophylaxis.
On our return to Mali last year we both took mefloquine
again and gave a reduced dose to our 3 year old son.
(Under the advice of physicians.) Again we were all malaria
and side effect free. I have personal knowledge of friends
who did not take prophylaxis or only took chloroquine and
suffered repeated bouts of malaria, one friend contracted
cerebral malaria and survived only because we were able to
get her to Bamako, and into the care of Peace Corps medical
staff in a timely manner. They estimated that if she had
gone untreated for three more hours that she probably
would have died.
There are three important points that anyone considering
travel, research, or work in chloroquine resistant malaria
areas should take from the experiences expressed in this
thread. First, the impact of repeated exposure to malaria
is a serious long term health threat as well as the very
real possibility that malaria can kill you in the short
run. (This is particularly true with young children and
those who have never been exposed to the parasite).
Because of this, whatever prophylaxis is taken, should be
taken religiously.
Second, mefloquine is neither 100% effective, nor side
effect free, but it can and does provide excellent
protection for many people. One should be certain then to
take the drug with enough lead time to discontinue its use
if the side effects prove to be overwhelming.
Third, there are numerous other things that you can and
should do to dramatically reduce your exposure to the
parasite. Often over looked, or simply flaunted by Africa
veterans as the paranoid activities of a Tenderfoot, are
the simple precautions of wearing long pants, socks, insect
repellent, use of mosquito nets, screens etc. to minimize
the number of bites to which you are exposed.
My final question is this: What sort of responsibility do
we have for the physical health of our students who are
taking advantage of travel, study abroad and research
opportunities in Africa? I was well prepared by Peace
Corps who provided extensive training on keeping oneself
healthy in the tropics. Others without such training could
well benefit from an advisor who provides a realistic
preview of these issues and ensures that the student has
access to up to date resources about health issues well
before leaving home. Zeric Kay Smith
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103
----------------------------Original message----------------------------
Date: Wed, 12 Feb 1997
I was a Peace Corps volunteer in Kenya in 1991 - 1992. At
this time, so I was told, meflaquine (which I believe is
the chemical name for the now commercially available drug)
was not approved by the FDA. As volunteers - and for
insurance reasons - we were required to take some
anti-malarial. We were told all the dangers of malaria -
and I have now discovered that the facts we were given were
exaggerated - and told that there was discovered a
chloroquine resistant strain. We were given a choice
whether we wanted to take chloroquine or meflaquine.
I chose the meflaquine and was told I had to sign a
waiver, releasing the US government of responsibility, if
anything went wrong. Young, fearless and ready to try
anything, I became part of an FDA study to determine the
side effects of meflaquine.
Within two weeks, the crazy dreams started, mostly sexual
in nature. Others in my group - women included - recounted
the various 'meflaquine dreams' that we had. We were in
the Peace Corps; it was the closest we came to the real
thing! About a month later is when the negative side
effects began.
I noticed that I was considerably less patient - a bad
quality for someone attempting to bridge cultures. I
became very depressed at the slightest bit of unwanted
information. I started sleeping irregularly, which I had
never experienced before in my life. (Friends and family
will debate this next point...) My hair started falling
out at an increasing rate. When I walked through a
doorway, I would see the door frame for minutes after,
like vapor trails, which although welcomed at some time,
became an irritant, thus beginning the cycle of impatience
and depression.
I remained on the drug for about 6 months - through my
first bout of malaria and then stopped taking the medicine
altogether. I ended up contracting another bout almost two
years later while working in Somalia, at which point I was
not taking anything.
The Peace Corps did periodically ask me about the
'side-effects.' All of these effects were experienced by
others, plus bed-wetting.
I will make a recommendation to those who will be in a
malaria region for extended periods of time - take nothing,
wear insect repellent (Skin-so-soft works wonders), wear
long sleeves in the evenings and sleep under your mosquito
net. After you have your first bout with malaria, it gets
easier. Just make sure you are not alone when you get it.
If you feel sick, get help immediately. If you are living
'there,' make friends quickly. The parasite is growing
stronger; data suggests human intervention is assisting
this.
Another piece of advice - do not trust western medical
practitioners when it comes to malaria - they are not
familiar with it, they have not studied it, and they do not
believe you when you tell them it could be malaria (this is
a generalization, but a good rule of thumb.) A Kenyan
friend of English decent, who lived in Japan, was visiting
his mother in Kenya. He contracted malaria unbeknownst and
returned to Japan. Within a week he was in the hospital.
A week later he was dead. Malaria is no joke, but it is
easily curable with a bit of sulfur. (P.S. If you are
allergic to sulfur, I suggest you vacation in the
Hamptons).
Good luck. If anyone has seen information on the
FDA/Peace Corps testing for meflaquine, please send it
along. Thank you.
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From: H-AFRICA---Mel Page
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Date: Mon, 10 Feb 1997
From: Abosede George, Rutgers University, jibike@eden.rutgers.edu
Date: Wed, 12 Feb 1997
From: Harry Marks, co-editor H-Sci-Med-Tech
Johns Hopkins University, hmarks@welchlink.welch.jhu.edu
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