After checking the health risks that I may encounter in Vietnam, Malaria is one of them, according to the German Department of State (Auswärtiges Amt). By the way, checking for specific risks that you may be exposed to during your travels is something you should always do before you leave home. And do it well in advance so you can take the necessary precautions like getting vaccinated, if you believe vaccinations gives you protection.
Because I’m generally a very critical and cautious person, I did a thorough risk analysis to see what precautions I would want to take. Let’s start with Malaria, shall we?
Let’s see what Mr. and Mrs. Wikipedia have to say about Malaria. How about a nice map to start with?
Frequency and origin of malaria cases in 1996
- |||| High Risk
- |||| Medium Risk
- |||| Low Risk
- |||| Very Low Risk
- |||| No Risk
Source: Wikipedia on “Malaria” based on the data from CHU Hôpitaux de Rouen. Fréquence et origine des cas de paludisme
OK, according CHU Hôpitaux de Rouen Vietnam is classified as a “Low Risk” malaria region. Next up, let’s see what our folks from the CDC (Centers for Disease Control and Prevention) say. I’m sure they also have a nice chart prepared for us, yes?
Alright, so the CDC classifies Vietnam as an epidemic malaria country, but at the same time states that in most countries the malaria risk is limited to certain areas.
We therefore have two different independent sources of data and above that, from different years (1996 vs 2003). We’ll disregard how the data was collected and for simplicity purposes just assume that both data sources are reliable and were collected in the same fashion. We will further assume that the CDC is a reliable and independent source information (cough 
). I know, sometimes you have to stretch your imagination 
For the people that don’t know what I’m taking about, let’s just say that in the past and very recent history the CDC has been known to have very tight ties to the pharmaceutical industry. So overstating the malaria risk would be in the interest of the CDC.
We therefore need a more detailed breakdown of the malaria regions in Vietnam to make a better decision. Let’s try the following site: http://www.malariahotspots.co.uk/facts-maphotspots.asp
Malaria Hotspots sponsored by GlaxoSmithKline
This website rates malaria in Vietnam “Extremely High”, even though it states that “[...] does not necessarily mean that the entire country is affected, as malaria may be restricted to certain areas or regions.”1 Personally, I think this website seems to exaggerate the risk of malaria, as it’s based on WHO data and is sponsored by, oh you guessed it, a well-kwown pharmaceutical company named GlaxoSmithKline. It’s nothing we haven’t seen countless times before – the WHO teaming up with pharmaceutical giants. We all know very well what happens when pharmacetical companies pay World Health Organization advisors to tell the public how extremely dangerous diseases, such as the bird or swine flu are, right? Damm, I haven’t gotten my flu shot yet!
Let’s look at one last website – Traveldoctor.info. Traveldoctor.info has a nice Google map incorporated into its website here that gives a detailed breakdown of the malaria regions in Vietnam, even though some of the information on their website is also based on data from the WHO. Our Traveldoc sums up the malaria risk in Vietnam nicely by saying the following2:
“The risk of malaria in Vietnam is low and is mainly found in the central highlands [...]“
www.traveldoctor.info on this risk of malaria in Vietnam (29.12.2009)
Traveldoctor.info also offers some very good advise here for people considering taking malaria medication during their travel abroad. They recommend the following:
Drugs used for prevention
- Chloroquine
- Lariam
- Malarone
- Doxycycline
Lariam is more effective against Chloroquine resistant malaria than Chloroquine and paludrine. There has been some discussion about side effects from lariam, but two thirds to three quarters of all users apparently have few problems.Malarone is a new drug combination and can be used for both prophylaxis and treatment. For prophylaxis the dose is 1 tablet daily from the day before entry to 7 days after departure from the malaria risk area. Malarone is primarily an alternative to Lariam and Doxycycline. Malarone is also an alternative to Chloroquine and paludrine for short stays, if you want to avoid taking tablets 4 weeks after departure from the malaria risk area.
Doxycycline is an antibiotic which can be used to prevent malaria resistant to other drugs. There is less experience with Doxycycline than with Lariam and Malarone. The side effects are mostly an allergic rash on areas exposed to sunlight.
Side effects
Comparing Chloroquine and Paludrine and Lariam the risk of mild side effects are about the same, but lariam users have up to four times higher risk of experiencing neuropsychiatric side effects of which difficulty with sleeping is the most common.
Overall 2% to 5% of all users, no matter which drug they use, experience symptoms, which are suspected to be side effects from the drugs and lead to cessation of medication.Our attitude to malaria prophylaxis
- In general the traveller should be offered the most effective drug taking the destination, mode of travel and length of stay into consideration.
- In areas with very low risk like for instance Thailand, drugs are not recommended for prophylaxis, only traditional methods like repellents and impregnated mosquito nets.
- In area with a high degree of resistance against chloroquine, like tropical Africa and part of South America and South East Asia, we recommend Malarone as first choice for short-term travellers, and Lariam for long term travellers, both withdoxycycline as an alternative.
- Protection should be as good as possible, but it is unacceptable to have the travel spoiled by side effects, if the risk of infection is low.
http://www.traveldoctor.info recommendation on Malaria
I can also highly recommend the Malaria Information System provided by the University of Bonn, Germany. Here you can zoom in on the countries of interest and select and deselect layers that you’re interested such as regions where prophylaxis is recommend or resistance to medication is known.
- Malaria Information System provided by the University of Bonn, Germany
At this point I have enough information and have concluded that I’ll be taking a wide variety of safety precautions towards Malaria and keeping my immune system in tip-top shape, which include:
- Natural Insect Repellent (”Care Plus Natural Anti-Insect Spray”. Can be purchased at Globetrotter.de)
- Chemical-based Insect Repellent based on Icaridin (”Nobite Sensitive”. Doesn’t have the negative side effects of DEET and it’s just as effective as DEET. It ca also be purchased at Globetrotter.de)
- Mosquito Net (I originally wanted to purchase an impregnated mosquito net, but I thought that was to expensive for two weeks in South-East Asia and the fact, that I’m not going to visit the high-risk areas in Vietnam such as the Mekong-Delta. So that didn’t justify the price for me. But it’s still a good investment if you plan to visit high risk areas for longer periods of time)
- Sleeping Air Conditioned hostels or hotels only
- Wearing long and light-colored sleeve shirts and pants
- Sodium Chlorite / MMS (as my stand-by Malaria protection)
- Propolis (Research shows it offers antiseptic, antibiotic, antibacterial, anti-fungal, and even antiviral properties. Propolis is Nature’s premiere preventive. It is so powerful in action, it is often called Russian penicillin in acknowledgement of the extensive research the Russians have mounted on this wonder worker from the bees. Propolis demonstrates strong antimicrobial properties against various bacterial and fungal infestations. Even streptococcus bacteria have been shown sensitive to propolis.)3
- Hydrogen Peroxide (H2O2 is one of the most powerful oxidizers known – stronger than chlorine, chlorine dioxide, and potassium permanganate)
I’ve also increased my daily intake of freshly pressed vegetable juices to give my immune system the extra horsepower. @Stephan, you know what I’m talking about 
Combining these safety precautions, should provide me with more than adequate safety. Personally, I believe I will be more in danger of getting run over in Vietnam, than anything else. And lo and behold the U.S. Department of State agrees with me on this one. 
“Traffic in Vietnam is chaotic. Traffic accidents occur frequently and the most common victims are motorbike riders and pedestrians. At least 30 people die each day from transportation-related injuries and many more are injured, often with traumatic head injuries. Traffic accident injuries are the leading cause of death, severe injury, and emergency evacuation of foreigners in Vietnam. Traffic accidents, including those involving a pedestrian and a motorized vehicle, are the single greatest health and safety risk U.S. citizens will face in Vietnam.“4 [emphasis added by me].
U.S. Department of State on Traffic Safety and Road Conditions in Vietnam (August 28, 2009)
Mhh…does that mean that if I travel with my German passport, instead of my U.S. passport, I’m less likely to be exposed to this kind of risk? We’ll see, as I’m actually traveling with my German passport this time.
* * *
And before anyone feels tempted and tries to sue me, here’s the standard disclaimer:
Statements contained within this article post or blog have not been evaluated by the Food and Drug Administration. Any of the aforementioned remedies or substances are not intended to diagnose, treat and cure or prevent disease. And as always, please consult your health care professional before changing any medication or adding supplements of any kind to medications…yadda, yadda, yadda….
Have you had any previous experiences with malaria medication? Or what are your safety precautions that you took? Let’s hear about it in the comments. And don’t forget to bookmark this article if you enjoyed the read!
Footnotes
- http://www.malariahotspots.co.uk/facts-maphotspots.asp [↩]
- Malaria in Vietnam, http://www.traveldoctor.info/trip/result.1.154.1.html, Retrieved 2009-12-29 [↩]
- http://www.draperbee.com/info/propolis.htm, Retrieved 2009-12-29 [↩]
- U.S. Department of State on Traffic Safety and Road Conditions in Vietnam, http://travel.state.gov/travel/cis_pa_tw/cis/cis_1060.html#traffic_safety [↩]
2 Comments
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Hi David,
Very good overview about the facts.
I have done 2007 a research about South Africa. We travelled in the North-East (Krueger NP) and this area is a medium risk zone. But you also need to consider the season. As we travelled in the dry season (south african winter) we decided to use repellent in combination with long-sleeve in kaki tones.
It was a great decision. I haven’t seen hardly any moscito in the 8 days in the park. I would recommend to buy the repellent in south africa as they have better working products there.
In case you feel sick, you can get good stand-by products all over RSA.
Bernhard
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Like or Dislike:
Thank you Bernhard for your very insightful comment. It’s good to know that I’m not the only one that tries to use alternative methods for malaria protection
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