Dr. George Kornreich is a retired physician and a sailor, who volunteers in a medical assistance project in the South Pacific nation of Vanuatu. The group he works with brings medical care to some of the most remote island villages of that nation, where the only reliable access is by sailboat. He contacted us about an article that had appeared on our web site about malaria in Vanautu. This led to an email exchange with Steve Dashew, who survived a bout of chloroquin-resistant malaria in Port Moresby, New Guinea in the 1970s.
His email contained a wealth of valuable info about preventing malaria, and he has kindly agreed to let us post that correspondence here. He may be able to follow up soon with additional data.
Hi, Steve, I guess ANY survivor of Port Morseby is a lucky person! The problem that you probably ran into was that chloroquin resistance is a growing threat in the South Pacific, particularly in Vanuatu, the Solomon Islands and PNG. For that reason, the Center for Disease Control no longer recommends prevention or treatment with Chloroquin there.
For prevention of malaria in areas of Chloroquin resistance, the traveler/cruiser should definitely take prophylactics, and that should consist of either Larium, Malarone, or Doxycycline. We talked before about some of the differences between Malarone and Larium. I forgot to mention then that the most unpleasant common side effect of Larium is the occurrence of vivid dreams. These are not nightmares but are so realistic that even some of the investigators testing the drug stopped taking it! Most of the folks I’ve questioned about this, however, did not experience this problem.
Any illness with fever and/or headache in that area part of the world should be considered to be malaria until proven otherwise by blood tests. If one is in an area where medical services are available, with a lab familiar with malaria testing, a blood test should be done. If this is not the case, one should begin self-treatment, and this requires use of a drug other than the one that was used for prevention (as it obviously didn’t “prevent” in this case). Usually, that would consist of Fansidar, 3 tablets as a single, one-time dose, or Larium, if the preventative medication was Malarone or Doxycline. If it then turns out later by blood testing that the malaria was caused by P. vivax, follow-up treatment should by taken with Primaquin, as that form of malaria forms liver cycts, and may relapse frequently.
I have some experience with a fast blood test done using a plastic slide, similar to a pregnancy test, and which requires only a drop or two of blood from a finger or ear-lobe stick, that anyone can learn to do. They are made by Cellabs, in Australia, ( www.cellabs.com.au ) and are very accurate. I would suggest that this be included in the ship’s medical pack. They do not require refrigeration, but I would be careful about the expiration date. The shelf life is apparently not too long. I am currently looking into sources to purchase them in small quantities, and will keep you advised.
I’ve been having a problem regarding assuring the availability on the market of malaria blood tests in small (read “less than 48 tests”) quantities for the cruiser and traveler. It seems that the manufacturer (Daimed of Switzerland) had recently changed the format of the test to one which is easier to use for the non lab-technician, but the packaging into small kits is promised but may not yet have hit the market. I used this product in Vanuatu last year, and it was excellent. There are other tests on the market, but they are next to useless, as they only check for one out of 4 species of the parasite, transported by the mosquito, that causes malaria in most parts of the world. At this point, I am about to call the distributors in Australia (for the South Pacific) and see what the status is.
I’ll be able to write more soon, as they should have definitive information by now. The issue of the test kits is so critical to the current situation in malaria prevention and treatment that I feel the information regarding availability must be current and accurate.