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Malaria prophylaxis in travellers: The current position

  • The Present State of Malaria Research
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Summary

Malaria prevention is a main challenge for physicians, nurses, health officers and tour operators. The attack rate of malaria in travellers is 1–10/10,000 departures, and the case fatality rate of imported malaria is around 0.5/100. Travellers should be informed about the risk they are going to take, how to protect against mosquito bites, about the antimalarials they will have to take and about what to do when a malaria breakthrough should occur.

The 4-aminoquinolines (chloroquine, amodiaquine) remain the drug of choice for the prevention ofPlasmodium vivax and of sensitiveP. falciparum infections. The problem is to find an effective and safe drug combination for travellers to areas whereP. falciparum is either resistant to chloroquine, to Fansidar (the combination of pyrimethamine plus sulfadoxine) or to both. These travellers will probably best be protected by an individually tailored drug combination, which includes amodiaquine or mefloquine as baseline drugs, and a supplementation with Fansidar, Maloprim (the combination of pyrimethamine with dapsone), paludrine or an antibiotic.

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References

  1. Bengtsson, E., Bjorkman, A., Brohult, J., Hedman, P., Persson, P., Rombo, L., and Wahlgren, M., Malaria prophylaxis when visiting areas of East Africa with chloroquine resistance. Lancet2 (1981) 249.

    Article  CAS  PubMed  Google Scholar 

  2. Boudreau, E.F., Webster, H.K., Pavanand, K., and Thosingha, L., Type II mefloquine resistance in Thialand. Lancet2 (1982) 1335.

    Article  CAS  PubMed  Google Scholar 

  3. Bray, R.S., and Garnham, P.C.C., The life cycle of primate malaria parasites. Br. med. Bull.38 (1982) 117–122.

    Article  CAS  PubMed  Google Scholar 

  4. Bruce-Chwatt, L.J., Essential malariology. W. Heinemann Medical Books Ltd., London 1980.

    Google Scholar 

  5. Bruce-Chwatt, L.J., Black, R.H., Canfield, C.J., Clyde, D.F., Peters, W., and Wernsdorfer, W.H., Chemotherapy of malaria, 2nd edn. WHO, Geneva 1981.

    Google Scholar 

  6. Bruce-Chwatt, L.J., Man against malaria; conquest or defeat, Trans. R. soc. trop Med. Hyg.73 (1979) 605–617.

    Article  CAS  PubMed  Google Scholar 

  7. Campbell, C.C., Payne, D., Schwartz, I.K., and Khatib, O.J., Evaluation of amodiaquine treatment of chloroquine-resistant Plasmodium falciparum malaria on Zanzibar, 1982. Am. J. trop. Med. Hyg.32 (1983) 1216–1220.

    Article  CAS  PubMed  Google Scholar 

  8. CDC, Health information for international travel. Morbid. Mortal. Wkly Rep.31 (1982) suppl.

  9. Colbourne, M.J., Malaria prophylaxis for long-term visitors. Comm. Dis. Rep.35 (1983) 3–4.

    Google Scholar 

  10. Colbourne, M.J., Malaria prophylaxis for visitors to south-east Asia and south-west Pacific. Comm. Dis. Rep.1 (1984) 3–4.

    Google Scholar 

  11. Dixon, K.E. Williams, R.G., Pongsupat, T., Pitaktong, U., and Phintuyolkin, P., A comparative trial of mefloquine and Fansidar in the treatment of falciparum malaria: failure of Fansidar. Trans. R. Soc. trop. Med. Hyg.76 (1982) 664–667.

    Article  CAS  PubMed  Google Scholar 

  12. Espinal, C.A., Uribe, L.M., Eslava, A., Rodriguez, M.E., Resistencia del plasmodium falciparum a combinación sulfa-pirimentamina. Descripción de los tres primeros casos en Colombia. Biomédica1 (1981) 213–217.

    Article  Google Scholar 

  13. Hansford, C.F., and Hoyland, J., An evaluation of co- trimoxazole in the treatment of Plasmodium falciparum malaria. S. Afr. med. J.61 (1982) 512–514.

    CAS  PubMed  Google Scholar 

  14. Holvoet, G., Michielsen, P., and Vandepitte, J., Airport malaria in Belgium. Lancet2 (1982) 881–882.

    Article  CAS  PubMed  Google Scholar 

  15. Jiang J.B., Li, G.Q., Guo, X.B., Kong, Y.C., and Arnold, K., Antimalarial activity of mefloquine and quinghaosu. Lancet2 (1982) 285–288.

    Article  CAS  PubMed  Google Scholar 

  16. Johnson, D.E., Roendej, P., and Williams, R.G., Falciparum malaria acquired in the area of the Thai-Khmer border resistant to treatment with Fansidar. Am. J. trop. Med. Hyg.31 (1982) 907–912.

    Article  CAS  PubMed  Google Scholar 

  17. Lapierre, J., Devant, J., Coquelin, B., Faurant, C., and Galal, A.A., Evaluation of experimental use of mefloquine for chemoprophylaxis of malaria in democratic Kampuchea (Kampuchean-Thai frontier region). WHO unpublished document, WHO/MAL/83.993 1983.

  18. McElnay, J.C., Mukhtar, H.A., D'Arcy, P.F., Temple, D.J., and Collier, P.S., The effect of magnesium trisilicate and kaolin on the in vivo absorption of chloroquine. J. trop. Med. Hyg.85 (1982) 159–163.

    CAS  PubMed  Google Scholar 

  19. Neumann, H.H., Malaria prophylaxis with chloroquine. Lancet2 (1981) 1231.

    Article  CAS  PubMed  Google Scholar 

  20. Noeypatimanond, S., Malikul, S., Benjapong, W., Duiyanada, D., and Ungkasrithongkul, M., Treatment of Plasmodium falciparum malaria with a combination of amodiaquine and tetracycline in Central Thailand. Trans. R. Soc. trop. Med. Hyg.77 (1983) 338–340.

    Article  CAS  PubMed  Google Scholar 

  21. Olsen, V.V., Why not proguanil in malaria prophylaxis? Lancet1 (1983) 649.

    Article  CAS  PubMed  Google Scholar 

  22. Pinichpongse, S., Doerstyn, E.B., Cullen, J.R., Yisunsri, L., Thongsombun, Y., and Thimasarn, K., An evaluation of five regimens for the outpatient therapy of Falciparum malaria in Thailand 1980–1981. Bull. WHO60 (1982) 907–912.

    CAS  PubMed  PubMed Central  Google Scholar 

  23. Phillips, R.E., Looareesuwan, S., Karbwang, J., Warrell, D.A., White, N.J., Kasemsarn, P., and Warhurst, D.C., Failure of chloroquine-erythromycin and chloroquine-tetracycline combinations in treatment of chloroquinine-resistant falciparum malaria in eastern Thailand. Lancet1 (1984) 300–302.

    Article  CAS  PubMed  Google Scholar 

  24. Rieckmann, K.H., Falciparum malaria: the urgent need for safe and effective drugs. A. Rev. Med.34 (1983) 321–335.

    Article  CAS  Google Scholar 

  25. Ritschel, W.A., Hammer, G.V., and Thompson, G.A., Pharmacokinetics of antimalarials and proposals for dosage regimens. Int. J. clin. Pharmac.6 (1978) 395–401.

    Google Scholar 

  26. Schwartz, I.K., Payne, D., Campbell, C.C., and Khatib, O.J., Invivo and in-vitro assessment of chloroquine-resistant plasmodium falciparum malaria in Zanzibar. Lancet1 (1983) 1003–1005.

    Article  CAS  PubMed  Google Scholar 

  27. Senior, R., The world travel market, pp. 1–250. Euromonitor Publ. Ltd. London 1982.

    Google Scholar 

  28. Smrkovski, L.L., Buck, R.L., Alcantara, A.K., Rodriguez, C.S., and Üylanco, C.V., In vitro mefloquine resistant Plasmodium falciparum from the Philippines. Lancet2 (1982) 322.

    Article  CAS  PubMed  Google Scholar 

  29. Smrkovski, L.L., Hoffman, S.L., Purnomo, Hussein, R.P., Masbar, S., and Kurniawan, L., Chloroquine resistant Plasmodium falciparum on the island of Flores, Indonesia. Trans. R. Soc. trop. Med. Hyg.77 (1983) 459–462.

    Article  CAS  PubMed  Google Scholar 

  30. Spencer, H.C., Kipingor, T., Agure, R., Koech, D.K. and Chulay, J.D., Plasmodium falciparum in Kisumu, Kenya:, differences in sensitivity to amodiaquine and chloroquine in vitro. J: Infect. Dis.148 (1983) 732–736.

    CAS  PubMed  Google Scholar 

  31. Stahel, E., Degrémont, A., and Lagler, U., Pyrimethamine-sulfadoxine resistant falciparum malaria acquired at Dar es Salaam. Lancet1 (1982) 1118–1119.

    Article  CAS  PubMed  Google Scholar 

  32. Stürchler, D., Endemiegebiete tropischer Infektionskrankheiten. H. Huber Verlag, Bern 1981.

    Google Scholar 

  33. WHO, World malaria situation 1981, Reprinted from, WHO Wkly Epidem. Rec.58 (1983) 189–192, 198–199, 206–209, 214–216, 222–224, 232–233.

    Google Scholar 

  34. WHO, Vaccination certivicate requirements for international travel and health advice to travellers. WHO, Geneva 1983.

    Google Scholar 

  35. Watkins, W.M., Sixsmith, D.G., Spencer, H.C., Boriga, D.A., Kariuki, D.M., Kipingor, T., and Koech, D.K., Effectiveness of amodiaquine as treatment for chloroquine-resistant plasmodium falciparum infections in Kenya. Lancet2 (1984) 357–359.

    Article  Google Scholar 

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Stürchler, D. Malaria prophylaxis in travellers: The current position. Experientia 40, 1357–1362 (1984). https://doi.org/10.1007/BF01951889

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