Post by tomarnold on Jun 23, 2007 1:20:52 GMT -5
To all folks going on the Jasper Team 3, leaving July 6, 2007. Please read.
An excellent reference by Sherri. Here are some CDC recommendations regarding malaria in Honduras (that is, for P vivax, which is the only species of concern in Honduras). This information is part of a more general article on the CDC website at:
www.cdc.gov/travel/regionalmalaria/camerica.htm
Hope this is helpful to each of you. You should all take your anti-malaria medicine starting 06-29-07 (or before), and continue it one pill per week on the same day of the week for each week you are in Honduras and for four weeks after you return from Honduras, last dose August 3, 2007. Follow the above schedule unless your physician has advised you to do it differently. The anti-malarial medication of choice is chloroquin, 500 mg each week according to the above schedule.
It is also helpful to use an insect repellent containing DEET. There are several diffenent preparations available, of varying concentrations. I recommend at least 25% DEET, since the higher concentrations are longer lasting. Note the reasons one might not use DEET in the CDC article. Concentrations of DEET greater than 50% do not provide additional benefit.
Mosquitos which carry malaria bite at night, so I do differ with CDC in regard to using insect repellent indoors and at night...I do it and recommend that each of you use the mosquito repellents at night as well, especially when we are staying in local Honduran homes. In addition, DEET is a most effective insect repellent for other critters and works during the day as well.....
Below is selected text from CDC at the above url.
In addition, be sure to bring all prescription medicines your physisian has advised you to take, in <your> prescription bottle/container (this is a customs issue..please do it this way). It is helpful for you to write down and bring with you, a list of each medicine you take, its strength and how often you take it, as well as a list of medicines to which you are allergic. (Please include all prescription medicines as well as all over the counter medicines, supplements and so forth....if you take it, I would be pleased to know about it). I will have temporary medical history forms with me on the trip, and will ask each of you to fill one out for me. I will keep them for the duration of the trip and destroy them after we return, unless one of us becomes ill enough to require treatment after we return, in which case, with your permission, I will make it available to you and/or your physician.
If you have questions regarding health issues and travel, please discuss these concerns with your physician or email me and I will be happy to discuss same with you or your physician. Call or email for any questions regarding the above information or any other questions. No one has become seriously ill after returning from our trips to Honduras, and God willing, that will continue to be the case.
best regards to all/looking forward to our trip together,
In His Service,
tom arnold, md
CDC text follows:
Transmission and Symptoms
Malaria is a serious disease transmitted to humans by the bite of an infected female Anopheles mosquito. Symptoms may include fever and flu-like illness, including chills, headache, muscle aches, and fatigue. Malaria may cause anemia and jaundice. Plasmodium falciparum infections, if not immediately treated, may cause kidney failure, coma, and death. Malaria can often be prevented by using antimalarial drugs and by using protection measures to prevent mosquito bites. However, in spite of all protective measures, travelers may still develop malaria.
Malaria symptoms will occur at least 7 to 9 days after being bitten by an infected mosquito. Fever in the first week of travel in a malaria-risk area is unlikely to be malaria; however, any fever should be promptly evaluated.
Malaria Risk by Country
Honduras: Rural areas only, including all areas (including resort areas) on Roatán and other Bay Islands.
Prevention
All travelers to malaria-risk areas in Mexico and Central America (except for Darién Province and San Blas Province in Panama; see below for those areas), including infants, children, and former residents of these countries, should take chloroquine as their antimalarial drug.
Travelers to Darién Province and San Blas Province in Panama (including the San Blas Islands) should take one of the following antimalarial drugs (listed alphabetically):
atovaquone/proguanil,
doxycycline,
mefloquine, or
primaquine (in special circumstances).
Most antimalarial drugs are well-tolerated; most travelers do not need to stop taking their drug because of side effects. However, if you are particularly concerned about side effects, discuss the possibility of starting your drug early (3-4 weeks in advance of your trip) with your health care provider. If you cannot tolerate the drug, ask your doctor to change your medication.
Chloroquine (brand name Aralen™ and generics)
Directions for Use
The adult dosage is 500 mg chloroquine phosphate once a week.
Take the first dose of chloroquine 1 week before arrival in the malaria-risk area.
Take chloroquine once a week, on the same day of the week, while in the malaria-risk area.
Take chloroquine once a week for 4 weeks after leaving the malaria-risk area.
Chloroquine should be taken on a full stomach to lessen nausea.
Chloroquine Side Effects
The most common side effects reported by travelers taking chloroquine include nausea and vomiting, headache, dizziness, blurred vision and itching. Chloroquine may worsen the symptoms of psoriasis. Most travelers taking chloroquine do not have side effects serious enough to stop taking the drug. Other antimalarial drugs are available if you cannot tolerate chloroquine; see your health care provider.
Contraindications
The following travelers should not take chloroquine (other antimalarial drugs are available; see your health care provider):
patients allergic to chloroquine
Protect Yourself from Mosquito Bites
Malaria is transmitted by the bite of an infected mosquito; these mosquitoes usually bite between dusk and dawn. To avoid being bitten, remain indoors in a screened or air-conditioned area during the peak biting period. If out-of-doors, wear long-sleeved shirts, long pants, and hats. Apply insect repellent (bug spray) to exposed skin.
Choosing an Insect Repellent
For the prevention of malaria, CDC recommends an insect repellent with DEET (N, N-diethyl-m-toluamide) as the repellent of choice. Many DEET products give long-lasting protection against the mosquitoes that transmit malaria (the anopheline mosquitoes).
A new repellent is now available in the United States that contains 7% picaridin (KBR 3023). Picaridin may be used if a DEET-containing repellent is not acceptable to the user. However, there is much less information available on how effective picaridin is at protecting against all of the types of mosquitoes that transmit malaria. Also, since the percent of picaridin is low, this repellent may only protect against bites for 1-4 hours.
At this time, use of other repellents is not recommended for the prevention of malaria because there is insufficient data on how well they protect against the mosquitoes that transmit malaria.
Precautions When Using Any Repellent
Read and follow the directions and precautions on the product label.
Use only when outdoors and thoroughly wash off the repellent from the skin with soap and water after coming indoors.
Do not breathe in, swallow, or get repellent into the eyes or mouth. If using a spray product, apply to your face by spraying your hands and rubbing the product carefully over the face, avoiding eyes and mouth.
Never use repellents on wounds or broken skin.
Pregnant women should use insect repellent as recommended for other adults. Wash off with soap and water after coming indoors.
Repellents may be used on infants older than 2 months of age.
Children under 10 years old should not apply insect repellent themselves. Do not apply to young children’s hands or around their eyes and mouth.
Using Repellents With DEET
Do not get repellent containing DEET into the mouth. DEET is toxic if swallowed.
Higher concentrations of DEET may have a longer repellent effect; however, concentrations over 50% provide no added protection.
Timed-release DEET products, which are micro-encapsulated, may have a longer repellent effect than liquid DEET products. Re-apply as necessary, following the label directions.
Using Repellents With Picaridin
Spray enough picaridin repellent to slightly moisten skin.
Reapply repellents with picaridin (7% picaridin is the only product currently available in the United States) every 3 to 4 hours. Do not apply more than 3 times a day.
Picaridin repellent causes moderate eye irritation. Avoid contact with eyes. If in eyes, wash with water for 15 to 20 minutes.
Other Recommended Anti-mosquito Measures
Travelers should take a flying insect spray on their trip to help clear rooms of mosquitoes. The product should contain a pyrethroid insecticide; these insecticides quickly kill flying insects, including mosquitoes.
Travelers not staying in well-screened or air-conditioned rooms should sleep under bed nets (mosquito nets), preferably nets treated with the insecticide permethrin. Permethrin both repels and kills mosquitoes as well as other biting insects and ticks. In the United States, permethrin is available as a spray or a liquid (e.g. Permanone™). Pre-treated nets, permethrin or another insecticide deltamethrin, are available overseas.
For information on ordering insecticide-treated bed nets: www.travmed.com, phone 1-800-872-8633, fax: 413-584-6656; or www.travelhealthhelp.com, phone 1-866-621-6260.
Protect infants (especially infants under 2 months of age not wearing insect repellent) by using a carrier draped with mosquito netting with an elastic edge for a tight fit.
Clothing, shoes, and camping gear, can also be treated with permethrin. Treated clothing can be repeatedly washed and still repel insects. Some commercial products (clothing) are now available in the United States that have been pretreated with permethrin.
end of CDC text.
An excellent reference by Sherri. Here are some CDC recommendations regarding malaria in Honduras (that is, for P vivax, which is the only species of concern in Honduras). This information is part of a more general article on the CDC website at:
www.cdc.gov/travel/regionalmalaria/camerica.htm
Hope this is helpful to each of you. You should all take your anti-malaria medicine starting 06-29-07 (or before), and continue it one pill per week on the same day of the week for each week you are in Honduras and for four weeks after you return from Honduras, last dose August 3, 2007. Follow the above schedule unless your physician has advised you to do it differently. The anti-malarial medication of choice is chloroquin, 500 mg each week according to the above schedule.
It is also helpful to use an insect repellent containing DEET. There are several diffenent preparations available, of varying concentrations. I recommend at least 25% DEET, since the higher concentrations are longer lasting. Note the reasons one might not use DEET in the CDC article. Concentrations of DEET greater than 50% do not provide additional benefit.
Mosquitos which carry malaria bite at night, so I do differ with CDC in regard to using insect repellent indoors and at night...I do it and recommend that each of you use the mosquito repellents at night as well, especially when we are staying in local Honduran homes. In addition, DEET is a most effective insect repellent for other critters and works during the day as well.....
Below is selected text from CDC at the above url.
In addition, be sure to bring all prescription medicines your physisian has advised you to take, in <your> prescription bottle/container (this is a customs issue..please do it this way). It is helpful for you to write down and bring with you, a list of each medicine you take, its strength and how often you take it, as well as a list of medicines to which you are allergic. (Please include all prescription medicines as well as all over the counter medicines, supplements and so forth....if you take it, I would be pleased to know about it). I will have temporary medical history forms with me on the trip, and will ask each of you to fill one out for me. I will keep them for the duration of the trip and destroy them after we return, unless one of us becomes ill enough to require treatment after we return, in which case, with your permission, I will make it available to you and/or your physician.
If you have questions regarding health issues and travel, please discuss these concerns with your physician or email me and I will be happy to discuss same with you or your physician. Call or email for any questions regarding the above information or any other questions. No one has become seriously ill after returning from our trips to Honduras, and God willing, that will continue to be the case.
best regards to all/looking forward to our trip together,
In His Service,
tom arnold, md
CDC text follows:
Transmission and Symptoms
Malaria is a serious disease transmitted to humans by the bite of an infected female Anopheles mosquito. Symptoms may include fever and flu-like illness, including chills, headache, muscle aches, and fatigue. Malaria may cause anemia and jaundice. Plasmodium falciparum infections, if not immediately treated, may cause kidney failure, coma, and death. Malaria can often be prevented by using antimalarial drugs and by using protection measures to prevent mosquito bites. However, in spite of all protective measures, travelers may still develop malaria.
Malaria symptoms will occur at least 7 to 9 days after being bitten by an infected mosquito. Fever in the first week of travel in a malaria-risk area is unlikely to be malaria; however, any fever should be promptly evaluated.
Malaria Risk by Country
Honduras: Rural areas only, including all areas (including resort areas) on Roatán and other Bay Islands.
Prevention
All travelers to malaria-risk areas in Mexico and Central America (except for Darién Province and San Blas Province in Panama; see below for those areas), including infants, children, and former residents of these countries, should take chloroquine as their antimalarial drug.
Travelers to Darién Province and San Blas Province in Panama (including the San Blas Islands) should take one of the following antimalarial drugs (listed alphabetically):
atovaquone/proguanil,
doxycycline,
mefloquine, or
primaquine (in special circumstances).
Most antimalarial drugs are well-tolerated; most travelers do not need to stop taking their drug because of side effects. However, if you are particularly concerned about side effects, discuss the possibility of starting your drug early (3-4 weeks in advance of your trip) with your health care provider. If you cannot tolerate the drug, ask your doctor to change your medication.
Chloroquine (brand name Aralen™ and generics)
Directions for Use
The adult dosage is 500 mg chloroquine phosphate once a week.
Take the first dose of chloroquine 1 week before arrival in the malaria-risk area.
Take chloroquine once a week, on the same day of the week, while in the malaria-risk area.
Take chloroquine once a week for 4 weeks after leaving the malaria-risk area.
Chloroquine should be taken on a full stomach to lessen nausea.
Chloroquine Side Effects
The most common side effects reported by travelers taking chloroquine include nausea and vomiting, headache, dizziness, blurred vision and itching. Chloroquine may worsen the symptoms of psoriasis. Most travelers taking chloroquine do not have side effects serious enough to stop taking the drug. Other antimalarial drugs are available if you cannot tolerate chloroquine; see your health care provider.
Contraindications
The following travelers should not take chloroquine (other antimalarial drugs are available; see your health care provider):
patients allergic to chloroquine
Protect Yourself from Mosquito Bites
Malaria is transmitted by the bite of an infected mosquito; these mosquitoes usually bite between dusk and dawn. To avoid being bitten, remain indoors in a screened or air-conditioned area during the peak biting period. If out-of-doors, wear long-sleeved shirts, long pants, and hats. Apply insect repellent (bug spray) to exposed skin.
Choosing an Insect Repellent
For the prevention of malaria, CDC recommends an insect repellent with DEET (N, N-diethyl-m-toluamide) as the repellent of choice. Many DEET products give long-lasting protection against the mosquitoes that transmit malaria (the anopheline mosquitoes).
A new repellent is now available in the United States that contains 7% picaridin (KBR 3023). Picaridin may be used if a DEET-containing repellent is not acceptable to the user. However, there is much less information available on how effective picaridin is at protecting against all of the types of mosquitoes that transmit malaria. Also, since the percent of picaridin is low, this repellent may only protect against bites for 1-4 hours.
At this time, use of other repellents is not recommended for the prevention of malaria because there is insufficient data on how well they protect against the mosquitoes that transmit malaria.
Precautions When Using Any Repellent
Read and follow the directions and precautions on the product label.
Use only when outdoors and thoroughly wash off the repellent from the skin with soap and water after coming indoors.
Do not breathe in, swallow, or get repellent into the eyes or mouth. If using a spray product, apply to your face by spraying your hands and rubbing the product carefully over the face, avoiding eyes and mouth.
Never use repellents on wounds or broken skin.
Pregnant women should use insect repellent as recommended for other adults. Wash off with soap and water after coming indoors.
Repellents may be used on infants older than 2 months of age.
Children under 10 years old should not apply insect repellent themselves. Do not apply to young children’s hands or around their eyes and mouth.
Using Repellents With DEET
Do not get repellent containing DEET into the mouth. DEET is toxic if swallowed.
Higher concentrations of DEET may have a longer repellent effect; however, concentrations over 50% provide no added protection.
Timed-release DEET products, which are micro-encapsulated, may have a longer repellent effect than liquid DEET products. Re-apply as necessary, following the label directions.
Using Repellents With Picaridin
Spray enough picaridin repellent to slightly moisten skin.
Reapply repellents with picaridin (7% picaridin is the only product currently available in the United States) every 3 to 4 hours. Do not apply more than 3 times a day.
Picaridin repellent causes moderate eye irritation. Avoid contact with eyes. If in eyes, wash with water for 15 to 20 minutes.
Other Recommended Anti-mosquito Measures
Travelers should take a flying insect spray on their trip to help clear rooms of mosquitoes. The product should contain a pyrethroid insecticide; these insecticides quickly kill flying insects, including mosquitoes.
Travelers not staying in well-screened or air-conditioned rooms should sleep under bed nets (mosquito nets), preferably nets treated with the insecticide permethrin. Permethrin both repels and kills mosquitoes as well as other biting insects and ticks. In the United States, permethrin is available as a spray or a liquid (e.g. Permanone™). Pre-treated nets, permethrin or another insecticide deltamethrin, are available overseas.
For information on ordering insecticide-treated bed nets: www.travmed.com, phone 1-800-872-8633, fax: 413-584-6656; or www.travelhealthhelp.com, phone 1-866-621-6260.
Protect infants (especially infants under 2 months of age not wearing insect repellent) by using a carrier draped with mosquito netting with an elastic edge for a tight fit.
Clothing, shoes, and camping gear, can also be treated with permethrin. Treated clothing can be repeatedly washed and still repel insects. Some commercial products (clothing) are now available in the United States that have been pretreated with permethrin.
end of CDC text.