An Organizational Approach to Malaria Protection: Balancing Precision and Practicality, Expert Panel Recommendations

Abstract

Global mobile workers risk serious disease and death from malaria while it is a curable and preventable disease. Organizations sending workers and their families into malarious areas are challenged by implementing efficient and consistent malaria control programs in the face of conflicting opinions, recommendations and perceptions regarding the necessity of malaria controls, especially regarding the use of chemoprophylaxis medications. Many of the issues related to malaria chemoprophylaxis have not been and are not likely to be studied in well-designed, randomized, double blinded clinical trials. In addition, country regulations differ and conflicting advice is provided by different health workers. To standardize advice and recommendations on malaria chemoprophylaxis, a list of issues was developed from questions frequently asked by managers, employees and contractors. During a two-day workshop, a world-renowned expert panel with extensive professional experience in infectious diseases, travel medicine, occupational medicine and health education, discussed the issues while reviewing the relevant literature and sharing their practical experience, to provide sound technical guidance. This paper provides scientific evidence-based malaria prevention guidance, balancing the precision of malaria protection with practical recommendations for chemoprophylaxis use, based on immune status and destination factors. The panel endorsed continued long-term use of chemoprophylaxis by individuals categorized as non-immune, traveling in high risk plasmodium falciparum areas. Specific guidelines were recommended for travelers to Mexico, Papua New Guinea and India. Guidance for travelers switching back and forth between various medications was provided to help individuals maintain protection and reduce the risk of adverse health affects from multiple drugs. Recommendations for offering medication breaks for offshore workers were not strongly endorsed due to unpredicted travel through high risk onshore locations and the difficulties in being able to effectively communicate and apply these guidelines.