Medical Considerations before International Travel

Freedman, David O.; Chen, Lin H.; Kozarsky, Phyllis E.

doi:10.1056/nejmra1508815

Cited by 94 publications

(95 citation statements)

References 60 publications

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“…Furthermore, travellers may be prescribed a medication ineffective for the intended travel area [5]. The increasing connectivity of malaria-endemic countries with non-endemic countries via air travel [4, 8], the lack of adequate pre-travel preparation, and personal behaviour that may increase Anopheles mosquito exposure [9] may keep malaria as a continued threat to travellers’ health.…”

Section: Introductionmentioning

confidence: 99%

Malaria after international travel: a GeoSentinel analysis, 2003–2016

Angelo

Libman

Caumes

et al. 2017

Malar J

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BackgroundMore than 30,000 malaria cases are reported annually among international travellers. Despite improvements in malaria control, malaria continues to threaten travellers due to inaccurate perception of risk and sub-optimal pre-travel preparation.MethodsRecords with a confirmed malaria diagnosis after travel from January 2003 to July 2016 were obtained from GeoSentinel, a global surveillance network of travel and tropical medicine providers that monitors travel-related morbidity. Records were excluded if exposure country was missing or unascertainable or if there was a concomitant acute diagnosis unrelated to malaria. Records were analyzed to describe the demographic and clinical characteristics of international travellers with malaria.ResultsThere were 5689 travellers included; 325 were children <18 years. More than half (53%) were visiting friends and relatives (VFRs). Most (83%) were exposed in sub-Saharan Africa. The median trip duration was 32 days (interquartile range 20–75); 53% did not have a pre-travel visit. More than half (62%) were hospitalized; children were hospitalized more frequently than adults (73 and 62%, respectively). Ninety-two per cent had a single Plasmodium species diagnosis, most frequently Plasmodium falciparum (4011; 76%). Travellers with P. falciparum were most frequently VFRs (60%). More than 40% of travellers with a trip duration ≤7 days had Plasmodium vivax. There were 444 (8%) travellers with severe malaria; 31 children had severe malaria. Twelve travellers died.ConclusionMalaria remains a serious threat to international travellers. Efforts must focus on preventive strategies aimed on children and VFRs, and chemoprophylaxis access and preventive measure adherence should be emphasized.

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Section: Introductionmentioning

confidence: 99%

Malaria after international travel: a GeoSentinel analysis, 2003–2016

Angelo

Libman

Caumes

et al. 2017

Malar J

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“…Hepatitis A vaccination can be over 94% effective, while the efficacy of typhoid vaccination can range from 60 to 80%. 1 All vaccines might have decreased efficacy in populations with advanced age or medical problems. Currently recommended malaria prophylaxis regimens are highly effective in preventing P. falciparum malaria, although adherence can be difficult to confirm and failure of prophylaxis can occur, particularly with relapsing species of malaria, P. vivax and P. ovale.…”

Section: Adherence To Preventative Measuresmentioning

confidence: 99%

“…Currently recommended malaria prophylaxis regimens are highly effective in preventing P. falciparum malaria, although adherence can be difficult to confirm and failure of prophylaxis can occur, particularly with relapsing species of malaria, P. vivax and P. ovale. 1 Therefore, malaria should never be ruled out based on reported history of prophylaxis.…”

Section: Adherence To Preventative Measuresmentioning

confidence: 99%

“…Depending on destination, studies indicate that the prevalence of travelrelated illnesses among travelers can reach as high 80%. 1,2 Furthermore, international travel has dramatically increased over the past decades, and international tourist arrivals alone reached 1.2 billion in 2015, with increased numbers of traveler to destinations outside of Europe and North America. 3 Recent economic and popular trends have also led to an expanding range of travelers beyond business travelers, tourists, and aid workers, including budget travelers, study abroad students, medical tourists, and travelers visiting friends and relatives (VFR).…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of the sick returned traveler

2019

Seminars in Diagnostic Pathology

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“…However, in the travel medicine literature, the methods used to calculate malaria attack rates to approximate individual risk 1–3 are flawed. For example, authors often determine the number of cases of imported malaria from an endemic area to non-endemic countries reported in national surveillance systems, divide by the estimated total number of travellers from non-endemic countries to this region, and use the resulting quotient to make recommendations on chemoprophylaxis for travellers.…”

mentioning

confidence: 99%