title: The low and declining risk of malaria in travellers to Latin America: is there still an indication for chemoprophylaxis?
abstract: 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.
authors: Travel Clinic, Hospital for Tropical Diseases, Mortimer Market, London, WC1E 6JB, UK. ron.behrens@lshtm.ac.uk
authors: Ron H
authors: RH
authors: Behrens
authors: Bernadette
authors: B
authors: Carroll
authors: Jiri
authors: J
authors: Beran
authors: Olivier
authors: O
authors: Bouchaud
authors: Urban
authors: U
authors: Hellgren
authors: Christoph
authors: C
authors: Hatz
authors: Tomas
authors: T
authors: Jelinek
authors: Fabrice
authors: F
authors: Legros
authors: Nikolai
authors: N
authors: Mühlberger
authors: Bjørn
authors: B
authors: Myrvang
authors: Heli
authors: H
authors: Siikamäki
authors: Leo
authors: L
authors: Visser
mesh_terms: 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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