I'm travelling to India in about three or four weeks. Because I'm going to be spending most of my time in Sikkim, ie at high altitudes, the travel clinic I visited suggested that malaria medication wasn't absolutely necessary. I've since read elsewhere that you are relatively less likely to be infected at higher altitudes. However, on my way to Sikkim, I plan to pass through Darjeeling. As this is also at a high altitude, I was under the impression that it would be relatively OK, but have read about a fatal outbreak of malaria in the area that would appear to contradict this. Can anyone shed any light on this, as I'm a tad confused?

Cheers.

Yes, the malaria issue can be quite confusing. Most medical professionals agree that the best way to avoid getting diseases like Malaria, which are transmitted by mosquitoes, is to avoid being bitten. (This mode of thinking can be compared to abstinence. It works in theory, but...) Wear as much clothing (long sleeves, pants and socks) as you can. (Please see the Mosquito Protection section of "Quit Dreaming and Go!" at www.laptophobo.com/qdg) On exposed skin, use DEET (Diethylmethylbenzamide). Even just a 15% solution is very effective, but can irritate skin if used too often or improperly. The DEET-less citronella repellents can also be effective. When you sleep, use a mosquito net and/or burn a mosquito coil. Having a fan blowing directly on you also helps a great deal.

Aside from protecting yourself from bug bites, there are prophylactic pills you can take, such as Chloroquine Phosphate or Mefloquine. These medications are widely available, but provide only partial protection and can have side effects. Many travelers (such as yours truly), because of the side effects (and ineffectiveness), choose not to take the pills and accept the risk. Treatment for the disease in areas where it is prevalent is often good because of local doctors’ experience with the disease. Malaria tablets are very expensive in the U.S. and European countries, but are far cheaper in countries where malaria is a problem. In some parts of the world, anti-malarials simply don’t work and many medical professionals say that if you contact Malaria while taking the pills, it can be more difficult to treat. My opinion is that if you plan to be in a high-risk Malaria area for three months or less, then go ahead and take the pills. If you will be in a Malaria area for more than three months, you may only want to take the pills in the higher risk areas.

If you experience severe side-effects, you may want to discontinue use. However, note that these medicines are not effective if taken intermittently. Also, the exact medicine recommended is different for different places due to resistant strains of the Malaria parasite. I strongly recommend you research this subject further, consult your Immunologist (who will probably confuse you even more), the CDC and books such as Staying Healthy in Asia, Africa & Latin America.

So, in a nutshell, be cautious and you won't need to take those nasty pills. And, anyway, Malaria is generally not fatal.

Ricardo
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