Malaria in long-term travelers: Infection risks and adherence to preventive measures - A prospective cohort study.

Autor: Suryapranata FST; Department of Infectious Diseases, Public Health Service (GGD) of Amsterdam, Nieuwe Achtergracht 100, PO Box 2200, 1000 CE, Amsterdam, the Netherlands; National Coordination Centre for Travellers' Health Advice (LCR), Nieuwe Achtergracht 100, PO Box 1008, 1000 BA, Amsterdam, the Netherlands; Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centers, Location AMC, Amsterdam Infection & Immunity, Amsterdam Public Health, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands., Overbosch FW; Department of Infectious Diseases, Public Health Service (GGD) of Amsterdam, Nieuwe Achtergracht 100, PO Box 2200, 1000 CE, Amsterdam, the Netherlands., Matser A; Department of Infectious Diseases, Public Health Service (GGD) of Amsterdam, Nieuwe Achtergracht 100, PO Box 2200, 1000 CE, Amsterdam, the Netherlands; Department of Infectious Diseases, Amsterdam University Medical Centers, Location AMC, Amsterdam Infection & Immunity, University of Amsterdam, Amsterdam Public Health, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands., Grobusch MP; Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centers, Location AMC, Amsterdam Infection & Immunity, Amsterdam Public Health, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands., McCall MBB; Department of Medical Microbiology, Radboud University Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands., van Rijckevorsel GGC; Department of Medical Microbiology, Radboud University Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands; Department of Infectious Diseases, National Institute for Public Health and the Environment, Antonie van Leeuwenhoeklaan 9, 3721 MA, Bilthoven, the Netherlands., Prins M; Department of Infectious Diseases, Public Health Service (GGD) of Amsterdam, Nieuwe Achtergracht 100, PO Box 2200, 1000 CE, Amsterdam, the Netherlands; Department of Infectious Diseases, Amsterdam University Medical Centers, Location AMC, Amsterdam Infection & Immunity, University of Amsterdam, Amsterdam Public Health, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands., Sonder GJB; Department of Infectious Diseases, Public Health Service (GGD) of Amsterdam, Nieuwe Achtergracht 100, PO Box 2200, 1000 CE, Amsterdam, the Netherlands; Department of Infectious Diseases, Amsterdam University Medical Centers, Location AMC, Amsterdam Infection & Immunity, University of Amsterdam, Amsterdam Public Health, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands. Electronic address: g.j.sonder@amsterdamumc.nl.
Jazyk: angličtina
Zdroj: Travel medicine and infectious disease [Travel Med Infect Dis] 2022 Sep-Oct; Vol. 49, pp. 102406. Date of Electronic Publication: 2022 Aug 04.
DOI: 10.1016/j.tmaid.2022.102406
Abstrakt: Background: Chemoprophylaxis and anti-mosquito measures are key to preventing malaria in travelers. Long-term travelers are at higher risk than short-term travelers, but their adherence to preventive measures is lower. Our aim was to determine malaria exposure risks and predictors for adherence to malaria-preventive measures in long-term travelers.
Methods: Long-term travelers (>12 weeks) completed a weekly questionnaire about preventive measures, symptoms, and malaria treatment abroad. Blood samples were tested for seroconversion to Plasmodium falciparum anti-circumsporozoite (PfCSP) antibody. Adherence to preventive measures was defined as number of weeks of their usage divided by number of weeks in malaria-endemic areas.
Results: Of 561 travelers, the median travel time was 20 weeks (IQR 16-25). Eighteen were treated for malaria, all in sub-Saharan Africa. Sixteen PfCSP seroconversions were found, of whom only 3 had traveled to high-endemic areas. Of the 18 travelers treated for malaria, only one seroconverted. No associations were found between covariates and seroconversion. Neither treatment abroad nor seroconversion were reliable predictors for exposure. 'Full adherence' to chemoprophylaxis was reported by 52% (218/417) and was associated with travel to Africa, use of mefloquine, lack of prior travel history, shorter duration of travel, and use of DEET.
Conclusions: The risk of malaria in this long-term travelers cohort was low. Our data confirm that anti-PfCSP seroconversion is not a reliable method to retrospectively identify incident infection, or probably exposure. Prevention efforts should focus on more experienced travellers and longer travel duration, for whom mefloquine should be considered as the first-choice chemoprophylaxis.
(Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)
Databáze: MEDLINE
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