Individualized Strategies Needed for Prevention of Malaria in Long-Term Travelers
Prevention of malaria for persons who travel for more than six months is complex and should be individualized, with advice from travel medicine specialists, according to a review article in the Nov. 8, 2006 issue of JAMA.
There were more than 800 million trips by travelers worldwide in 2005, according to background information in the article. For long-term travelers visiting malaria-endemic countries, recommendations for prevention have been difficult to standardize due to the diversity of long-term travelers and their itineraries, the variation in the quality of and access to medical care, the limited data on malaria incidence in travelers overseas, and the lack of controlled studies on long-term safety and effectiveness of anti-malarial agents. Further complicating the recommendations is the growth in the intensity of transmission and resistance patterns of the malaria parasites, the seasonality of transmission, and the wide range of international guidelines and travelers' beliefs and expectations.
Lin H. Chen, MD, of Mount Auburn Hospital in Cambridge, Mass., and colleagues conducted a review of relevant studies and articles, published through July 2006, to examine the risk of malaria in long-term travelers, recent developments in personal protective measures, and the safety and tolerability of malaria treatments during long-term use and to consider prevention strategies.
The studies indicated that long-term travelers (more than six months) 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," the researchers write.
The authors add that vivax malaria (a form of malaria marked by convulsions that occur every 48 hours and caused by the parasite Plasmodium vivax) causes significant illness in travelers, but relapses of vivax malaria are not prevented with the current first-line chemoprophylaxis regimens.
"Long-term travelers to malaria-endemic areas face risk of death, morbidity, and reduced productivity because of malaria. General guidelines are desirable, but recommendations for malaria prevention in long-term travelers must be individualized and should be provided by travel medicine specialists. Personal protective measures are paramount. Identification of reliable medical facilities at destination is crucial for long-term travelers regardless of their malaria prevention strategies, and a number of resources are available to aid in this process. Data on safety of chemoprophylaxis drugs show reasonable clinical support for long-term use, particularly for mefloquine."
"All travelers should be advised to carry or arrange adequate supplies of antimalarial agents, because counterfeit drugs are rampant in developing countries. Long-term travelers should also consider evacuation insurance for medical emergencies," they write. "Presumptive antirelapse therapy should be considered for long-term travelers who have been intensively exposed to P vivax. Because inconsistent recommendations undermine the adherence to any preventive strategy, national and international experts should strive toward consensus on guidelines for malaria prevention in long-term travelers."
In a global world, significant factors affect the spread of infectious diseases, including international trade, air travel and globalized food production. "Airport malaria" is a term coined by researchers to explain the more recent spread of malaria to areas such as the United States and Europe, which some scientists credit to warmer climate changes.Airport malaria is transmitted when a mosquito ...
BALTIMORE -- New vaccine requirements will affect anyone who is applying for an immigrant visa for entry into the U.S. and anyone seeking adjustment of status for permanent residence. Applicants must show proof of vaccinations against vaccine-preventable diseases, as recommended by the U.S. Advisory Committee on Immunization Practices. Passport Health, a company that specializes in travel medicine and vaccinations, announced ...
Diarrhea PatchResearchers at the University of Texas School of Public Health have found that patients given a travelers’ diarrhea vaccine were significantly less likely to suffer from clinically significant diarrhea than those who received placebo, according to a study published in this week’s edition of the Lancet. The patch-based vaccine is part of the Phase 2 study in conjunction with ...
As Americans travel to Israel for the Jewish holiday of Passover, the Centers for Disease Control and Prevention (CDC) advises all travelers to ensure they are protected from measles before departing, because of a measles outbreak in Israel. Since September, more than 900 cases of measles have been reported in Israel, with about 700 cases in the cities of Jerusalem ...
DENVER -- Michelle Reesman, RN, executive director of Passport Health Colorado, says far too many international travelers, from business travelers to the more adventurous types, leave home without taking the basic steps she suggests below. "People need to put the same kind of preparation into their health as they do into their destination choice, passport acquisition or flight plans," ...
Bacteria and viruses are the microscopic organisms – otherwise known as germs -- that are responsible for causing and transmitting illness and disease. These microbes are so small, that according to the American Society for Microbiology, if the smallest of all microbes was the size of a baseball, an average bacterium would then be the size of the pitcher's mound, and just one of the millions of cells that make up your body would be the size of the ballpark!
