Prevention of Malaria in Long-term Travelers

Abstract

Prevention of malaria in long-term travelers is a complex issue and requires expert advice from travel medicine specialists. Recommendations for prevention of malaria in long-term travelers must be individualized.

Imported Malaria in Children in Industrialized Countries, 1992–2002

“…Our collated cases have also been infl uenced by traveler's choice of destination and use of preventive measures during travel, but other determinants included possible immunity or partial immunity of newly arrived immigrants to industrialized countries and number of travelers to malaria-endemic areas (23).…”

Malaria Chemoprophylaxis for the International Traveler, Current Options and Future Possibilities

“…Staying indoors, sleeping in screened-structures, and using mosquito nets during peak feeding times are all effective and relatively simple ways to reduce transmission of malaria. Other protective measures including clothing that minimizes exposed skin, eliminating mosquito breeding sites, and using appropriate repellents/insecticides on skin and clothing, should be discussed with the traveler as well (Chen et al, 2006;CDC, 2012). A systematic literature review concluded that environmental management programs were highly effective at reducing the morbidity and mortality associated with malaria, and if educated properly travelers can reduce their risk significantly through these personal and environmental protective measures (Keiser et al, 2005).…”

“…Serious side effects, although rare, include myopathy, hepatitis, hearing loss, Stevens-Johnson Syndrome, seizures, and irreversible retinopathy (WHO, 2010). Retinopathy is usually seen after 100g cumulative dose, which is equivalent to what a long-term traveler may ingest in 5-6 years of weekly dosing (Chen et al, 2006). Chloroquine-induced retinopathy is rare in patients taking malaria prophylaxis and is more frequently seen in the higher doses administered for the treatment of rheumatoid arthritis (CDC, 2012).…”

“…In a large (N=2701) trial of peace corps volunteers undergoing malaria prophylaxis it was found that chloroquine was better tolerated and had fewer serious side effects than mefloquine or doxycycline, however prophylaxis in general was not tolerated well with 9% reporting severe events and 23% at some point changing their prophylactic medication (Korhonen et al, 2007). Chloroquine is considered safe for use in children and pregnancy, however strict adherence to weight-based dosing must be adhered to for children since serious adverse events have been reported in children receiving as little as 1 gram of chloroquine (Chen et al, 2006). While chloroquine is safe for breast-feeding mothers, the infant should receive separate prophylaxis as the amount of chloroquine secreted in breast milk is not sufficient for protection.…”

“…months in duration, can be very difficult as consensus guidelines in this population are not available (Chen et al, 2006). It has been over ten years since the U.S. Food and Drug Administration has approved an antimalarial chemoprophylactic drug.…”