Skip to main content

Advertisement

SpringerLink
Log in

Current Challenges in Travelers’ Malaria

  • Invited Commentary
  • Published:
Current Infectious Disease Reports Aims and scope Submit manuscript

Abstract

Travel health providers are often confronted with complex scenarios when advising travelers on malaria prevention. Current challenges in prevention include malaria risk assessment, where a detailed itinerary and knowledge of malaria epidemiology are needed. Up-to-date information on the correct use, limitations, and drug interactions of current priority chemoprophylaxis agents (atovaquone/proguanil, mefloquine, doxycycline) is key. Another challenge is to identify and reach travelers who are most at risk of malaria, such as the traveler visiting friends and relatives. Posttravel, delays in presentation, diagnosis, and inappropriate treatment of malaria are key risk factors leading to death. Treatment of malaria is an emergency requiring expert in-patient management and referral to a center with adequate expertise. Artemisinin combination therapies are the drugs of choice for uncomplicated malaria. Complicated malaria is treated preferably with intravenous artesunate, and the supply and quality of this life-saving antimalarial in some settings can pose one of the most urgent challenges in travelers’ malaria.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Jensenius M, Han P, Schlagenhauf P, et al. Acute and Potentially Life-Threatening tropical diseases in Western Travelers – A GeoSentinel Multicenter Study. 1996-2011. AmJTrop Med Hyg. 2013;88:397–404.

    Article  Google Scholar 

  2. Checkley AM et al. Risk factors for mortality from imported falciparum malaria in the United Kingdom over 20 years: an observational study. BMJ. 2012;344:e2116.

    Article  PubMed  Google Scholar 

  3. Askling HH et al. Malaria risk in travellers. Emerg Infect Dis. 2005;11:436–41.

    Article  PubMed  Google Scholar 

  4. Baird JK. Evidence and implications of mortality associated with acute Plasmodium vivax malaria. Clin Rev Microbiol. 2013;26:36–57.

    Article  Google Scholar 

  5. • Baird JK. Suppressive chemoprophylaxis invites avoidable risk of serious illness caused by Plasmodium vivax malaria. Travel Med Infect Dis. 2013. doi:10.1016/j.tmaid.2013.01.002.

    PubMed  Google Scholar 

  6. Antinori S, Galimberti L, Milazzo L, Corbellino M. Plasmodium knowlesi: The emerging zoonotic malaria parasite Acta Tropica 2013:191–201

  7. • Schlagenhauf P, Tschopp A, Johnson R et al. Tolerability of malaria chemoprophylaxis in non-immune travellers to sub-Saharan Africa: multicentre, randomised, double blind, four arm study. BMJ. 2003;327:e1078.

  8. Schlagenhauf P, Adamcova M, Schaerer MT, et al. Use of mefloquine in children, a review of dosage, pharmacokinetics and tolerability. Malaria J. 2011;10:292.

    Google Scholar 

  9. • Chen LH, Wilson ME, Schlagenhauf P. Controversies and misconceptions in malaria chemoprophylaxis for travelers. JAMA. 2007;297:2251–63.

    Article  PubMed  CAS  Google Scholar 

  10. •• Schlagenhauf P, Suter P, Regep L et al. Pregnancy and fetal outcomes after exposure to mefloquine in the pre- and periconception period and during pregnancy. Clin Infect Dis. 2012;54:e124–31.

  11. Mahajan B, Zheng H, Pham PT, Sedegah MY, Majam VF, Akolkar N, et al. Polymerase chain reaction-based tests for pan-species and species-specific detection of human Plasmodium parasites. Transfusion. 2012. doi:10.1111/j.1537-2995.2011.03541.x [Epub ahead of print].

    PubMed  Google Scholar 

  12. Luchavez J, Baker J, Alcantara S, Belizario Jr V, Cheng Q, McCarthy JS, et al. Laboratory demonstration of a prozone-like effect in HRP2-detecting malaria rapid diagnostic tests: implications for clinical management. Malar J. 2011;10:286.

    Article  PubMed  Google Scholar 

  13. Gillet P, Scheirlinck A, Stokx J, De Weggheleire A, Chaúque HS, Canhanga OD, et al. Prozone in malaria rapid diagnostics tests: how many cases are missed? Malar J. 2011;10:166.

    Article  PubMed  Google Scholar 

  14. Koita OA, Doumbo OK, Ouattara A, Tall LK, Konaré A, Diakité M, et al. False-negative rapid diagnostic tests for malaria and deletion of the histidine-rich repeat region of the hrp2 gene. AmJTrop Med Hyg. 2012;86:194–8.

    Article  CAS  Google Scholar 

  15. Baker J, Gatton ML, Peters J, Ho MF, McCarthy JS, Cheng Q. Transcription and expression of Plasmodium falciparum histidine-rich proteins in different stages and strains: implications for rapid diagnostic tests. PLoS One. 2011;6:e22593.

    Article  PubMed  CAS  Google Scholar 

  16. Chiodini PL, Bowers K, Jorgensen P, Barnwell JW, Grady KK, Luchavez J, et al. The heat stability of Plasmodium lactate dehydrogenase-based and histidine-rich protein 2-based malaria rapid diagnostic tests. Trans R Soc Trop Med Hyg. 2007;101:331–7.

    Article  PubMed  CAS  Google Scholar 

  17. van Hellemond JJ, Rutten M, Koelewijn R, Zeeman AM, Verweij JJ, Wismans PJ, et al. Human Plasmodium knowlesi infection detected by rapid diagnostic tests for malaria. Emerg Infect Dis. 2009;15:1478–80.

    Article  PubMed  Google Scholar 

  18. World Health Organization. Severe falciparum malaria. Trans R Soc Trop Med Hyg. 2000;94 Suppl 1:S1–S90.

    Article  Google Scholar 

  19. World Health Organization. Guidelines for the treatment of malaria. WHO, Geneva, 2011 (http://www.who.int/malaria/world_malaria_report_2010/en/index.html)

  20. Wernsdorfer WH. Coartemether (artemether and lumefantrine): an oral antimalarial drug. Expert Rev Anti Infect Ther. 2004;2:181–96.

    Article  PubMed  CAS  Google Scholar 

  21. Franklin BS, Vitorino BL, Coelho HC, Menezes-Neto A, Santos ML, Campos FM, et al. Plasma circulating nucleic acids levels increase according to the morbidity of Plasmodium vivax malaria. PLoS One. 2011;6:e19842.

    Article  PubMed  CAS  Google Scholar 

  22. Bruneel F, Tubach F, Corne P, Megarbane B, Mira JP, Peytel E, et al. Severe Imported Malaria in Adults (SIMA) Study Group: Severe imported falciparum malaria: a cohort study in 400 critically ill adults. PLoS One. 2010;5:e13236.

    Article  PubMed  Google Scholar 

  23. Dondorp A, Nosten F, Stepniewska K, Day N, White N. Artesunate versus quinine for treatment of severe falciparum malaria: a randomised trial. Lancet. 2005;366:717–25.

    Article  PubMed  Google Scholar 

  24. Dondorp AM, Fanello CI, Hendriksen IC, Gomes E, Seni A, Chhaganlal KD, et al. AQUAMAT group. Artesunate versus quinine in the treatment of severe falciparum malaria in African children (AQUAMAT): an open-label, randomised trial. Lancet. 2010;376:1647–57.

    Article  PubMed  CAS  Google Scholar 

  25. Sinclair D, Donegan S, Isba R, Lalloo DG. Artesunate versus quinine for treating severe malaria. The Cochrane Library 2012. DOI: 10.1002/14651858.CD005967.pub4.

  26. Zoller T, Junghanss T, Kapaun A, Gjorup I, Richter J, Hugo-Persson M, et al. Intravenous artesunate for severe malaria in travelers. Eur Emerg Infect Dis. 2011;17:771–7.

    Article  Google Scholar 

  27. Kreeftmeijer-Vegter AR, van Genderen PJ, Visser LG, Bierman WF, Clerinx J, van Veldhuizen CK, et al. Treatment outcome of intravenous artesunate in patients with severe malaria in the Netherlands and Belgium. Malar J. 2012;11:102.

    Article  PubMed  CAS  Google Scholar 

  28. Rolling T, Schmiedel S, Wichmann D, Wittkopf D, Burchard GD, Cramer JP. Post-treatment haemolysis in severe imported malaria after intravenous artesunate: case report of three patients with hyperparasitaemia. Malar J. 2012;11:169.

    Article  PubMed  Google Scholar 

  29. Société de Pathologie Infectieuse de Langue Française; Collège des Universitaires de Maladies Infectieuses et Tropicales; Société Française de Médecine des Armées; Société Française de Parasitologie; Société Française de Pédiatrie; Société de Médecine des Voyages; Société de Pathologie Exotique; Société de Réanimation de Langue Française: Recommendations for clinical practice. Management and prevention of imported Plasmodium falciparum malaria. Med Mal Infect. 2008;38:54–67.

  30. Aloni NM, Nsangu M, Kunuanunua T, Kadima TB, Muanda TF. Haemolytic crisis of blackwater fever following artemether-lumefantrine intake. Bull Soc Pathol Exot. 2010;103:296–8.

    Article  PubMed  CAS  Google Scholar 

  31. •• Askling HH, Bruneel F, Buchard G, Castelli F, Chiodini PL, Grobusch MP, et al. Management of imported malaria in Europe. Malar J. 2012;11:328.

    Article  PubMed  Google Scholar 

  32. Siswantoro H, Russell B, Ratcliff A, Prasetyorini B, Chalfein F, Marfurt J, et al. In vivo and in vitro efficacy of chloroquine against Plasmodium malariae and P. ovale in Papua, Indonesia. Antimicrob Agent Chemother. 2011;55:197–202.

    Article  CAS  Google Scholar 

  33. Bassat Q. The use of artemether-lumefantrine for the treatment of uncomplicated Plasmodium vivax malaria. PLoS Negl Trop Dis. 2011;5:e1325.

    Article  PubMed  CAS  Google Scholar 

  34. Pukrittayakamee S, Chantra A, Simpson JA, Vanijanonta S, Clemens R, Looareesuwan S, et al. Therapeutic responses to different antimalarial drugs in vivax malaria. Antimicrob Agent Chemother. 2000;44:1680–5.

    Article  CAS  Google Scholar 

  35. Taylor WR, Widjaja H, Richie TL, Basri H, Ohrt C, Tjitra, et al. Chloroquine/doxycycline combination versus chloroquine alone and doxycycline alone for the treatment of Plasmodium falciparum and Plasmodium vivax malaria in north-eastern Irian Jaya, Indonesia. AmJTrop Med Hyg. 2001;64:223–8.

    CAS  Google Scholar 

  36. Baird JK, Hoffman SL. Primaquine therapy for malaria. Clin Infect Dis. 2004;39:1336–45.

    Article  PubMed  CAS  Google Scholar 

  37. Fernando D, Rodrigo C, Rajapakse S. Primaquine in vivax malaria: an update and review on management issues. Malar J. 2011;10:351.

    Article  PubMed  CAS  Google Scholar 

  38. Centers for Disease Control and Prevention: Guidelines for Treatment of Malaria in the United States. http://www.cdc.gov/malaria/resources/pdf/treatmenttable.pdf (Accessed 15th March 2013)

  39. Singh B, Daneshvar C. Plasmodium knowlesi Malaria in Malaysia. Med J Malaysia. 2010;65:224–30.

    Google Scholar 

  40. William T, Menon J, Rajaram G, Chan L, Ma G, Donaldsnon S, et al. Severe P. knowlesi malaria in a tertiary care hospital, Sabah, Malaysis. Emerg Infect Dis. 2011;17:1248–55.

    Article  PubMed  Google Scholar 

Web References

  1. World Tourism Organisation UNWTO Tourism Highlights 2012 Edition, http://mkt.unwto.org/en/publication/unwto-tourism-highlights-2012-edition Accessed January 8th, 2013).

  2. WHO. World Malaria Report 2010 www.who.int/malaria/publications/atoz/9789241564106/en/index.html

  3. **CDC malaria prevention guidelines 2014, The Yellow Book www.cdc.org

Download references

Compliance with Ethics Guidelines

Conflict of Interest

Patricia Schlagenhauf and Eskild Peteresen declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

  1. Epidemiology of Communicable Diseases, University of Zürich Centre for Travel Medicine, Hirschengraben 84, 8001, Zürich, Switzerland

    Patricia Schlagenhauf

  2. Department of Infectious Diseases, Aahus University Hospital, Aahus, Denmark

    Eskild Petersen

Authors
  1. Patricia Schlagenhauf
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Eskild Petersen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Patricia Schlagenhauf.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Schlagenhauf, P., Petersen, E. Current Challenges in Travelers’ Malaria. Curr Infect Dis Rep 15, 307–315 (2013). https://doi.org/10.1007/s11908-013-0343-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11908-013-0343-3

Keywords

Search

Navigation