The low and declining risk of malaria in travellers to Latin America: is there still an indication for chemoprophylaxis?
A comparison was made between local malaria transmission and malaria imported by travellers to identify the utility of national and regional annual parasite index (API) in predicting malaria risk and its value in generating recommendations on malaria prophylaxis for travellers. Regional malaria transmission data was correlated with malaria acquired in Latin America and imported into the USA and nine European countries. Between 2000 and 2004, most countries reported declining malaria transmission. Highest API's in 2003/4 were in Surinam (287.4) Guyana (209.2) and French Guiana (147.4). The major source of travel associated malaria was Honduras, French Guiana, Guatemala, Mexico and Ecuador. During 2004 there were 6.3 million visits from the ten study countries and in 2005, 209 cases of malaria of which 22 (11%) were Plasmodium falciparum. The risk of adverse events are high and the benefit of avoided benign vivax malaria is very low under current policy, which may be causing more harm than benefit.
Behrens
Ron H
RH
Travel Clinic, Hospital for Tropical Diseases, Mortimer Market, London, WC1E 6JB, UK. ron.behrens@lshtm.ac.uk
Carroll
Bernadette
B
Beran
Jiri
J
Bouchaud
Olivier
O
Hellgren
Urban
U
Hatz
Christoph
C
Jelinek
Tomas
T
Legros
Fabrice
F
Mühlberger
Nikolai
N
Myrvang
Bjørn
B
Siikamäki
Heli
H
Visser
Leo
L
D002489:Central America / Q000453:epidemiology; D018890:Chemoprevention; D005060:Europe / Q000453:epidemiology; D006801:Humans; D008288:Malaria / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D010175:Pan American Health Organization; D012307:Risk Factors; D013020:South America / Q000453:epidemiology; D014195:Travel; D014481:United States / Q000453:epidemiology
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