title: Special infectious disease risks of expatriates and long-term travelers in tropical countries. Part I: malaria.
abstract: Malaria risk is dependent upon the entomological inoculation rate actually faced by the long-term traveler. Risk is cumulative, increases with duration of exposure, is greatest in rural and periurban areas, and least in urban centers. Risk may be zero in some urban centers, especially during dry seasons. Chemoprophylaxis compliance is hindered by the high adverse event rate often reported by users, is often suboptimal in expatriates, and decreases with duration of stay. Compliance with personal protection measures may also be suboptimal, and use of insecticide-treated nets and effective repellents should be encouraged. Alternative strategies to mitigate risk include seasonal chemoprophylaxis, nonuse of chemoprophylaxis with rapid treatment, self-testing, self-treatment where competent care and quality drugs are unavailable, and vector control. Choice of strategies will depend upon assessment of actual risk and likely compliance, with a combination of measures usually appropriate.
authors.affiliation: Royal Free and University College Medical School, London, UK. malaria@freesurf.ch
authors.forename: Stephen
authors.initials: S
authors.lastname: Toovey
authors.forename: Filip
authors.initials: F
authors.lastname: Moerman
authors.forename: Alfons
authors.initials: A
authors.lastname: van Gompel
mesh_terms: D000962:Antimalarials / Q000627:therapeutic use; D018890:Chemoprevention; D006801:Humans; D008288:Malaria / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control*; D009032:Mosquito Control; D012036:Refugees / Q000706:statistics & numerical data*; D014195:Travel; D014329:Tropical Climate
chemical_list: D000962:Antimalarials