[70s-80s overlander]

The following article, in the Journal of the American Medical Association, is the best there is -- and that's not quite good enough. Clearly the authors were disappointed, too. Nonetheless, if you are going to India for a LONG time, you might want to read over the discussion of the options. The pros and cons of specific regimens are reviewed and debated. The abstract is here supplied. AMA members can get the full article online: http://jama.ama-assn...ull/296/18/2234 -- or your library can get the full article.

Prevention of Malaria in Long-term Travelers
Lin H. Chen, MD; Mary E. Wilson, MD; Patricia Schlagenhauf, PhD;
Travel Medicine Ctr, Div of Infectious Diseases, Mt Auburn Hospital, Cambridge, Mass 02238, USA. lchen@hms.harvard.edu

JAMA. 2006;296:2234-2244.             ABSTRACT
Context:  
     Long-term travelers, defined here as those traveling for periods of 6 months or longer, face particular  
     challenges regarding malaria prevention. Current guidelines for malaria prevention primarily address
     prevention of Plasmodium falciparum infections in short-term travelers.
Objectives:  
     To examine the risk of malaria in long-term travelers, recent developments in personal protective
     measures, and the safety and tolerability of malaria chemoprophylaxis during long-term use and to
     consider prevention strategies including continuous chemoprophylaxis, stand-by emergency
     self-treatment, seasonal prophylaxis, and strategies to prevent primary infection and relapses from P
     vivax malaria.
Evidence Acquisition:  
     Comprehensive search of scientific publications including MEDLINE via both OVID and PubMED for
     relevant studies and articles with a cutoff date of July 2006, using the search terms long-term travel and
     malaria prevention, long-term malaria chemoprophylaxis, and insect repellent and malaria. Additional
     references were obtained from searching the bibliographies of the selected articles, from dissertations,
     and from the proceedings of relevant conferences on travel medicine. There were no language
     restrictions.
Evidence Synthesis:  
     Long-term travelers have a higher risk of malaria than short-term travelers. Long-term travelers
     underuse personal protective measures and adhere poorly to continuous chemoprophylaxis regimens. A
     number of strategies are used during long-term stays: discontinuation of chemoprophylaxis after the
     initial period, sequential regimens with different medications for chemoprophylaxis, stand-by emergency
     self-treatment, and seasonal chemoprophylaxis targeting high-incidence periods or locations. All
     strategies have advantages and drawbacks. Counterfeit drugs sold in countries endemic for malaria pose
     serious concern for long-term travelers who purchase their medications overseas. Vivax malaria causes
     significant illness in travelers, but relapses of vivax malaria are not prevented with the current first-line
     chemoprophylaxis regimens. Consensus guidelines are needed for prevention of malaria in long-term
     travelers.
Conclusions:  
     Prevention of malaria in long-term travelers is a complex issue and requires expert advice from travel
     medicine specialists. Recommendations for prevention of malaria in long-term travelers must be
     individualized.