Malaria prevention and stand-by emergency treatment among Japanese travelers

Abstract

While chemoprophylaxis remains the safest option for most travelers to malaria high-risk areas, stand-by emergency treatment (SBET) may also be a sensible option especially for travelers to low-risk areas, due to the possible adverse effects (AEs) of prophylactic antimalarials. However, studies on the suitability of SBET actually implemented by travelers are scarce, especially those targeting Japanese travelers. We investigated to what extent malaria prevention measures are taken and how effectively SBET is used by Japanese travelers to malaria-endemic areas. A questionnaire study was conducted targeting Japanese travelers who visited quarantine stations for pre-travel health advice and who had previously visited malaria-endemic areas as defined by the World Health Organization (N = 160). The results showed that only a minority (13%) of travelers to malaria-endemic areas took chemoprophylaxis. Although most (89%) of the SBET users (N = 9) took antimalarial drugs when they experienced both fever and chills, characteristic of clinical malaria, there were several problems related to SBET. Some (22%) of the subjects conducted SBET less than 7 days after entering the area, most (89%) of them did so when a medical facility was readily accessible, and many (56%) failed to seek medical attention soon after SBET or did not at all. Japanese travelers to malaria-endemic areas seemed less protected with the use of chemoprophylaxis. Furthermore, problems related to SBET among Japanese travelers were identified. These should be taken into full consideration when educating both travelers and travel health professionals to avoid risks of malaria and possible AEs of antimalarial drugs.