European consensus on malaria chemoprophylaxis

Abstract number: 1732_119

Hatz C.

Every year several thousand malaria cases with a mortality around 1% are reported in Europe. Visiting friends and Relatives (VFRs) are at particular risk.

The complex situation of malaria transmission in various endemic areas requires differentiated recommendations for malaria prophylaxis. Malaria prophylaxis comprises of multiple components. Malaria risk can be reduced by compliant exposure prevention, and with chemoprophylactic drugs for travel to high risk areas are available.

Key points for malaria prevention and management include awareness in endemic regions and after return, avoid mosquito bites, compliance with chemoprophylaxis, and seeking immediate diagnosis and therapy in case of fever.

The importance of exposure prophylaxis should be emphasized.

It is recommended to use mosquito repellents after dusk, especially if outdoor activities are performed. Light-coloured, loose-fitting insecticide-treated clothing with long trousers and long sleeves are suggested. Sleeping under insecticide treated bed nets or in air-conditioned rooms which are pre-treated with insecticides (knockdown spray) is recommended.

Chemoprophylaxis is recommended in high risk areas. In most settings, either mefloquine (Lariam®), atovaquone/proguanil (Malarone®) or doxycycline (monohydrate) are used. In German speaking countries, emergency treatment is recommended for trips to regions with low or intermediate malaria risk. This strategy is recommended when the infection risk is lower than the risk of severe drug side effects.

Good information by the consulting doctor and personal responsibility of the traveller are essential for the correct handling of emergency-self-treatment. Drugs used include artemether/lumefantrine (Riamet®), atovaquone/proguanil (Malarone®) or mefloquine (Lariam®). The guidelines for the application of the emergency-self-treatment should be discussed thoroughly with the traveller, to make sure that in case of fever the correct action will be taken:

1. In case of fever (sudden onset or rapidly progressive) – axillary temperature >37.5°C (oral, tympanal or rectal >38°C) – a doctor should be seen and a malaria blood test should be performed. A working thermometer is essential in the tropics.

2. If no doctor can be seen within 24h and the traveller is in an endemic region for at least 6 days, the fever should be lowered.

3. The malaria emergency medication should be taken with adequate amounts of fluid.

4. In every case, also after the intake of the malaria drug a doctor must be consulted at the earliest possible time.

Session Details

Date: 31/03/2007
Time: 00:00-00:00
Session name: European Society of Clinical Microbiology and Infectious Diseases
Location: ICC, Munich, Germany
Presentation type:
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