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Prevention of malaria infection in travelers

Authors
Paul M Arguin, MD
Jay S Keystone, MD, MSc (CTM), FRCPC
Section Editor
Johanna Daily, MD, MSc
Deputy Editor
Elinor L Baron, MD, DTMH

INTRODUCTION

Malaria is an important cause of fever and serious illness in returned travelers [1-3]. Among nearly 7000 returned travelers with fever seen at a GeoSentinel clinic between 1997 and 2006, for example, malaria was the most common specific etiologic diagnosis, found in 21 percent of cases [1]. The relative risk of malaria is higher among returned travelers from sub-Saharan Africa than those from Asia or the Americas [4].

Approximately 1727 cases of imported malaria were reported in 2013 to the United States Centers for Disease Control and Prevention [4]. More than half of the reported cases are due to Plasmodium falciparum, which causes the most severe disease; patients with P. falciparum may progress to life-threatening illness within hours [5,6]. Since 1997, there has been an average of six malaria deaths per year in the United States.

Prevention efforts should be aimed at all forms of malaria. In addition to P. falciparum, other Plasmodium species that cause human malaria include P. vivax, P. ovale, P. malariae, and P. knowlesi. While P. falciparum is most likely to result in severe disease, all malaria species can cause severe disease and death [7,8]. In general, most chemoprophylaxis regimens are designed to prevent primary attacks of malaria. Primaquine can also prevent relapses of malaria caused by P. vivax and P. ovale. (See 'Drug mechanisms' below and 'Primaquine' below.)

Most travelers who develop malaria do so because they do not adhere to an effective chemoprophylactic drug regimen [9-11]. In addition, many travelers frequently fail to use personal protection measures for mosquito bite prevention.

Issues related to risk assessment, counseling, mosquito bite prevention, and antimalarial chemoprophylaxis for prevention of malaria will be reviewed here. The clinical manifestations, diagnosis, and treatment of malaria are discussed separately. (See "Clinical manifestations of malaria in nonpregnant adults and children" and "Diagnosis of malaria" and "Treatment of severe malaria" and "Treatment of uncomplicated falciparum malaria in nonpregnant adults and children".)

                      

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