Mosquito Bite Prevention Research Articles

Standby emergency treatment of malaria in travelers: experience to date and new developments

The concept of ‘standby emergency treatment’ (SBET) describes the strategy where travelers carry an emergency malaria treatment for self-administration when no medical attention is available or for use under medical supervision after a confirmed malaria diagnosis, and raises many issues for discussion. International guidelines vary on the topic, and there is controversy regarding the appropriate niche for this imperfect strategy. There are situations when SBET can supplement chemoprophylaxis with mosquito bite prevention and for some travelers, particularly those visiting minimal malaria risk areas, carriage of SBET and concomitant anti-mosquito bite measures can constitute the main antimalaria strategy. A strong argument in support of equipping travelers with a quality effective antimalarial treatment as part of their travel medical kit is the global proliferation of counterfeit antimalarials, a situation that is increasing in Africa but is especially prevalent in Asia where more than 50% of artemisinin products are fake. New developments such as improved rapid malaria tests and their wider distribution together with the availability of effective, well-tolerated malaria treatments, such as atovaquone/proguanil, artemether/lumefantrine and a new artemisinin combination dihydroartemisin/piperaquine, which is licensed in Europe for uncomplicated malaria, suggest that it is time to revisit and re-evaluate this strategy for travelers.

Malaria Knowledge, Concern, Land Management, and Protection Practices among Land Owners and/or Managers in Lowland versus Highland Ecuador

To control malaria effectively, it is essential to understand the current knowledge, beliefs, concerns, land management practices, and mosquito bite protection methods in use by citizens. This study presents a comparative, quantitative, interview-based study of land owners and/or managers (n = 262) in the Ecuadorian lowlands (presently considered malarious) (n = 131) and highlands (potentially malarious in the future) (n = 131). Although respondents had a strong understanding of where the disease occurs in their own country and of the basic relationship among standing water, mosquitoes, and malaria, about half of respondents in potential risk areas denied the current possibility of malaria infection on their own property. As well, about half of respondents with potential anopheline larval habitat did not report its presence, likely due to a highly specific definition of suitable mosquito habitat. Most respondents who are considered at risk of malaria currently use at least one type of mosquito bite prevention, most commonly bed nets.

Dengue fever in returned Swedish travelers from Thailand

The dengue viruses (DENV) are endemic in the tropical and sub-tropical countries and cause the most common arthropod-borne viral disease in humans. Travelers visiting endemic areas may both acquire and spread DENV infections, and this is the reason why prevention of mosquito bites is of crucial importance. Dengue fever (DF) has become the most common cause for tropical fever in Swedish tourists. Swedish data from 1995 to 2010 show that the number of DF cases has increased since the beginning of 2000; partly due to improved diagnostics based on IgM detection, and partly due to an increase in the number of tourists traveling to, and between, endemic areas. Young adults aged 20–29 are mostly affected, and epidemiological data indicate increased incidence rates from 2008 onwards. Our data pose a call for attention when traveling to DENV endemic areas as well as an increased awareness among physicians when treating returning travelers.

Knowledge, Attitudes, and Practices Among Foreign Backpackers Toward Malaria Risk in Southeast Asia

Malaria is still prevalent in Southeast Asia where large numbers of backpackers visit each year. This study aimed to assess the knowledge, attitude, and practices among foreign backpackers toward malaria risk in Southeast Asia. Questionnaires were administered to foreign backpackers in Bangkok, Thailand. They were asked about their general background, their attitude to malaria risk, and their preventive measures against malaria. Their knowledge about malaria was assessed by 10 true-false questions in the questionnaires. In total, 434 questionnaires were evaluated. Fifty-five percent of travelers were male and the median age was 28 years. The main reason for travel was tourism (91%). Almost all travelers (94%) were aware of the risk of malaria. Twenty-two percent of them would take antimalarial prophylaxis and 33% would use measures against mosquito bite, but nearly 40% had "no prevention" at all. Mean knowledge score was only 5.52 of 10. Most backpackers (92%) knew that malaria is a serious disease and sometime fatal and 74% knew that some travelers could develop malaria after they return. However, up to 35% believed that eating contaminated food could lead to malaria infection. And 49% believed that malaria could be 100% prevented by chemoprophylaxis. In backpackers, who had traveled in the forest (n = 65), only 54% used insect repellent regularly. Among those who had taken antimalarial prophylaxis, nearly 30% had stopped the medication prematurely. Although most backpackers perceive the risk of malaria in Southeast Asia, they have some misunderstandings about malaria and tend to comply poorly with mosquito bite prevention and chemoprophylactic strategies.

Review of Malaria Risk and Prevention for Use in Corporate Travel

Malaria continues to be a significant, life-threatening illness in many parts of the world. For corporate travelers from countries with low endemicity, the risk of infection is considerable. Many corporate travelers are unaware of their risk, unsure of the correct preventative measures, and receive incorrect advice regarding prevention or do not comply with advice they have received. This review addresses the risk of malaria to the nonimmune corporate traveler, disease transmission, and recommended means of prevention, including prevention of mosquito bites and antimalaria chemoprophylaxis.

Knowledge, Awareness and Practices Regarding Dengue Fever among the Adult Population of Dengue Hit Cosmopolitan

BackgroundThe World health Organization (WHO) declares dengue and dengue hemorrhagic fever to be endemic in South Asia. Despite the magnitude of problem, no documented evidence exists in Pakistan which reveals the awareness and practices of the country's adult population regarding dengue fever, its spread, symptoms, treatment and prevention. This study was conducted to assess the level of knowledge, attitudes and practices regarding dengue fever in people visiting tertiary care hospitals in Karachi, Pakistan.MethodsA cross-sectional pilot study was conducted among people visiting tertiary care hospitals in Karachi. Through convenience sampling, a pre-tested and structured questionnaire was administered through a face-to-face unprompted interview with 447 visitors. Knowledge was recorded on a scale of 1–3.ResultsAbout 89.9% of individuals interviewed had heard of dengue fever. Sufficient knowledge about dengue was found to be in 38.5% of the sample, with 66% of these in Aga Khan University Hospital and 33% in Civil Hospital Karachi. Literate individuals were relatively more well-informed about dengue fever as compared to the illiterate people (p<0.001). Knowledge based upon preventive measures was found to be predominantly focused towards prevention of mosquito bites (78.3%) rather than eradication of mosquito population (17.3%). Use of anti- mosquito spray was the most prevalent (48.1%) preventive measure. Television was considered as the most important and useful source of information on the disease.ConclusionAdult population of Karachi has adequate knowledge related to the disease ‘dengue’ on isolated aspects, but the overall prevalence of ‘sufficient knowledge’ based on our criteria is poor. We demonstrated adequate prevalence of preventive practices against the disease. Further studies correlating the association between knowledge and its effectiveness against dengue will be helpful in demonstrating the implications of awareness campaigns.

Dengue and dengue hemorrhagic fever: management issues in an intensive care unit

To describe the epidemiology, clinical features and treatment of dengue fever and dengue shock syndrome. To prepare this review, a literature search was made on PubMed and on the World Health Organization (WHO) and PAHO websites using the terms dengue and dengue shock syndrome. This information was complemented with personal practice. Dengue is the most important arthropod-borne viral disease of humans. Its presentation is protean and varies from an undifferentiated viral syndrome to hemorrhagic fever and severe shock. Dengue fever is a self-limiting, nonspecific illness characterized by fever, headache, myalgia, and constitutional symptoms. Its severe forms (hemorrhagic fever and shock syndrome) may lead to multisystem involvement and death. Early diagnosis, close monitoring for deterioration and response to treatment are necessary in all cases. WHO has provided a stepwise approach to management that is useful for milder forms and early shock. In the more severe forms aggressive fluid resuscitation and support for failing organs is necessary for the critically ill patient. Research addressing pathophysiological differences between dengue shock and septic shock, choice of fluids, inotropes and techniques of organ support are likely to yield benefits for the critically ill. There is no specific therapy for dengue infections. Good supportive care may be lifesaving, but ultimately initiatives aimed at vector control and prevention of mosquito bites may provide the greatest benefits.

Dengue e dengue hemorrágico: aspectos do manejo na unidade de terapia intensiva

OBJETIVOS: Descrever a epidemiologia, as características clínicas e o tratamento do dengue e das síndromes do choque associadas ao dengue. FONTES DOS DADOS: Para esta revisão de literatura, foi feita uma pesquisa no Pubmed e nos websites da Organização Mundial da Saúde (OMS) e OPAS usando os termos dengue e síndrome do choque associada ao dengue. A informação foi complementada com a experiência pessoal dos autores. SÍNTESE DOS DADOS: O dengue é a mais importante doença viral transmitida por artrópodos em seres humanos. A doença se manifesta de diversas formas, variando desde uma síndrome viral não-diferenciada até febre hemorrágica e choque grave. O dengue é uma enfermidade autolimitada, não específica, caracterizada por febre, cefaléia, mialgia, e sintomas constitucionais. As formas mais graves (febre hemorrágica e síndrome do choque) podem levar a um comprometimento multissistêmico e ao óbito. O diagnóstico precoce e um acompanhamento contínuo do agravamento e da resposta ao tratamento são necessários em todos os casos. A OMS recomenda uma abordagem escalonada para o manejo, adequada para as formas mais leves e para o choque precoce. Nas formas mais graves, é preciso uma abordagem agressiva de reanimação com fluidos e de suporte à falência de órgãos em pacientes em estado crítico. As pesquisas sobre as diferenças fisiopatológicas entre o choque do dengue e o choque séptico, seleção de fluidos, agentes inotrópicos e técnicas de suporte a órgãos podem beneficiar os pacientes em estado crítico. CONCLUSÕES: Não há uma terapia específica para infecções causadas pelo dengue. Um bom tratamento de suporte pode salvar vidas mas, em última análise, as iniciativas de controle do vetor e de prevenção contra picadas do mosquito podem trazer os maiores benefícios.

Using knowledge, attitudes and practice (KAP) surveys on lymphatic filariasis to prepare a health promotion campaign for mass drug administration in Alor District, Indonesia

We report the results of two surveys of people's knowledge, attitudes and practices (KAP) regarding lymphatic filariasis (LF) in Alor District, eastern Indonesia. The results of the surveys were used to prepare and evaluate the social mobilization component of a pilot mass drug administration (MDA) in five villages. In the study area, the filarial parasites Brugia timori and Wuchereria bancrofti are highly endemic. Frequent and severe adverse reactions after MDA may occur especially in areas endemic for B. timori and therefore, a special communication strategy was designed to inform and to educate communities about LF and its control. The first KAP survey was conducted as a baseline pre-MDA with diethylcarbamazine and albendazole and the second as a post-intervention evaluation in order to obtain information on the impact of the communication campaign. Before the information campaign and the subsequent MDA, 54% of the study population had heard of one of the three main terms for LF, whereas after health education and MDA, 89% had heard of at least one of the three terms. Similarly, pre-MDA, 21% reported having had previously taken the treatment for filariasis, while post-MDA, 88% reported having taken the treatment during the pilot treatment period. The historical fears and traumatic experiences associated with past LF treatment campaigns in Indonesia were averted since both the communication campaign and the MDA were designed appropriately for and together with the community. As a result, compliance was sufficient in the first round to successfully begin the elimination process.

Malaria in UK travellers: assessment, prevention and treatment

Malaria is the most serious tropical disease. Increasing numbers of people are travelling to tropical destinations where they are at risk of malaria. Nurses need to be aware of the disease risk, prevention of mosquito bites and appropriate chemoprophylaxis to protect the health of travellers. This article describes the malaria lifecycle, bite prevention, chemoprophylaxis, diagnosis and prevention strategies for people travelling to malarious areas. Additional resources are supplied for nurses who want further information.

Malaria in UK travellers: assessment, prevention and treatment

Malaria is the most serious tropical disease. Increasing numbers of people are travelling to tropical destinations where they are at risk of malaria. Nurses need to be aware of the disease risk, prevention of mosquito bites and appropriate chemoprophylaxis to protect the health of travellers. This article describes the malaria lifecycle, bite prevention, chemoprophylaxis, diagnosis and prevention strategies for people travelling to malarious areas. Additional resources are supplied for nurses who want further information.

Pre-West Nile Virus Outbreak: Perceptions and Practices to Prevent Mosquito Bites and Viral Encephalitis in the United States

Mosquitoes can transmit over 100 of the viruses that can cause encephalitis, meningitis, and hemorrhagic disease in humans (Chin 2000; Gubler 1996; Monath 1989). While much is known about the ecology, epidemiology, and clinical manifestations of the arboviral encephalitides (Campbell et al. 2002; Centers for Disease Control and Prevention 1997; Gubler 1998; Hayes 1989; Hubálek and Halouzka 1999), little empirical research exists regarding the U.S. population's knowledge of mosquitoes and arboviral encephalitis, particularly prior to the U.S. outbreak of West Nile virus (WNV) in 1999. A nationally representative 55-item survey instrument was successfully administered to 1,500 adults in the United States and an additional 250 adults in six states in the Northeast (Connecticut, Delaware, New Jersey, New York, Pennsylvania, and Rhode Island) regarding mosquitoes and mosquito-borne viral encephalitis. A summary outcome measure for mosquito bite prevention was created. Analyses revealed that the following were statistically significant predictors of behaviors taken to prevent mosquito bites: being concerned about being bitten by mosquitoes, perceived effectiveness of staying indoors in late afternoon and early evening was protective, perceived effectiveness that mosquito repellent is not harmful to health, owning dogs and/or cats as pets, being married, and being > or = 18-44 years old. Being concerned about being bitten by mosquitoes was the most robust predictor of behavioral action to prevent mosquito bites (OR = 7.3; 95% CI = 4.3, 12.2). Observed misperceptions and inadequate knowledge regarding insect repellents suggest increased promotion of the safety and efficacy of DEET-containing insect repellents is warranted.

Problems in prescribing malaria chemoprophylaxis for travelers.

To offer effective malaria chemoprophylaxis for travelers in a country, the physician must know the precise status of malaria there (frequency, resistance), determine the degree of exposure to mosquito bites, evaluate the precise clinical condition of the traveler, and improve the traveler's compliance with treatment by providing good information on potential side-effects. These side-effects, sometimes overemphasized in the media, lead to poor compliance, particularly after returning home, and, consequently, increase the risk of acquiring malaria. The recently approved Malarone could overcome these drawbacks. But its cost is high and its wide use could also lead to the emergence of resistant strains. Therefore, training professionals in travel medicine is important in malaria prevention and decrease the prescription of abusive or inaccurate prophylaxis (e.g., most tourists traveling in organized tours in Asia, with no stay in remote malaria endemic areas, do not need any prophylaxis). In addition, prevention of mosquito bites with repellents, impregnated bed nets, and indoor insecticide-dispensing devices is still an important tool for controlling malaria in travelers.

Analysis of vivax malaria cases in Gangwon-do (province), Korea in the year 2000.

A total of 827 malaria cases were reported in the Gangwon-do in the year 2000. There were 18.2 cases per 100,000 inhabitants. There were 283 cases among civilians and 544 cases among the military. 90.6% of cases were reported in Cheorwon--(531), Hwacheon--(152), and Goseong--(66) gun (county), which bordered the demilitarized zone (DMZ). A distinct feature pertaining to the malaria cases in Gangwon-do is that the number of cases has increased about two times over the last year. The mean time from the beginning of symptoms to malaria diagnosis was five days. Control systems for malaria by public health organizations and military organizations are well maintained, but were not able to reduce the malaria prevalence rate. The cause for the increase in pattern of the malaria cases in Gangwon-do may be caused by the spreading of prevalent areas of malaria to the east. Continuous endeavor such as early detection of cases, early treatment, education on clinical symptoms and prevention of mosquito bites with repellent and mosquito nets will help to reduce the infection rate of malaria in Gangwon-do.

How do rural households perceive and prioritise malaria and mosquito nets? A study in five communities of Nigeria

The aim of this study was to determine households' levels of prioritization and perception of malaria, ordinary mosquito nets and insecticide-treated nets (ITNs). A cross-sectional survey was conducted in five malaria holo-endemic communities in Enugu State, South-eastern Nigeria. The household heads or the representatives from randomly selected households were interviewed, using a pre-tested interviewer-administered questionnaire. The majority of the respondents had a good knowledge about malaria and the use of ordinary mosquito nets to prevent malaria. However, few knew about the existence of ITNs. Most respondents also stated that malaria was a priority problem and perceived some risk of contracting it. Despite the high level of knowledge about the use of mosquito nets, only 14.0%, 15.7%, 9.6% and 8.0% of the respondents from four of the communities had ever purchased any type of mosquito nets, except in Orba where the proportion was 50.3%. However, more than 80% in all the communities expressed a desire to buy insecticide-treated mosquito nets for the prevention of mosquito bites. There was considerable knowledge about malaria and the use of mosquito nets to prevent it. There were also high levels of prioritization of the disease, mosquito nets and ITNs which signalled the possibility of establishing sustainable community-based ITN programmes, especially as households wanted to buy the ITNs. Public Health(2000) 114, 407–410

Malaria protection measures used by in-flight travelers to South African game parks.

Malaria prevention in travelers depends upon dissemination of accurate information about malaria risk, prevention of mosquito bites, appropriate chemoprophylaxis use and knowledge of the symptoms of malaria. A study was undertaken of travelers to the Kruger National Park and private game parks in Mpumalanga Province, South Africa to investigate travelers knowledge, of malaria, chemoprophylaxis use, and experience of adverse events. In-flight self administered questionnaires were distributed and completed by travelers on flights returning to Johannesburg International Airport, from the malaria areas. The study was conducted during the highest malaria risk period during 1996. The Mpumalanga game parks are those most visited in South Africa and are found in the extreme northeast of the country, which adjoins Mozambique in the east and Zimbabwe in the north. This area is classified by the South African health authorities as being a high risk Malaria area.10 Chloroquine-resistant Plasmodium falciparum malaria has been described in this area.2,3 The Department of Health in South Africa recommends the use of mefloquine alone or the combination of chloroquine and proguanil, (doxycycline is prescribed for travelers in which the former antimalarials cannot be utilized), for visitors to this area during the high risk period for malaria, which extends from October to May.4 For the remainder of the year mosquito avoidance measures are recommended. Little is known about travelers' compliance with these recommendations and their knowledge of malaria. A study to explore these factors was undertaken as a joint initiative between the SAIMR travel clinic, Mpumalanga Department of Health, and the South African National Parks.

Malaria, Mefloquine, Madness, and Mosquito Nets

To the Editor.— For decades, the approach to malaria prophylaxis was to avoid getting bitten by mosquitoes, yet now in articles about malaria prophylaxis, 1 advice on the prevention of mosquito bites is usually relegated to a short sentence or paragraph at the end, if that. It is long overdue that we should have resumed expending our efforts on advising travelers to malarious areas and those who live there on the wisdom and methods of avoiding being bitten by malaria-carrying mosquitoes. Simple expedients are available that will greatly reduce exposure to these dangerous conditions.