The low and declining risk of malaria in travellers to Latin America: is there still an indication for chemoprophylaxis?

Ron H Behrens,Fabrice Legros,Urban Hellgren,Bernadette Carroll,Tomas Jelinek,Jiri Beran,Bjørn Myrvang,Olivier Bouchaud,Christoph Hatz,Nikolai Mühlberger,Leo Visser,Heli Siikamäki

doi:10.1186/1475-2875-6-114

Abstract

A comparison was made between local malaria transmission and malaria imported by travellers to identify the utility of national and regional annual parasite index (API) in predicting malaria risk and its value in generating recommendations on malaria prophylaxis for travellers.Regional malaria transmission data was correlated with malaria acquired in Latin America and imported into the USA and nine European countries. Between 2000 and 2004, most countries reported declining malaria transmission. Highest API's in 2003/4 were in Surinam (287.4) Guyana (209.2) and French Guiana (147.4). The major source of travel associated malaria was Honduras, French Guiana, Guatemala, Mexico and Ecuador. During 2004 there were 6.3 million visits from the ten study countries and in 2005, 209 cases of malaria of which 22 (11%) were Plasmodium falciparum. The risk of adverse events are high and the benefit of avoided benign vivax malaria is very low under current policy, which may be causing more harm than benefit.

Highlights

Many public health bodies base their recommendations for the prevention of malaria in travellers on national surveillance data, which provides information on the intensity and risk of malaria in local populations, expressed as the annual parasite index (API), which may reflect regional risks
The local population risk is based on reports from the Pan American Health Organization (PAHO) Regional Office of the World Health Organization with information on API provided by countries within the region[2,3]
This study was designed to identify whether local transmission of malaria within countries of Latin America reflected the pattern and trends of malaria acquired by travellers from ten developed countries

Summary

Introduction

Many public health bodies base their recommendations for the prevention of malaria in travellers on national surveillance data, which provides information on the intensity and risk of malaria in local populations, expressed as the annual parasite index (API), which may reflect regional risks. While this approach appears rational, there is no evidence that patterns of travel-acquired malaria cor-. Highlighting the disparity between native and traveller's vulnerability and exposure to infection he has emphasized the need to consider prophylaxis toxicity when prescribing for travel to low risk malaria regions. Providing appropriate malaria prophylaxis advice for travellers visiting countries in Central and South America can be complex and challenging, when the journey involves many regions or countries where multiple parasite species are present

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