Could A Malaria Vaccine Be On The Way?

malaria
USAID and the President’s Malaria Initiative support the distribution and use of bednets to protect against malaria. Bednets are important for children and pregnant women who are most vulnerable to the disease. Photo: Alison Bird/USAID

The UK drug company GlaxoSmithKline is applying for regulatory approval of the world’s first malaria vaccine, the BBC reports.

The move comes after tests that the company said were promising. For the past several years, GlaxoSmithKline has conducted tests of its vaccine on almost 15,500 children in seven African countries. The company reports that 18 months after vaccination, there was a 27 percent reduction in malaria cases in infants aged 6-12 weeks and a 46 percent reduction in children aged 5-17 months.

Now it’s applying to the European Medicines Agency to start marketing the vaccine. GlaxoSmithKline’s research was supported by the Bill and Melinda Gates Foundation and the company says it will make the vaccine affordable for poorer nations.Ninety percent of the world’s malaria cases are in the poorer regions of sub-Saharan Africa where the vaccine was tested. Globally, malaria kills 800,000 people a year. It’s also a major hazard for adventure travelers. While antimalarial pills are generally effective, they can have serious side effects. A vaccination would go a long way to easing the burden on people who choose to visit the tropics.

Approval for the vaccine could come in 2014. Unfortunately, the percentages the company is quoting do not indicate that it will be as effective as many of the vaccines we are used to. Other measures are still needed like the education of the public of the dangers of standing water and the need to use mosquito netting. More innovative methods for fighting the disease like infecting them with bacteria are also being studied.

Hopefully GlaxoSmithKline’s vaccine will be just the first generation of a series of improving vaccines that will one day relieve the world of a dangerous disease.

Knocked up abroad: pregnant travel in the first trimester

pregnant travelFor more on pregnant travel, see parts 1 and 2 of Knocked up abroad: pregnancy in a foreign country here and here.

There’s no question that having a baby changes you: your body, your lifestyle, even your shoe size. One thing I hoped not to change altogether was traveling, as long as it was reasonably safe and comfortable for me and the baby. From the beginning of my pregnancy in Istanbul, my doctor has okayed travel, as long as I get up to stretch frequently on flights and try not to overdo it. Most doctors (and mothers) agree that the second trimester is the most comfortable time for pregnant travel but the first trimester can be a good time as well (while you can still squeeze into pre-maternity clothes and walk without waddling) with a little extra precaution and a little more babying (of the mother, of course).


The first trimester of pregnancy is a tricky time for many women: the risk of miscarriage is highest up to 10 weeks, morning sickness is common, and hormones are running wild. It’s too early to tell anyone outside family or close friends and without a visible belly, it’s impossible for strangers to tell as well. At later points in your pregnancy, a baby bump acts as the international symbol for pregnancy and can make it much easier to express your condition when traveling abroad. If you travel in the early months before showing, you may want to learn the local language words for “I’m pregnant” to avoid a Bridget Jones-esque “mit kinder” scene if you need extra help while traveling.


Over this past December, my husband and I were looking for a good trip to take over the holidays, when I was around 10 weeks pregnant. Our location in Istanbul changes the list of short-haul destinations considerably from what we would have considered from New York, and we debated between a warm-weather beach destination (husband) or a snowy and “Christmassy” European city (me). We ruled out Egypt (not warm enough and not Christmassy), New Zealand (even less convenient to get to than from New York), and Sri Lanka (not enough time to plan properly and some risks of disease I couldn’t be vaccinated against). In the end, we chose…Russia.
Going to Russia in winter while pregnant may seem crazy to some, but for me it made sense: Moscow and St. Petersburg are a few hours from Istanbul by direct flight, my husband speaks fluent Russian in case of any problems, and there was no risk of malaria or eating any food that had spoiled in the sun. While it was cold and snowing during our trip and I couldn’t take advantage of some of Russia’s cold-weather remedies like vodka and saunas, a week in Moscow and St. Petersburg was a perfect mix of exotic and comfortable.

Nearly every cafe had a variety of non-alcoholic and caffeine-free beverages for me to choose from, I even had non-alcoholic sangria, mojitos, and mulled wine in addition to fresh juices and herbal teas. Both cities are beautiful to explore in the snow, with plenty of museums and cafes to warm up in, and the New Year holiday displays made it festive.

If you are planning a trip to a foreign country while pregnant, it makes sense to keep in mind the following guidelines. Always discuss plans with your doctor before booking and err on the side of caution when choosing a destination.

Check airline restrictions – Most airlines allow pregnant women to fly internationally up to 28 weeks, after which you must provide a doctor’s note issued within a week or so of departure. 35 weeks (earlier for women carrying multiples) is the cutoff for nearly all airlines to prevent women from giving birth on board. Most US domestic carriers will allow pregnant women to fly up to the final month; hilariously, Continental will not let women board if “physical signs of labor are present” though they don’t specify what.

Consider travel insurance – If your medical insurance doesn’t cover you overseas, you may want to look into supplementary medical travel insurance, but be sure it covers pregnancy as many policies do not. Additionally, if you are traveling to a country where English is not spoken, you may want to research the name of a clinic or doctor in case of emergency as well.

Be prepared for jet lag – Before pregnancy, I had little issues with jet lag, trying to get on local time as soon as possible. I discovered when flying back from the US to Turkey that it hits you much harder as a pregnant traveler, especially as you can’t use sleeping pills or alcohol to help you sleep. Factor this into your schedule and give yourself plenty of time to acclimate and adjust to time changes.

Realize your limits have changed – On a usual trip, I’d be up early to walk around a city all day, have a late lunch (or maybe just a big afternoon beer) followed by more museums and exploration, and still be up for checking out the local nightlife. Once pregnant, I required more sleep and three solid meals a day (plus maybe some snacks, I am eating for two!), tired after walking short distances, and was ready to call it a night long before last call. If you have an itinerary, pare it down to the must-sees and double the time to see everything; better to take it easy and enjoy your trip than feel exhausted and sick.

Look for destinations that don’t require vaccinations – One of the first tests your doctor will give you after confirming pregnancy will be for immunizations to hepatitis and rubella. If you haven’t had the vaccines, they will have to wait until after the baby is born as they are not safe for pregnant women. I have not had the hepatitis vaccine yet, and thus have a greater risk of contracting it, which rules out much of Africa and southeast Asia for travel, but also means I must avoid raw vegetables including salad in Istanbul. Most other medications and vaccines commonly given to travelers before going to an area prone to Malaria, Typhoid or Yellow Fever are not advised for pregnant women. But there’s still a big world out there, check the CDC for destination-specific information.

Be extra aware of food and water safety – Pregnant women are more susceptible to food poisoning the average person, as the immune system is suppressed so it doesn’t reject the fetus. This is the reason most pregnant women are told to avoid sushi and food that is not prepared in sanitized conditions. Even adventurous eaters should play it safe while pregnant and drink bottled water when in doubt. I recently had an opportunity to visit Mumbai, India but after consulting with a few friends who had lived there, I worried I’d spend the trip inside my hotel room eating pre-packaged food. Again,

check the CDC and use the same common sense you’d use anytime while traveling: stick with food that is freshly prepared in restaurants full of people.


Stay tuned for more on pregnancy travel, including Turkish superstitions and customs, travelling in the second trimester, where to do pre-baby shopping, and more on having a baby in a foreign country. Check here for further updates.

[Photo courtesy Mike Barish from the Istanbul tram]

Lariam Dreams (which pills do you pop?)

If you’ve traveled to a tropical country, you’ve probably heard of Mefloquine. It is the most popular prophylactic against malaria, and is often sold under its trade name, Lariam. Lariam can have some serious side effects such as depression, anxiety, paranoia, nightmares and insomnia. You might say, “having nightmares is better than catching malaria and ending up in a hospital or worse.” I’m sure everyone would agree with that.

But when you wake up in a strange foreign land after a Lariam-induced nightmare…and you aren’t quite sure if you are really awake or if your waking state is just another extension of your dream, it can be pretty unnerving.

After such an experience, you might ask yourself if it is really necessary to ingest Mefloquine every time you enter a tropical region. I’ve known people who pop the little pills once a week when they are in Hong Kong or Singapore where the chance of catching malaria is akin to the chance that you will win the lottery. I guess some travelers choose to err on the side of caution when they enter any unfamiliar place.I haven’t even mentioned the host of shots and other pills that some guidebooks and doctors say you might want to consider. Typhoid is a big one. Cholera is another. Neither of these have vaccines that are 100% effective and they can bring about particularly nasty side effects. That doesn’t stop doctors from recommending them and people from getting the shots.

So what do you really need when you are traveling in a developing, tropical country? I guess it depends on how apprehensive you are. For me, Lariam and obscure vaccines are out unless I find that I am entering an area where a particular disease is truly a threat (see the WHO web site if you want to research a country you plan to visit). I also keep up to date on basic immunizations like tetanus and Hep B. And keep in mind, no matter how Lariam happy you get, there are diseases like SARS and H5N1 out there to remind us that health concerns are always going to be a scary part of traveling. And so I ask you, Gadling readers: what do you consider a necessary part of your travel-sized medicine cabinet?

Dengue Fever on the Rise in Mexico

The other night we were sitting with a friend enjoying a few Pacificos when he asked if he could turn the fan on to keep the mosquitoes away. As one who always get bitten by these bloodsucking irritants, I was more than happy for the fan to keep me bite-free. As he clicked the fan on, our friend casually mentioned that with the rainy season comes dengue fever, which is not too dangerous,”unless you get Dengue Hemorrhagic Fever (DHF)…”

Excuse me? The what?

Before we left on this trip we went to the travel clinic to get the necessary shots as well as the medications we might need. As we will be traveling through high-risk malaria areas we stocked up on anti-malarials and brought along a good supply of bug spray. I figured malaria, not dengue fever, would be our biggest health risk. Truth be told, I have never been too concerned with dengue. I know that it can make you quite ill, I know there are no drugs to treat it but what I didn’t realize was that you can potentially die from it.

Dengue fever is transmitted through female Aedes mosquitoes. They feed on an infected person and then, after an 8 to 10 day incubation period, they are able to pass on this illness for the rest of their lives. Dengue hemorrhagic fever is a much more serious version of dengue. It occurs as a result of complications and, with liver enlargement, circulatory failure and convulsions as part of its repertoire, it is potentially fatal.

Scary…right?

Dengue fever is on the rise in Mexico, Central America and South America according to the World Health Organisation. Since we are planning to spend a significant amount of time in Latin America I did some research and found out that in Mexico alone dengue hemorrhagic fever accounts for one out of every four cases of dengue fever compared to seven years ago when it was one of out fifty. This indicates that DHF is rapidly becoming a serious travel health issue. As if travelers don’t have enough to worry about with malaria and other infectious diseases, here is one that you just have to suffer through if you are unlucky enough to become infected.

So what do you have to look forward to if you contract this mosquito-borne illness?

Symptoms

Dengue fever is characterized by:

  • a flu-like feeling
  • fever
  • headache
  • joint ache
  • nausea / vomiting
  • swollen lymph nodes
  • decreased appetite

Dengue hemorrhagic fever include the above symptoms as well as:

  • a sudden rise in temperature
  • irritability
  • restlessness
  • extreme sweating
  • a shock-like state
  • bleeding may start to occur under the skin or in little pinpricks
  • rash

Treatment
As I mentioned there is no treatment for either dengue fever or the more severe DHF. Dengue fever should subside after the fever breaks. Tylenol as well as lots of liquids (to prevent dehydration) are recommended to ease discomfort. Should symptoms worsen, the patient needs to receive medical attention immediately as this illness can be fatal. DHF is best treated by medical professionals who have experience with this condition if possible.

Prevention
Prevention really is the key . If the mosquitoes don’t bite you, you will remain dengue-free!

  • Wear light-colored clothing to cover up bare skin especially at dawn and dusk when the “skeeters” are more likely to be out looking for a meal
  • Use repellent with 10% to 30% DEET (some people say this is worse for you…I say pick your poison. I’d rather take my chances with DEET than end up with a potentially life-threatening sickness)
  • Pay attention to the climate as rainy season is mosquito breeding season
  • Bring a mosquito net to protect yourself when sleeping
  • Mosquito coils! These are the best if you find yourself in a room infested with mosquitoes. (There are health reports claiming these coils are dangerous to your health so protect yourself by ensuring good ventilation when you use them.)
  • Some say taking Vitamin B will make you less attractive to these bloodsuckers but there is no scientific proof to back this up

Immunizations
Currently, the WHO is working towards finding a vaccine but at the present time none are available though it seems two potential vaccines have progressed to a stage where they may soon be tested.

The moral of this story is that dengue fever is on the rise in Mexico and in the rest of Latin America. It does pose a serious risk for travelers and, though, many health organizations are working towards solving the problem, it would be a wise idea to pack the bug-repellent (kid’s repellents tend be less harsh) and a good quality mosquito net before you set off on a Latin American adventure.

“No Wrong Turns”
chronicles Kelsey and her husband’s road trip — in real time — from Canada to the southern tip of South America in their trusty red VW Golf named Marlin.

UPDATE: Reader Mollyn suggests that Tylenol may not be as safe as simple Ibuprofen. Please check with your doctor before self-medicating, especially if you think you have Dengue Fever!

Tracks4Africa puts a continent at your fingertips

A trip to Africa requires some serious preparation. Guidebooks. Vaccinations. Maps. Tourist visas. Mosquito nets. Hiring guides. For many people, the very idea of the African continent conjures images of huge steamer trunks, pith helmets and mountains of travel gear. But for the technology-inclined, the mysterious continent author Paul Theroux once dubbed “the dark star” is becoming just a little bit more accessible, thanks to Tracks4Africa.

Essentially a giant community mapping project, Tracks4Africa is a non-profit organization that maintains user-generated GPS maps of some of the more remote and “eco-sensitive” areas of Africa. Although the project originally started as a way for outdoor enthusiasts to preserve some of Africa’s most unique plant and animal life, it has since blossomed into a full blown database of “off the beaten path” sights in Africa. More than 1,400 adventure travelers have contributed data on everything from recent elephant attacks to ghost towns and covered countries ranging from Ethiopia to Mozambique. And because it’s entirely user-created, there’s a good chance users will also have access to the most current information on the ground. Take this in contrast to an Africa guidebook from Lonely Planet, which might not get updated for several years (if at all).

All you need to get started with Tracks4Africa is a compatible GPS unit and a sense of adventure. Armchair adventurers take heart – the Tracks4Africa database is also viewable through Google Earth. Now get out there and find me a nice date plantation to check out in Namibia.