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旅行者中疟疾感染的预防

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

引言

疟疾是旅行归来者出现发热和严重疾病的一项重要原因[1-3]。例如，1997-2006年间，在GeoSentinel诊所就诊的近7000名出现发热的旅行归来者中，疟疾是最常见的特异性病因学诊断，占所有病例的21%[1]。从撒哈拉以南的非洲地区返回的旅行者发生疟疾的相对风险比从亚洲或美洲返回的旅行者更高[4]。

2010年，上报至美国疾病预防控制中心(centers for disease control and prevention, CDC)的输入性疟疾大约为1700例；鉴于病例可能并未完全上报，所以实际输入性疟疾的数量很有可能被低估[5]。超过半数的报告病例是由恶性疟原虫(所致疾病最为严重)导致；感染恶性疟原虫的患者可能在数小时内进展为致命疾病，而且通常存在广泛的耐药性[6,7]。自1997年以来，美国年均疟疾死亡病例为6例。

预防措施应该针对所有类型的疟疾。除恶性疟原虫外，其他可导致人类疟疾的疟原虫种包括间日疟原虫、卵形疟原虫、三日疟原虫和诺氏疟原虫。这几种疟疾通常会导致发热性疾病，但并不常导致重症疾病且很少危及生命，虽然间日疟原虫和诺氏疟原虫感染病例中已有发生死亡的相关报道[8,9]。一般来说，大多数化学预防方案旨在预防疟疾的首次发作，但也许无法预防间日疟原虫和卵形疟原虫引起的后期复发。 (参见下文‘药物作用机制’和‘伯氨喹’)

大多数发生疟疾的旅行者之所以出现这种情况，是因为他们没有坚持有效的化学预防服药方案[10-12]。此外，许多旅行者常常未能采取个人保护措施预防蚊虫叮咬。

有关疟疾预防的风险评估、咨询、预防蚊虫叮咬和抗疟疾化学预防的内容将总结在此。疟疾的临床表现、诊断和治疗将单独讨论。 (参见“疟疾的临床表现”和“Diagnosis of malaria”和“重型恶性疟的治疗”和“Treatment of uncomplicated falciparum malaria in nonpregnant adults and children”)

                     

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Literature review current through: 2017-06 . | This topic last updated: 2017-06-20.
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