Philippine Malaria / Mosquito Map / Dengue Fever Map

[fred]

3. Containing citriodiol ( oil of lemon eucalyptus). Example :- "Mosi-Guard". A natural repellent, non-sticky, non-toxic, safer on sensitive skins and for children, harmless to most plastics / fabrics. But more expensive, may need more frequent re-application.

In regards application,it seems to last far longer than the OFF lotion ..Might be because its oiler which keeps it active..6-8 hours sounds about right..

Insect repellents are part of that protection, together with protective clothing, nets, fans and air conditioning where possible.

Fans are a great mozzi deterrent but air conditioning on its own is practically useless in my experience.. Lets not forget that they thrive and bite in Siberia!

Mozi-Guard insect repellent is an excellent product, although it is rather smelly with a pungent citronella(lemon) smell. .... I bet Fred smells very sexy though

I actually like the citronella smell..
As long as the Mozzies dont find me sexy I`ll call it a result!!

[fred]

This is next on my shopping list..Cant get them here yet but something I would say is a really good balikbayan box item from the UK if planning to live here or anywhere else mozzies or midges thrive...Like Scotland!

[Doc Alan]

Biting insects, including the 2,500 different species of mosquitoes, are not usually active (although they may survive) at temperatures below 10 degrees. Even in the north of Siberia, Verkhoyansk - one of the coldest places in the world - has temperatures above 10 degrees in summer, often above 20 degrees. Similarly midges breed in Scotland from April to October, and "Autan" is a good repellent. How long repellents last depends, among other factors, on the concentration bought (DEET varies from 20% to 95%). Temperature is important, but malaria is endemic in tropical or subtropical regions - and not elsewhere - for other reasons. There are a million deaths every year from malaria, 90% in Sub-Saharan Africa, shameful considering there is effective prevention and treatment at a cost, if only there were the resources available.

[KeithD]

I've now attached a Dengue Fever Map to the first post. You may also like to read this on Dengue Fever in the Philippines. http://www.ifrc.org/docs/appeals/rpt...ep29071001.pdf

[KeithD]

One other point, which is very important, is that when purchasing anti-malaria tablets, DO NOT buy those with chloroquine in, as the mosquitos in the Philippines have resistance to it, usually Nivaquine or Avloclor. Because of this resistance it means the type of infection is Plasmodium Falciparum malaria which is the most serious form of the disease, which covers about 70% of cases. The remaining 30% is Plasmodium vivax. Falciparum malaria, if not treated straight away, can lead to severe malaria, such as cerebral malaria. However Plasmodium vivax malaria does not lead to cerebral malaria but it can cause relapse if treatment was not completed.

Recommended anti-malaria drugs for the Philippines:
Mefloquine one 250mg tablet weekly or
Doxycycline one 100mg capsule daily or
Malarone one tablet daily

I'd go with Mefloquine (Lariam) weekly myself. So for a 3 week trip you would require 10 tablets, as you need to start taking them 3 weeks prior to leaving, and continue for a month after you return.

Side-effects of all these meds are listed here: http://www.doctorfox.co.uk/news/mala...-side-effects/

[Doc Alan]

It's vital that the information given on this thread is accurate, and to my knowledge what Keith says in this post (35) is correct. Note that drugs for malaria prophylaxis (prevention) are not prescribable on the NHS. Treatment is of course on the NHS ; prophylaxis is not absolute and if the patient has already taken prophylaxis, different drugs will be used.
Obviously we can't give precise recommendations for every member. Take into account : risk, extent of drug resistance, side effects, and patient-related factors ( age, pregnancy, general health such as kidney / liver disease ). Falciparum malaria is particularly dangerous in pregnancy, especially in the last trimester.
The British National Formulary (www.bnf.org) gives advice for UK residents travelling to endemic areas, agreed by malaria specialists, and I have always confirmed with it before posting.
For those requiring long term prophylaxis, Mefloquine is licensed for up to a year ( but has been used for up to 3 years without undue problems) ; Doxocycline can be used for up to 2 years ; Malarone is licensed for up to 28 days, but can be used for up to a year ( possibly longer ) with caution - take specialist advice.

[fred]

Keith... Thanks for the Dengue map.. Do you have a virtual magnifying glass to go with it?

[Englishman2010]

Keith... Thanks for the Dengue map.. Do you have a virtual magnifying glass to go with it?

I was going to ask the same question Any chance you can post a larger version Keith?

[KeithD]

I've fixed the map

[Englishman2010]

I've fixed the map

Much better now, thanks

[KeithD]

Blind

[Maria B]

In 30 years of travelling throughout the R.P Ive never once met any foreigner or Filipino that has suffered with Malaria!! Ever!!
IMO that map is a crock of .... and not something I would be concerned with..

I agree with you Fred. I'm from Cebu and I only heard once, a malaria victim who was an achorman (covering some news in the forest) who travels northern part in the forest in the upper Luzon. That was quite a long time ago after college that I cannot remember the name of the place. My husband first visited me in 2006 & told him that he doesn't need a malaria jab.

[worthingmale]

had Mosquitos in Palawan, and in Davao but had the air con on cold so they didnt like the room

[Maria B]

had Mosquitos in Palawan, and in Davao but had the air con on cold so they didnt like the room

for as long as it's not a malaria or dengue mosquito...
If it's rainy season in the Phils....always close the window & doors before 6pm as the mosquito starts wandering around

[KeithD]

The only mosquito I saw in Cavite was a dead one!!! I didn't both with the pills or repellents, but then I wasn't wandering around much, especially after dark.

[Doc Alan]

I agree with you Fred. I'm from Cebu ... My husband first visited me in 2006 & told him that he doesn't need a malaria jab.

If you read my posts you will know that Cebu and Bohol ( where Fred lives ) are two of an increasing number of provinces which are malaria - free, so it's unsurprising you have not seen a case. That does not mean all provinces are yet malaria - free, however. There is also no such thing as a " malaria jab " - no vaccination is currently available. In another thread in the Health Section ( " Malaria in Cavite ... " ) my post gives up to date information, with a useful link ( http://www.actmalaria.net/downloads/...hilippines.pdf ) *
It's very important that members get the correct advice about malaria, so they can make an informed judgement as to whether or not they take the correct malaria tablets, which are doxocycline or mefloquine for the Philippines. Travel insurance may NOT cover claims for treatment of malaria ( or any other tropical disease ) where the recommended medication ( or vaccination ) has not been given.
* In that link the map shows : Category A ( red ) = 1000 + cases / year ; Category B ( blue ) = 100 - 999 cases / year ; Category C ( yellow ) = less than 100 cases + significant reduction in last 5 years ; Category D ( green ) = malaria- free provinces.

[scott&ligaya]

I have stayed on and off in Palawan north of the main city in a reasonably rural site since 2006.. My wife and little ones (3 1/2yrsand 1 1/2yrs) were there for 13 months. As long as you take sensible preacautuions in the late afternoon and evening, long loose light weight clothings, occasional smoke coil on verandas, electronic device in bedrooom and close all the screens around 4pm then no problem. We also use repellant when it has been raining. Have heard of one Dutch/Filipino 9 yr old who got Dengue after spending a day with his family at a more remote beach/cove, but as long as you know to recocgnise symptoms quickly it is lke a bad flue.. although in the provinces ignorance can lead to death. Basically Palawan is NOT malaria free in the areas away from the main towns like Roxas, Aborlan, PPS San Vincente, Port Barton and Coron

[Terpe]

I recently read an interesting article claiming that a daily intake of 300mg Thiamin (Vitamin B1) works wonders for the prevention of mosquito bites.
(It said it takes a full 3 days before maximum effectiveness is reached.)

I did some research and it seems Thiamin (Vitamin B1) is pretty useful stuff
Also it seems that there’s no known toxicity from taking 300 mg Thiamin (Vitamin B1) supplements a day.

Thiamin (Vitamin B1) is water-soluble, so you do in fact need some every day anyway.

From my research I understood that Thiamin’s importance is related to the conversion of carbohydrates in food into energy the body can use.
It is apparently also needed to keep the brain and nervous system charged up.

Anyway, maybe it's worth trying to prevent mosquito bites.

Anyone got experience of this??

[andy222]

Mozzie Guard? Where do i get that from guys?

[Englishman2010]

. Basically Palawan is NOT malaria free in the areas away from the main towns like Roxas, Aborlan, PPS San Vincente, Port Barton and Coron

Thanks Scott, I was thinking about this again earlier. I never take Malaria tablets anywhere else in the Phil's but I did take them when I went to PPS Palawan in January, and was thinking about it again when I go back to El Nido and Busuanga/Coron in a few months time. I'll probably take them again, better to be safe than sorry

[Doc Alan]

I'll probably take ( malaria tablets ) again, better to be safe than sorry

Very wise Ian, and I'm sure you've read my #46 above, which is the most up to date information I can find .

[Englishman2010]

Very wise Ian, and I'm sure you've read my #46 above, which is the most up to date information I can find .

I certainly have Doc, and thanks for your ongoing good advice on medical matters ...and I always listen to a Doctors advice, except when they tell me to stop smoking

[Doc Alan]

Elsewhere there has been further discussion about avoiding mosquito bites (http://filipinaroses.com/showthread....hlight=malaria ). Some are more susceptible than others.
Even if you are bitten, the risk of malaria is from low to non-existent, depending on which part of the Philippines you’re visiting, or live in ( see above ). Should you decide on prevention, the recommended drugs ( this thread ) haven’t changed. Although the Department of Health reported 36,000 cases ( 42/100,000 ) in 2005, there were only 162 deaths ( compared to 26,000 from TB ) in the following year. The commonest, and most serious, type is due to Plasmodium falciparum ( there are three others ).
Worldwide, the bad news is that malaria deaths may be 1.24 million, almost twice previous estimates, according to a reliable Seattle team funded by the Bill and Melinda Gates Foundation ( http://www.thelancet.com/journals/la...034-8/fulltext ).
However, as in the Philippines, the best estimates are that malaria deaths have steadily decreased – by a third - between 2004 and 2010. Most are still in Africa, and in children ( where ¼ children die from malaria ). We always used to think that children exposed to malaria either died, or acquired immunity, so rarely dying from malaria as adults. What has now been shown is that in Africa a third of all deaths, and two fifths elsewhere, are actually in adults. In part this is explained by drug treatment of mothers, decreasing children’s immunity. We still don't fully understand acquired immunity. Of course visitors to malarial areas such as European tourists have NO immunity, which is why prevention should be taken seriously.
We don’t – and can’t – have completely reliable figures for malaria numbers around the world .
However, in the past decade about 230 million cases have been treated, and the same number of bed nets distributed to those at risk. Although eradication is not yet possible, there’s hope the number of deaths will keep falling – to less than 100,000 by 2020 .

[Steve.r]

Interesting Alan, thanks

I think it impossible to believe it can ever be eradicated though.

[Doc Alan]

This summarises dengue ( thanks to Maria ) :-

More detail here :- http://www.nhs.uk/Conditions/dengue/...roduction.aspx
Even more here :-
http://whqlibdoc.who.int/publication...547871_eng.pdf ).
As we all know, dengue fever is a mosquito-borne disease caused by dengue viruses ( DV ). We also know severe forms of dengue infection can be fatal and are a leading cause of hospital admission in many parts of the world, not just Philippines. There has been a 30-fold increase in the number of dengue cases in the past 50 years.There are an estimated 50—100 million infections each year. It’s especially common in southeast Asia ( over 120,000 cases, but under 200 deaths, in Philippines in 2010 ), but dengue has spread throughout Latin America and more than half of the world's population now lives in dengue-endemic countries. Increasing numbers of travellers return from endemic regions with dengue, and there are now a few cases of locally acquired dengue in the USA and Europe. You should always tell your doctor of recent travels, if you do have fever or other symptoms after coming back to UK.
What’s new ?
The first Association of Southeast Asian Nations (ASEAN) Dengue Day was held last June, to focus attention on dengue and the need to develop more effective prevention and control strategies. ASEAN member states represent more than 600 million individuals who bear the major part of the global burden of dengue. The ASEAN Dengue Day was an example of the shift from reactive programmes to forward planning.
A World Dengue Day has been proposed, to underscore the effects of dengue and encourage a global response. Greater awareness of the disease, together with new diagnostics, drugs, and vaccines, should help to make dengue a preventable disease.
As there is no cross-protection between the 4 DV serotypes, only a "tetravalent " vaccine – working against all 4 types - is acceptable. Despite many years of work, progress in DV vaccine development has been slow. DV grows poorly in cell culture and there is no reliable animal “ model “ for dengue ( DV only infects humans ). Tetravalent DV vaccines have so far been disappointing ( compared to " monovalent " vaccines, acting on only one type ).
However, one such vaccine, developed by France’s Sanofi Pasteur, is undergoing a 4 year “Phase III” clinical trial, the final hurdle before it becomes available to the public. I understand this is being carried out in San Pablo, Laguna and Cebu province.
It could be cut short especially if no dangerous side effects are found or if the authorities and regulatory bodies including the World Health Organization and the United States Food and Drug Administration “ fast track “ approval.
Reasons to be cheerful !

[Doc Alan]

Unlike other infections, dengue is usually more severe the second time round, as a member ( Chiechie ) has described in another thread ( http://filipinaroses.com/showthread....engue-Mosquito ).
• There is still no specific treatment or vaccine. It’s complicated because there are four different types of virus causing dengue ( serotypes – DEN-1, DEN-2, DEN-3, and DEN-4 ). Recovery from one gives lifelong immunity, but infection by other serotypes increases the risk of severe dengue. It does this by “ confusing “ the immune response ( antibodies and “ T cells “ ). Recent work in several centres round the world has confirmed this. It has slowed development of a vaccine, although there is hope at least one ( being tested in Philippines and Thailand ) will be available by 2015.
• Despite the increase in dengue – endemic in over 100 countries, including Philippines – it is not usually fatal. Good medical care means less than 1% deaths ( although possibly 5% of the estimated 50 – 100 million worldwide cases do prove fatal ).
• It’s a mosquito-borne infection and the only methods to control dengue are by targeting the mosquitoes.
• Last year the Philippines Department of Health ( DOH ) unveiled a campaign “ AKSYON BARANGAY KONTRA DENGUE “ ( ABaKaDa ) to encourage community action. This includes Search and destroy mosquito sites (covering water containers ), Self-protection ( long-sleeved shirts, mosquito repellents ), and Seeking early advice/ consultation at the nearest health center.
• So far this year the DOH has reported around 19,000 cases ( 25% lower than last year ), with 107 deaths ( less than 1% ) – although there were more cases in three regions ( Zamboanga, Davao and Bicol ).

[Iani]

Last thing I want to do is trivialise dengue or malaria, but a bit of common sense and understanding of the mossies will go a long way.

Generally, dengue is a different mossie, is active during the day, and at low levels (walking around by the pool = maybe putting yourself at risk. Also sitting at the bar?

It's not what people want to do, but wearing long pants, socks (grief) may help, as it's the lower areas most at risk of being nibbled.

Malarial ones, well they are more active at night, especially in the rainy season, and it frankly doesn't matter if you're high or low.

Fans are said to confuse them.

Oh and allegedly, the lemon body butter from body shop helps repel mossies - smells absolutely brilliant too. I used it a lot and can't tell if my bites were before or after smearing the stuff on at night, so..........well.

What I did notice in Thailand, was that they left me alone after eating the local food for a few days. Maybe it's the lemongrass

[Doc Alan]

Last thing I want to do is trivialise dengue or malaria, but a bit of common sense and understanding of the mossies will go a long way.

Thanks for your input. This thread is " sticky " ( unclosed ) because it does include common sense and understanding from many members, with regular updates from myself. 1.5 million deaths in the world, and countless more illnesses, due to mosquito transmission - every year - is no trivial matter.
It should not be long before we have a vaccine and specific treatment for dengue. Meanwhile it may help to explain - clearly and to the best of my knowledge - why they are taking so long to produce. I have done the same to explain the situation with malaria. Many members view this thread. Some have suffered malaria and dengue. All wish to avoid them. Information here should be accurate, and evidence - based.

[grahamw48]

Maybe it's the Thiamine in the beer.

[Doc Alan]

• Unlike the situation with dengue, there are specific drugs for malaria.
• The decision as to whether drugs should be taken rests with the individual and where exactly they intend to travel . Most travellers to the Philippines don’t take antimalarials.
• As the drugs need to be paid for, it’s important to choose the right ones for where you are going. Expect to pay 40 GBP for a course.
• Price should not be the only factor – up to a third of antimalarials on sale around the world - including South East Asia - are fake . The NHS will treat – for free - those unfortunate enough to be diagnosed with malaria on return to the UK.
• Drug resistance to front-line treatments for malaria is increasing. The parasite to worry about is Plasmodium falciparum, carried by mosquitoes.
• For the Philippines, these are the drugs to take : Mefloquine ( Larium ) 250 mg starting 1 - 3 weeks before travel, every week in the malarious area ; OR doxycycline ( Vibramycin ) 100 mg daily, starting 2 days before. Continue tablets for 4 weeks after leaving. Proguanil 100 mg and atovaquone 250 mg ( Malarone ) is a third choice – start 2 days before and continue for 1 week after leaving. They are over 90% effective. Possible side effects are too numerous to list here – consult your healthcare professional first, and read the instructions.
• Do NOT take chloroquine ( Avloclor, Nivaquine, or Malarivon ) alone or with proguanil ( Paludrine / Avloclor ), quinine, artemether with lumefantrine ( Riamet ), primaquine, pyrimethamine ( Daraprim ) or pyrimethamine with sulfadoxine. This is because of resistance or ineffectiveness or use in treatment of known malaria.
• For travel to other malarious areas, risk - and the recommended drugs - vary.