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SCUBA-L  November 1999, Week 2

SCUBA-L November 1999, Week 2

Subject:

Malaria - Loooooong

From:

Christian Gerzner <[log in to unmask]>

Reply-To:

Scuba diving discussion list <[log in to unmask]>

Date:

Tue, 9 Nov 1999 09:53:28 +1100

Content-Type:

text/plain

Parts/Attachments:

Parts/Attachments

text/plain (167 lines)

Folks,
 
Recently we had a bit of a discussion on this perennial problem  and so
I decided to go to the "horse's mouth" as it were and I asked my mate
Rod Pearce, owner of the "Barbarian", an itsy bitsy liveaboard plying
(mostly) between Lae and Alotau in Papua New Guinea
<http://www.diversionOZ.com/> and follow the links. Rod is the typical
laconic Ozzie but born and bred in PNG. He found both the "Blackjack", a
B52 bomber in 47 metres (154ft), and the S'Jacob, an armed freighter in
(up to) 59 metres (193.5ft. They're the more important ones he
found and I did a pretty evocative piece on the S'Jacob some time ago
under <The Best Wreck I've Ever Done">.
 
Rod, being a man of few words, especially written ones, passed the buck.
 
What follows below my sig is the response I got. I purposely didn't put
it into quotes because I just know how those are pesky if you want to
pass the information along. I have, to the best of my ability, cleaned
up the text somewhat. I've probably missed a few bits.
 
Cheers, HTH
 
Christian
 
CHEMCARE
Morobe Pharmacy
P.O. Box 349, Lae, Papua New Guinea
Phone (675) 4726195  Fax (675) 4726590
Email: [log in to unmask]
 
RE: Malaria in the Highlands of Papua New Guinea
 
Christian,
 
I am making contact with you on behalf of Rodney Pearce of =91BARBARIAN=92=
 
regarding your email about malaria in the highlands.
 
In short, malaria has become a recognised problem in the highlands in
recent years although I have seen  data available through the MALARIA
SURVEILLANCE UNIT based in Goroka suggesting that there have always been
some malaria problems up off the coastal regions.
 
The growth in the problem is attributed to a number of factors:
 
1) Increased movement of the population between the coast and the
highlands because of improved transport facilities and roads and
increased economic activity in the population
 
2) Movement of the Anopheles Mosquito (carrier of malaria) into the
region, presumably due to the environmental changes, namely a general
warming of the climatic conditions in the highlands caused by
deforestation and global warming.
 
The combination of the above has resulted in more people who are
infected with the malaria parasite on the coast travelling to the
highlands, where having been bitten by existing populations of the
Anopheles Mosquito, they then transmit the infection throughout the rest
of the population.
 
Note:
 
-The Anopheles Mosquito has been  clearly identified as existing in the
Goroka, Mt Hagen and other various Southern Highlands regions, by the
Malaria Surviellance Unit in Goroka
 
-Your are quite correct in assuming that the spread of malaria is
altitude and thus temperature dependent, however, these factors are not
absolute barriers to the spread of the infection ... for example, if a
client was to fly direct to Mt Hagen to attempt an ascent of Mt Wilhem,
avoiding any lengthy stay on the coast, there would be no guarantee that
the person would not be bitten by a malaria-carrying mosquito.
 
To conclude, our best advice to all travellers to PNG, is to take all
precautions against malaria infection  no matter where they intend to go
=2E.. coast, highlands and all in between.
 
The level of protection required will depend on a number of factors:
-For example, someone staying just in Port Moresby for a couple of days
will have an extremely low risk of contracting malaria due to the
dryness of the climate there and the lack of breeding habitat for the mos=
quito.
 
-Someone staying in one of the coastal provincial centres, e.g. Lae,
Madang , Wewak etc, going on bushwalks around the centre and say off the
dive boat during the course of a charter would have to look at maximum
protection both externally (clothing, repellents etc) and with oral medic=
ation.
 
Preventative Medication ... in order of effectiveness and increasing
side effects: Adult doseage only
 
a) DOXYCYCLINE 100mg Tablets: One tablet daily with food,take at the
same time each day.  (This drug is ONLY for prevention,it has NO
efficacy when taken on it=92s own in treatment=85must be combined with ot=
her
drugs during treatment)
 
b) PALUDRINE 100MG Tablets: Take TWO tablets daily with food, take on
the same day each week, at the same time. **This drug has only recently
re-emerged for use ... in the 1960=92s and 1970=92s, the excessive usage =
of
the drug lead to high resistance in malaria strains, resulting in a
virtual zero effectiveness as a  preventative treatment ... the lack of
use over the 1980=92s and early 1990=92s has allowed the resistant strain=
s
to dissipate and allow the use of the drug once again ... especially in
children who have allergic problems with Chloroquine.
 
c) CHLOROQUINE 250MG Tablets: TWO tablets ONCE a week with food. Take on
the same day each week, at the same time. **Chloroquine 250mg
Tablets=3DChloroquine BASE 150mg Tablets
 
d) CHLOROQUINE 250MG TABLETS x 2 plus MALOPRIM TABLET x 1: Take this
combination ONCE a week, with food. Take on the same day each week, at
the same time. ***This particular combination (Chloroquine plus
Maloprim) has fallen out of recent recommendations due to the adverse
effect of Maloprim on liver function and blood counts =
 
 =
 
e) MEFLOQUINE (Lariam) 250mg Tablets: Take ONE tablet ONCE a week, with
food. Take on the same day  each week, at the same time. **This drug is
recognized as the strongest preventative treatment currently available,
however, Health Department recommendations here are that the drug only
be used in the short term by transient travellers and is not to be used
in the long term (longer than 3 months =3D 12 doses) to avoid possible
resistance developing and adverse effects caused by extended use ...
sleep disorders, liver function/blood count abnormalities.
 
****Regardless of which drugs  above are used, the schedule must begin
at least two weeks prior to departure (to make sure there are no
immediate allergy or adverse effect problems), while in the exposed
region, and for at least 4 weeks after leaving the region (malaria can
have up to 7 days of incubation prior to onset, thus medication must be
continued to eliminate any primary stages of the disease).
 
The major adverse effects associated with all of the above are basically
two areas: gastrointestinal ... stomach discomfort, cramps, diarrhoea,
some skin disorders ... most common in short term use, typically
holidaymakers and travellers. The effects of greater concern ... organ
function, blood counts ... are usually associated with the long term use
by residents and contract workers etc.
 
In conclusion, one must remember that not every person who visits PNG
contracts malaria ... yes they do get bitten, sheer mosquito numbers
dictate that especially on the coast, however every bite is NOT
necessarily a transmission ... the key to a safe holiday is sensible
prevention, namely appropriate clothing, repellents and medication
suitable for the age and medical history of the person (hence a need for
consultation with a qualified medical practitioner).
 =
 
The above information has been developed through my experience of
operating in retail pharmacies in PNG over the last six years, dealing
with the national population, expatriates and tourists ... I  have
worked in Alotau, Port Moresby and, currently, Lae ... I work for a
company operating fourteen pharmacies throughout PNG, from the coast to
the highlands.
 
I hope this helps ... if you require any detailed information regarding
TREATMENT of malaria, please let me know and I shall send you the
relevant information.
 
Homer Caris B.Pharm
Manager

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