Prevention Of Malaria In Travelers Research Articles

Return to Travel in the Coronavirus Disease 2019 Pandemic Recovery Period and Implications for Imported Malaria: Reinforcing Prevention, Early Diagnosis, and Appropriate Treatment of Malaria.

Return to international travel in the COVID-19 pandemic recovery period is expected to increase the number of patients with imported malaria in the United States (US). Malaria prevention in travelers and preparedness for timely diagnosis and appropriate treatment are key to minimize imported malaria morbidity and mortality. Intravenous artesunate (IVAS) is now available from commercial distributors in the US for the treatment of severe malaria. Hospitals and pharmacists should have a plan for malaria treatment, including stocking artemether-lumefantrine for uncomplicated malaria, and stocking or planning for rapid procurement of IVAS for the treatment of severe malaria.

Survey and Analysis of Chemoprophylaxis Policies for Domestic Travel in Malaria-Endemic Countries.

The prevention of malaria in travelers with the use of antimalarials often occurs in connection with international travel to areas of significant risk of infection. Although these travelers sometimes cause outbreaks in their malaria-free home countries, the cardinal objective of prescribed chemoprophylaxis is to protect the traveler from patent malaria during travel. Here we consider the chemoprophylaxis of domestic travelers from malaria-free but -receptive areas within malaria-endemic countries. The main objective in this setting is the protection of those areas from reintroduced malaria transmission. In order to better understand policy and practices in this regard, we surveyed malaria prevention and treatment guidelines of 36 malaria-endemic countries and 2 that have recently eliminated malaria (Sri Lanka, China) for recommendations regarding malaria chemoprophylaxis for domestic travel. Among them, just 8 provided specific and positive recommendations, 1 recommended without specific guidance, and 4 advised against the practice. Most nations (25/38; 66%) did not mention chemoprophylaxis for domestic travel, though many of those did offer guidance for international travel. The few positive recommendations for domestic travel were dominated by the suppressive prophylaxis options of daily doxycycline or atovaquone-proguanil or weekly mefloquine. The incomplete protection afforded by these strategies, along with impractical dosing in connection with the typically brief domestic travel, may in part explain the broad lack of policies and practices across malaria-endemic nations regarding chemoprophylaxis.

An update on prevention of malaria in travelers.

Malaria, a parasitic disease caused by protozoa belonging to the genus Plasmodium, continues to represent a formidable public health challenge. Despite being a preventable disease, cases reported among travelers have continued to increase in recent decades. Protection of travelers against malaria, a potentially life-threatening disease, is of paramount importance, and it is therefore necessary for healthcare professionals to be up to date with the most recent recommendations. The present review provides an update of the existent measures for malaria prevention among travelers.

Economic analysis of the stand-by emergency treatment (SBET) for malaria in travellers

Abstract Background Stand-by emergency treatment (SBET) is a possible approach for malaria prevention in travellers to low transmission areas (such as South-Eastern Asia [SEA]), but current evidence casts doubts on its feasibility and does not allow to decide whether this strategy is economically rational. Thus, this research aimed to appraise SBET in terms of cost-benefit/cost-effectiveness analysis from the perspective of the National Health Service (NHS). Methods To design a specific model, SBET benefits (valued as avoided direct and indirect costs of illness) were weighted against the costs associated with SBET doses to be prescribed in order to avoid one imported case of malaria. Direct healthcare costs were obtained allocating last surveillance data for imported malaria to the charge of the corresponding diagnosis-related group category and estimating outpatient care costs. Indirect social costs were calculated in terms of lost productivity. The economic framework was adjusted for the probability of malaria transmission in SEA region and weighed on the Italian context. Results In the model, for five malaria cases estimated to be imported from SEA to Italy in 2017, it was calculated that NHS would be charged with around € 22,487·50. Social costs were determined at € 7,100. Thus, the total Italian public expenditure for malaria cases in SEA travellers was of € 29,587·50 in 2017. In contrast, 50,000 doses were considered to be carried to avoid one malaria imported case, with a cost of € 2.5 million. Conclusions At cost-effectiveness analysis, reimbursement strategy does not lead to a favourable gain owing to the total cost of the SBET doses to be prescribed for avoiding one malaria case. The appraisal of costs and benefits brings into question the economic validation of SBET, also calling for further strategies to be reassessed for travellers to low-risk areas. Key messages Besides the evidence of incorrect SBET use among travellers, the appraisal of costs and benefits brings into question the economic validation of this strategy. Reimbursement for SBET seems to be not cost–effective from the perspective of National Health Services.

Malaria Disease and Chemoprophylaxis Usage among Israeli Travelers to Endemic Countries.

Prevention of malaria in travelers to endemic countries is one of the complex challenges of travel medicine. Israel has a widespread culture of travel to developing countries, but information regarding malaria prevention is limited so far. Our study, conducted in Sheba Medical Center, Israel, during the years 2008-2018 examined malaria chemoprophylaxis usage and malaria cases in a large group of Israeli travelers returning from endemic countries with any medical complaint. Data were collected regarding travel destinations, conditions, duration of stay, and pretravel consultation. Altogether, 4,708 travelers were included in our study. Travel destinations included Asia (51%), Latin America (31%), and sub-Saharan Africa (SSA) (17%). Median travel duration was 26 days. Only 11.9% reported taking malaria chemoprophylaxis. Of the travelers to SSA, 41.3% took prophylaxis as opposed to only 6% outside of Africa. During the study years, 136 cases of malaria were diagnosed; among them, 82 (60%) were infected with Plasmodium falciparum, of whom all but two were from SSA and none adhered to prophylaxis. Malaria chemoprophylaxis usage was found to be negligible in travel to many countries still considered endemic. Higher prophylaxis usage was found among travelers to SSA, but numbers are still lower than recommended. The low number of malaria cases seen in destinations outside SSA, as documented in our cohort, is likely to represent travel to low risk areas and not high prophylaxis usage. We urge re-evaluation of current CDC and Israeli guidelines which still recommend using chemoprophylaxis in many low-risk countries, as focus on high-risk countries may increase adherence.

Guidelines for malaria prevention in travellers: what is new?

Practice nurses are at the forefront of malaria prevention in travellers. Mary Gawthrop gives an overview of the recent changes to the UK guidelines Malaria is a severe and potentially life-threatening febrile illness caused by infection with the parasite Plasmodium. Malaria does not currently occur naturally in the UK, but continues to be a significant, preventable risk for UK travellers visiting malaria-endemic countries. Public Health England (PHE) provide annual updated guidelines for health professionals advising UK travellers on malaria prevention. The PHE guidelines provide country-specific malaria recommendations, including malaria prevalence maps, advice for special risk travellers like pregnant women, and contain a frequently asked questions section. This article covers the updates made in the most recently published version of the guidelines.

Pre-travel malaria enquiries to the United Kingdom national travel advice line 2016: Advice mainly needed on malaria maps and risk groups.

Malaria prevention in travellers can be complex and requires consideration of a number of factors. UK healthcare professionals providing pre-travel malaria advice can access specialist support from the National Travel Health Network and Centre (NaTHNaC) telephone advice line. The aim of this study is to characterise queries to the NaTHNaC telephone advice line regarding pre-travel malaria advice. Telephone calls received to NaTHNaC's advice line are recorded using an online data capture form. All calls relating to malaria advice during 2016 were selected and data extracted. Analysis was undertaken using Microsoft Excel and STATA. During 2016, 1803 malaria-related calls were received; the majority from general practice and calls were from across the UK. The most common type of pre-travel malaria query was country-specific followed by travellers with special health needs. Many queries related to pregnant and breastfeeding travellers, children under 5 years and travellers over 60 years. This review presents a large and exceptional dataset and reflects the ambiguity amongst some healthcare professionals regarding malaria advice. We have identified potential knowledge gaps, and as a result will strengthen future guidance, enhance existing malaria maps, and inform the development of future clinical educational activity.

Malaria Chemoprophylaxis for Travelers: The Knowledge of Physicians in the State of Qatar, 2017

Introduction: Malaria is among the most significant travel-related infections encountered by travelers to endemic countries in terms of morbidity and mortality. In Qatar, imported malaria has increased over the last 5 years; 493 travel-related cases were confirmed in 2016. In the current study, the knowledge of malaria chemoprophylaxis among physicians in the State of Qatar was assessed. Methods: This was a cross-sectional study conducted during a national travel health workshop at the Ministry of Public Health, Qatar. Physicians participating in the workshop from different national healthcare institutions providing travel medicine services were invited to voluntarily complete a self-administered, structured questionnaire. Results: Forty-two medical doctors participated in the study (92 response rate). Based on their specialty, almost two-thirds (64.3%) of the participants were family medicine physicians, and one-fifth (21.43%) were general practitioners. Furthermore, most of the doctors were untrained in travel medicine. The majority of participants demonstrated a good knowledge of the malaria parasite (100%), Plasmodium species (64.3%), incidence (83.3%), transmission (66.7%), and drug-resistance (95.2%) of malaria. Additionally, most physicians (>90) were knowledgeable about the major features of severe or complicated malaria as well as malaria prevention and chemoprophylaxis. Conclusion: This study highlights several areas of good knowledge on travel-related malaria prophylaxis and prevention among the study participants; however, there are still a few knowledge gaps that require mitigation. Continuing training programs on malaria prevention in travelers will sustain this good level of knowledge among physicians and improve the quality of pre-travel advice provided by travel medicine practitioners in Qatar.

Malaria prevention in travellers 2017: Changes to the guidelines and implications for practice

The new 2017 malaria prevention guidelines provide practical and comprehensive advice and recommendations for practice nurses working in travel health

Low and Declining Risk for Malaria in Visitors to Indonesia: A Review of Local Indonesian and European Travelers' Data and a Suggestion for New Prophylactic Guidelines

The world's malaria map is constantly changing and with it the risk for travelers to contract malaria. While some efforts to appreciate the malaria situation for indigenous populations in Indonesia have been made recently, there is only sparse data in the literature on the risk for travelers to Indonesia. Data were collected from the Indonesian Ministry of Health (MoH), the World Health Organization (WHO), the Indonesian official statistics website Badan Pusat Statistik (BPS), and from the different European national surveillance bodies. Finally, a comparison between recent official guidelines for prevention of malaria in travelers from Germany, the United States, the UK, and from WHO was done. Data from Denmark, Germany, Sweden and Switzerland show a steady decline of imported cases of malaria from Indonesia from 1997 to 2013, with a leveling off during the last few years. In our study material, the Plasmodium falciparum incidence 2009 to 2013 was 0.35 cases per 100,000 visits and the Plasmodium vivax incidence 1.3 cases per 100,000 visits, with a 95% confidence interval of 0.1-0.9 and 0.7-2.2, respectively. Indonesian data also show a decline of malaria cases-the Annual Parasite Index (API) for all species of malaria has decreased from 4.68 cases per 1,000 inhabitants in 1990 to 1.38 cases per 1,000 inhabitants in 2013. Based on these data updated recommendations for malaria prophylaxis in travelers to Indonesia are suggested.

Malaria: prevention and treatment

Malaria is the most important of all tropical parasitic diseases. The World Health Organization estimates that approximately 3.3 billion people in the world are at risk of malaria. There are approximately 220 000 000 cases of malaria worldwide each year, with 660 000 deaths. It is widely distributed across tropical and sub-tropical areas. However, malaria is not only seen in the tropics: in 2011 there were 1677 imported cases of malaria diagnosed in the UK and there were eight deaths from malaria. This article aims to describe the lifecycle of the malaria parasite, and clinical features of malaria, summarise current recommendations about malaria prevention in travellers from the UK to malaria-endemic regions, and also to offer guidance on diagnosis and treatment of infection in the returning traveller, with a particular focus on the role of GPs.

Prevention of Malaria in Travelers: Bite Avoidance and Chemoprophylactic Measures

Prevention and management of malaria in travelers is dependent on awareness of risk, bite avoidance, chemoprophylaxis and early diagnosis. Prophylactic recommendations should be made based on details of travel itinerary and medical history. Travelers should be advised to use appropriate measures for avoiding mosquito bites, including insect repellent, insecticide-treated bed nets, and appropriate behavior modification. In areas of chloroquine sensitivity, chloroquine is usually the preferred chemoprophylactic agent. In areas of chloroquine resistance, atovaquone-proguanil, mefloquine or doxycycline may be used. Atovaquone-proguanil is highly effective in preventing Plasmodium falciparum malaria, is well-tolerated, and is active against both liver and blood stages, which decreases the length of time required for post-travel prophylaxis. Alternative agents include doxycycline and mefloquine. Doxycycline is also well-tolerated and is a less expensive alternative to atovaquone-proguanil, but must be taken for 4 weeks after leaving the malaria-endemic region. Mefloquine can also be considered, particularly in those who have previously demonstrated tolerance. Mefloquine is associated with increased risk of neuropsychiatric adverse events and is often started ∼ 3 weeks prior to departure to help determine tolerability. In areas of high P. vivax or P. ovale presence, the use of terminal primaquine prophylaxis can be considered to prevent relapses post-travel. As with all drug regimens, the risks and benefits of use must be weighed in each individual traveler. None of these agents are 100 % effective, and travelers should be informed to seek urgent medical attention if fever develops during or after travel, regardless of the agent used.

PROPHYLAXIS OF MALARIA

Malaria prevention in travelers to endemic areas remains dependent principally on chemoprophylaxis. Although malaria chemoprophylaxis refers to all malaria species, a distinction should be drawn between falciparum malaria prophylaxis and the prophylaxis of the relapsing malaria species (vivax & ovale). While the emergence of drug resistant strains, as well as the costs and adverse reactions to medications, complicate falciparum prophylaxis use, there are virtually no drugs available for vivax prophylaxis, beside of primaquine. Based on travelers malaria data, a revised recommendation for using chemoprophylaxis in low risk areas should be considered

Prophylaxis of malaria.

Malaria prevention in travelers to endemic areas remains dependent principally on chemoprophylaxis. Although malaria chemoprophylaxis refers to all malaria species, a distinction should be drawn between falciparum malaria prophylaxis and the prophylaxis of the relapsing malaria species (vivax & ovale). While the emergence of drug resistant strains, as well as the costs and adverse reactions to medications, complicate falciparum prophylaxis use, there are virtually no drugs available for vivax prophylaxis, beside of primaquine.Based on traveler’s malaria data, a revised recommendation for using chemoprophylaxis in low risk areas should be considered.

Duty of care, part 1: the pre-travel consultation

Practice NursingVol. 22, No. 6 Travel Health ClinicDuty of care, part 1: the pre-travel consultationSandra GrieveSandra GrieveSearch for more papers by this authorSandra GrievePublished Online:29 Sep 2013https://doi.org/10.12968/pnur.2011.22.6.298AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View articleReferencesBauer I (2002a) Health advice in North Queensland from the perspective of travellers to destinations in the developing world. J Br Travel Health Assoc 3: 42–8 Google ScholarBauer I (2002b) Knowledge and Behavior of Tourists to Manu National Park, Peru, in Relation to Leishmaniasis. J Travel Med 9(4): 173–9 Crossref, Google ScholarBauer I (2005) Educational issues and concerns in travel health advice: Is all the effort a waste of time? J Travel Med 12(1): 45–52 Crossref, Google ScholarCarroll B, Behrens RH, Crichton D (1998) Primary health care needs for travel medicine training in Britain. J Travel Med 5(1): 3–6 Crossref, Google ScholarCarroll B, Daniel A, Behrens R (2008) Travel health. Part 1: preparing the tropical traveller. Br J Nurs 17(16): 1046–51 Link, Google ScholarChiodini J (2005) Providing a travel health service in primary care. Nurs Stand 19(39): 57–65 Crossref, Google ScholarChiodini J, Boyne L, Grieve S, Jordan A (2007) Competencies: An Integrated Career and Competency Framework for Nurses in Travel Health Medicine. Royal College of Nursing, London Google ScholarChiodini J (2008) A model travel health consultation. Practice Nurse 35(6): 42–7 Google ScholarChiodini J, Grieve S, Rosselot Get al. (2011) A survey of the ISTM Nurse Professional Group to assess members’ needs and identify areas for improvement. Poster presented at International Society of Travel Medecine Conference, Boston, MA: USA. 8–12 May 2011 Google ScholarCox C (2010) Legal responsibility and accountability. Nurs Manag 17(3): 18-20 Crossref, Google ScholarDepartment of Health (2003). Delivering Investment in General Practice: Implementing the New GMS Contract. http://tiny.cc/4petj (accessed 5 May 2011) Google ScholarHealth Protection Agency (2011) Guidelines for Malaria Prevention in Travellers from the United Kingdom. HPA, London Google ScholarLasswell HD (1953) The structure and function of communication in society. In: Bryson Led The Communication of Ideas. Harper and Co, New York Google ScholarLeggat P A (2000) Sources of health advice given to travellers. J Travel Med 7(2): 85–8 Crossref, Google ScholarMoerland W, Koeman S, van den Hoek Aet al. (2006) The quality of travel clinics in the Netherlands. J Travel Med 13(6): 356–60 Crossref, Google ScholarNursing and Midwifery Council (2008) The Code: Standards of Conduct, Performance and Ethics for Nurses and Midwives. NMC, 2008 Google ScholarProfessional Contractors Group (2007) A duty of care for HMRC. http://tiny.cc/84ib4 (accessed 17 May 2011) Google ScholarRoyal College of Nursing (2011) The Principles of Nursing Practice: Principles and Measures Consultation Summary Report for Nurse Leaders. http://tiny.cc/n7wtn Google ScholarUmeed M (2009) Meeting patients’ travel health needs. Practice Nurse 38(1): 13–7 Google ScholarWarren E (2010). The consultation; how to do it. Part 1. Practice Nurse 40(5): 12–4 Google ScholarWillcox A, Munson E (2007) The emergence of the nursing consultation. Practice Nursing 18(8): 409–12 Link, Google ScholarWillcox A (2010) Catastrophic consultations: how to avoid them. Presentation at RCN Travel Health Annual Conference, London. 18 September 2010 Google ScholarWillcox A (2011) Nurse-led Pre-travel Health Consultations: Evaluating Current Practice and Developing a New Model. Unpublished research findings, PhD. University of Warwick Google ScholarWorld Health Organization (2011) International Travel and Health. WHO, Geneva Google Scholar FiguresReferencesRelatedDetailsCited byProviding assistance to Britons travelling abroadIan Peate29 September 2013 | Practice Nursing, Vol. 23, No. 1 1 June 2011Volume 22Issue 6ISSN (print): 0964-9271ISSN (online): 2052-2940 Metrics History Accepted 6 May 2011 Published online 29 September 2013 Published in print 1 June 2011 Information© MA Healthcare LimitedKeywordsduty of caretravel health consultationtravel healthPDF download

Determinants of Malaria Prophylaxis Among German Travelers to Kenya, Senegal, and Thailand

Malaria chemoprophylaxis is a mainstay of malaria prevention in travelers. Adequate pretravel advice forms the basis for efficient malaria prophylaxis. This study assessed the determinants for seeking pretravel advice and evaluated the quality of advice from each source and its influence on the patterns and outcome of malaria prophylaxis intake. In March and April 2004, a self-administered questionnaire was distributed by cabin crews to passengers flying back to Germany from three popular tourist destinations: Kenya, Senegal, and Thailand. To evaluate the quality of advice and actual intake, figures were assessed against the official recommendations of the German Society of Travel Medicine and International Health (DTG). A total of 1,001 passengers were included in the study (Kenya, 492; Senegal, 131; and Thailand, 378), of which 81% had sought any kind of pretravel health advice. Travelers' age and time of pretravel consultation were associated with the source of information consulted. Seventy-five percent of travelers from Senegal and Kenya received DTG compliant advice compared to only 17% of travelers from areas with low malaria risk in Thailand. Travelers returning from Kenya and Senegal had used correct chemoprophylaxis in only 65 and 47% of trips, respectively. In multivariate analysis, the factors determining correct intake among Senegal and Kenya travelers were receiving pretravel advice (from nonmedical professionals: OR 4.4, 95% CI 1.9-10.0 and from medical professionals: OR 15.4, 95% CI 7.3-32.4), a correct risk perception (OR 2.9, 95% CI 1.9-4.5), 2 to 3 weeks of travel abroad (vs a duration >3 wk: OR 2.2, 95% CI 1.3-3.8), and travel to Kenya (OR 1.9, 95% CI 1.1-3.1). Malaria prevention among a large proportion of German travelers to tropical destinations is inadequate. Public health efforts should be made to raise awareness among travelers, travel agencies, and medical institutions in Germany.

Guidance for malaria prevention in travellers from the UK has been updated and issued by the Health Protection Agency

Guidance for malaria prevention in travellers from the UK has been updated and issued by the Health Protection Agency

Chimioprophylaxie du paludisme chez l'enfant

Chemoprophylaxis is essential for malaria prevention in travelers. When malaria is susceptible to chloroquine, this drug (Nivaquine ®) has to be used. In France, chloroquine is given daily (1.5 mg/kg/d), from departure to 4 weeks after return. In case of low chloroquine-resistance, French authorities recommend the use of chloroquine + proguanil (Savarine ® if the body weight is > 50 kg or Nivaquine ® + Paludrine ® if < 50 kg), or atovaquone + proguanil (Malarone ®). Nivaquine ® (1.5 mg / kg / d) and Paludrine ® (3 mg/kg/d) must be taken for up to one month after return, although Malarone ® (1 pediatric tablet/10 kg/d, in children > 10 kg weight) may be disrupted after one single week. Adverse events are more rare with atovaquone + proguanil, than with chloroquine + proguanil. When chloroquine-resistance is high, Malarone ® or mefloquine (Lariam ®) are used. Weekly drug regimen is recommended with mefloquine (5 mg/kg/w) for the travel duration and 3 weeks after return; drug tolerance is good in pediatric prophylaxis. The use of doxycycline is limited to some specific conditions of risk, in children of > 8 years of age. New agents such as tafenoquine, an amino-8 quinoleine, might enhance patient's compliance if given monthly.

Primaquine for prevention of malaria in travelers.

An expanding risk and range of endemic malaria threatens travelers. Primaquine is an old drug recently demonstrated to offer effective prophylaxis. Clinical trials conducted in Indonesia, Kenya, and Colombia showed that a primaquine base (30 mg per day) had protective efficacy against Plasmodium falciparum and Plasmodium vivax of 85%-93%. Among 339 children (age, >8 years) and adults taking this regimen for 12-52 weeks, there was no greater risk of adverse symptomatic events among primaquine users than among recipients of placebo in double-blind studies. Among 151 subjects evaluated after 20 or 52 weeks of daily primaquine therapy, methemoglobinemia was found to be mild (<13%; typically <6%) and transient (duration, <2 weeks). We consider primaquine base (0.5 mg/kg per day consumed with food) to be safe, well-tolerated, and effective prophylaxis against malaria for nonpregnant persons and those with normal glucose-6-phosphate dehydrogenase levels. Primaquine's major advantage over most drugs for chemoprophylaxis is that it does not have to be taken before entering or beyond 3 days after leaving a malarious area.

Delayed onset of malaria--implications for chemoprophylaxis in travelers.

Most antimalarial agents used by travelers act on the parasite's blood stage and therefore do not prevent late-onset illness, particularly that due to species that cause relapsing malaria. We examined the magnitude of this problem among Israeli and American travelers. We examined malaria surveillance data from Israel and the United States to determine the traveler's destination, the infecting species, the type of chemoprophylaxis used, and the incubation period. In Israel, from 1994 through 1999, there were 300 cases of malaria among returning travelers in which one species of plasmodium could be identified. In 134 of these cases (44.7 percent), the illness developed more than two months after the traveler's return; nearly all of these cases were due to infection with Plasmodium vivax or P. ovale. In 108 of the 134 cases (80.6 percent), the patient had used an antimalarial regimen according to national guidelines. In the United States, from 1992 through 1998, there were 2822 cases of malaria among travelers in which the cause could be evaluated. Late illness developed in 987 (35.0 percent) of these travelers. The infection was due to P. vivax in 811 travelers, P. ovale in 66, P. falciparum in 59, and P. malariae in 51; 614 (62.2 percent) of those with late-onset illness had appropriately taken an effective antimalarial agent. In more than one third of malaria-infected travelers, the illness developed more than two months after their return. Most of these late-onset illnesses are not prevented by the commonly used and effective blood schizonticides. Agents that act on the liver phase of malaria parasites are needed for more effective prevention of malaria in travelers.