Controversies and Misconceptions in Malaria Chemoprophylaxis for Travelers

Chen, Lin H.; Wilson, Mary; Schlagenhauf, Patricia

doi:10.1001/jama.297.20.2251

Cited by 110 publications

(76 citation statements)

References 89 publications

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“…The largest vulnerable populations are infants and women during their first pregnancy living in endemic lands [1]. But malaria-naïve individuals exposed to epidemic malaria or upon travel to malaria-endemic regions are also at risk of severe disease and death [2,3].…”

Section: Introductionmentioning

confidence: 99%

Phase 2a trial of 0, 1, and 3 month and 0, 7, and 28 day immunization schedules of malaria vaccine RTS,S/AS02 in malaria-naïve adults at the Walter Reed Army Institute of Research

Kester

Cummings

Ockenhouse

et al. 2008

Vaccine

120

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K.E. Kester et al.against falciparum malaria would be compatible with the Expanded Programme on Immunization, or in combination with other prevention measures, interrupt epidemic malaria or protect individuals upon sudden travel to an endemic area. Methods:We conducted an open label, Phase 2a trial of two different full dose schedules of RTS,S/AS02 in 40 healthy malaria-naïve adults. Cohort 1 (n = 20) was immunized on a 0, 1, and 3 month schedule and Cohort 2 (n = 20) on a 0, 7, and 28 day schedule. Three weeks later, 38 vaccinees and 12 unimmunized infectivity controls underwent malaria challenge. Results: Both regimens had a good safety and tolerability profile. Peak GMCs of antibody to the circumsporozoite protein (CSP) were similar in Cohort 1 (78 g/mL; 95% CI: 45-134) and Cohort 2 (65 g/mL; 95% CI: 40-104). Vaccine efficacy for Cohort 1 was 45% (95% CI: 18-62%) and for Cohort 2, 39% (95% CI: 11-56%). Protected volunteers had a higher GMC of anti-CSP antibody (114 g/mL) than did volunteers with a 2-day delay (70 g/mL) or no delay (30 g/mL) in the time to onset of parasitemia (Kruskal-Wallis, p = 0.019). A trend was seen for higher CSP-specific IFN-␥ responses in PBMC from protected volunteers only in Cohort 1, but not in Cohort 2, for ex vivo and for cultured ELISPOT assays. Conclusion: In malaria-naïve adults, the efficacy of three-dose RTS,S/AS02 regimens on either a 0, 1, and 3 month schedule or an abbreviated 0, 7, and 28 day schedule was not discernibly different from two previously reported trials of two-dose regimens given at 0, 1 month that conferred 47% (95% CI: −19 to 76%) protection and in another trial 42% (95% CI: 5-63%). A strong association of CSP-specific antibody with protection against malaria challenge is observed and confirms similar observations made in other studies. Subsequent trials of adjuvanted RTS,S in African children and infants on a 0, 1, and 2 month schedule have demonstrated a favorable safety and efficacy profile.

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Section: Introductionmentioning

confidence: 99%

Phase 2a trial of 0, 1, and 3 month and 0, 7, and 28 day immunization schedules of malaria vaccine RTS,S/AS02 in malaria-naïve adults at the Walter Reed Army Institute of Research

Kester

Cummings

Ockenhouse

et al. 2008

Vaccine

120

View full text Add to dashboard Cite

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“…28 As Djibouti progresses toward malaria elimination, opportunities will emerge for military personnel and international travelers to the country to forgo year-round chemoprophylaxis. Although national travel guidelines specific to Djibouti currently recommend chemoprophylaxis, 16,17,29,30 authorities in the United States, France, Germany, and Japan suggest that deferment of chemoprophylaxis is reasonable in settings where cases of malaria occur sporadically and the risk of malaria transmission is very low, 29,31 and among certain expatriates and long-term travelers. [30][31][32] Since 2003, official guidance has recommended only seasonal chemoprophylaxis for French forces, and German authorities recommended similar guidance for its forces in 2008.…”

Section: Discussionmentioning

confidence: 99%

“…Although national travel guidelines specific to Djibouti currently recommend chemoprophylaxis, 16,17,29,30 authorities in the United States, France, Germany, and Japan suggest that deferment of chemoprophylaxis is reasonable in settings where cases of malaria occur sporadically and the risk of malaria transmission is very low, 29,31 and among certain expatriates and long-term travelers. [30][31][32] Since 2003, official guidance has recommended only seasonal chemoprophylaxis for French forces, and German authorities recommended similar guidance for its forces in 2008. When chemoprophylaxis is deferred, strict adherence to mosquito-avoidance measures, prompt evaluation and treatment of febrile illness, and universal availability of emergency standby treatment of those distant from medical care are strict necessities.…”

Section: Discussionmentioning

confidence: 99%

“…33 Such policies have the advantage of minimizing broader exposure to the risk of adverse events and inappropriate prescribing associated with chemoprophylaxis. 31,34 A growing appreciation by military policymakers of the risks associated with the widespread use of certain chemoprophylaxis regimens, 34 and a growing acceptance of deferment under well-defined circumstances, 35,36 appear ready to inform future discussion in this area. Acknowledgments: We thank Catherine K. Craven, for her assistance in the review of this manuscript and in directing RLN to many useful references; Christopher Rogier, for his valuable assistance and support; Marcus Beckman for his advice and personal communications and information; Thierry Coton for his critical review; numerous departments within the Djiboutian MOH involved in the malaria program; and the French, U.S., and Djiboutian medical teams whose efforts to ensure timely notification of malaria cases serve to inform our understanding of malaria in the Republic of Djibouti.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Malaria in the Republic of Djibouti, 1998–2009

Ollivier¹,

Nevin²,

Darar³

et al. 2011

The American Society of Tropical Medicine and Hygiene

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Historically, native populations in the Republic of Djibouti have experienced only low and unstable malaria transmission and intermittent epidemics. In recent years, efforts at malaria control have been aggressively pursued. This study was performed to inform revised malaria prevention recommendations for military service members and international travelers to the country. Laboratory-confirmed cases of malaria documented at large medical facilities and within military and civilian health care systems in the Republic of Djibouti from 1998 to 2009 were reviewed. In recent years, fewer than 5% of febrile cases among the three largest passive surveillance systems were laboratory-confirmed as malaria, and incidence of confirmed malaria was well below 1/1,000 persons/year. As efforts in the Republic of Djibouti progress toward elimination, and in conjunction with continued efforts at surveillance, emphasizing mosquito-avoidance measures and standby emergency treatment will become reasonable recommendations for malaria prevention.

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“…Por lo tanto, la prevención está basada en la combinación de la quimioprofilaxis con información sobre prevención de picaduras [105][106][107][108] .…”

Section: Quimioprofilaxis Antipalúdicaunclassified

Ellos también viajan

García

2013

Rev Pediatr Aten Primaria

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Child Travellers CountThe World Tourism Organization estimates that in 2013 tourism will continue growing and that in 2020 there will be 1.6 billion international trips taken. In 2011, there were 13.3 million trips taken abroad in Spain. There are very few figures for the number of international trips taken by Spanish children, but it is known that they form about 10% of travellers, a similar percentage to that found in US studies. Furthermore, during the last decade the immigrant population of Spain has grown, increasing the number of families returning to their home country to visit friends and relations. Although children make up a significant proportion of international travellers there is little information on pre-travel medicine for this group. The aim of this article is to describe the particularities of general advice, vaccination recommendations and malaria prevention for child international travellers, with the purpose of both infectious and non-infectious disease prevention.La Organización Mundial del Turismo estima que en el año 2013 el turismo continuará creciendo y que en el año 2020 los viajes internacionales van a ser 1,6 billones. En 2011 se realizaron en España 13,3 millones de viajes al extranjero. Las estimaciones de niños españoles que realizan un viaje internacional son muy escasas, pero se sabe que estos representan aproximadamente un 10% de los viajeros, porcentaje parecido al mencionado en estudios realizados en EE. UU. Además, en la última década en España ha aumentado la población inmigrante, lo que incrementa el número de familias que retornan a sus países de origen para visitar a sus amigos y familiares. Aunque los niños representan una parte importante de los viajeros internacionales, existe poca información acerca de la medicina previaje en este grupo de población. El objetivo de este artículo es describir las particularidades, en el niño que realiza un viaje internacional, de los consejos generales y las recomendaciones de vacunación y prevención de la malaria; se pretende prevenir no solo las enfermedades infecciosas, sino también las no infecciosas. Key words: . Además, en la última década en España se ha incrementado la población inmigrante, lo que aumenta el número de familias que retornan a sus países de origen para visitar a

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Controversies and Misconceptions in Malaria Chemoprophylaxis for Travelers

Cited by 110 publications

References 89 publications

Phase 2a trial of 0, 1, and 3 month and 0, 7, and 28 day immunization schedules of malaria vaccine RTS,S/AS02 in malaria-naïve adults at the Walter Reed Army Institute of Research

Phase 2a trial of 0, 1, and 3 month and 0, 7, and 28 day immunization schedules of malaria vaccine RTS,S/AS02 in malaria-naïve adults at the Walter Reed Army Institute of Research

Malaria in the Republic of Djibouti, 1998–2009

Ellos también viajan

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