An observational prospective cohort study assessed malaria risk perception, knowledge and prophylaxis practices among individuals of African ethnicity living in Paris and travelling to their country of origin to visit friends or relatives (VFR). The study compared two groups of VFR who had visited a travel clinic (TC; n=122) or a travel agency (TA; n=69) before departure. Of the 47% of VFR citing malaria as a health concern, 75% knew that malaria is mosquito-borne and that bed nets are an effective preventive measure. Perception of high malaria risk was greater in the TA group (33%) than in the TC group (7%). The availability of a malaria vaccine was mentioned by 35% of VFR, with frequent confusion between yellow fever vaccine and malaria prevention. Twenty-nine percent took adequate chemoprophylaxis with complete adherence, which was higher among the TC group (41%) than the TA group (12%). Effective antivector protection measures used were bed nets (16%), wearing long clothes at night (14%) and air conditioning (8%), with no differences between the study groups except in the use of impregnated bed nets (11% of the TC group and none of the TA group). Media coverage, malaria chemoprophylaxis repayment and cultural adaptation of preventive messages should be improved to reduce the high rate of inadequate malaria prophylaxis in VFR.

The purpose of our entomological survey was to estimate mosquito biodiversity, infectivity rates and insecticide resistance levels in Anopheles species in four study sites in a mining area with high malaria transmission in southeastern Guinea. Anopheles gambiae s.l. (77%) was the most common Anopheles collected followed by An. funestus (20%). The specimens of the An. gambiae complex were predominantly An. gambiae S form (97.6%) with 1.4% of An. gambiae M form found in Kérouané only, and 1% of An. arabiensis which was present in all four study sites. Anopheles gambiae S form and An. funestus were found to be infected with Plasmodium falciparum, with infectivity rates of 4.1% and 4.4% and inoculation rates of 0.60 and 0.19 infected bite/person/night, respectively. In addition, a high level (79%) of the knockdown resistance (kdr) L1014F mutation was reported in the populations of An. gambiae S form. The high malaria transmission that occurs in the prospected area of Guinea requires a long-term vector control programme. However, such a control programme will have to consider the presence of the kdr gene at a surprisingly high level within the dominant vector, which could reduce the expected impact of vector control.

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TX 75083-3836, U.S.A., fax 01-972-952-9435. AbstractThe Severe Acute Respiratory Syndrome (SARS) in 2003 is an emerging disease that spread rapidly worldwide. Remote and offshore operations appeared particularly at risk for various reasons. Medical teams were not prepared for the management of outbreaks. The density of population made close contact transmission possible. Remoteness resulted in misinterpreted information, weak and delayed adapted support, and improbable medical evacuation.As a result, companies immediately set travel policies and screening procedures to decrease the probability of having someone on site presenting early signs of SARS. In cooperation with site management, alert level policies were implemented to plan responses adapted to pre-defined thresholds of risk. Information and training focused on prompt detection and isolation of cases, strict infection control in medical facilities, and the tracing and quarantine of contacts. Specific SARS management kits were elaborated to address the treatment of suspect cases, the organisation of isolation and the protection of medical teams. Medical evacuation of cases became a challenge due to medical transportation issues, operational limitations and international administrative constraints. Information dissemination services and email alerts were set up via a SARS dedicated web site in order to provide compiled data and operational information to medical directors. This paper will review the experiences of companies tackling the SARS outbreak in remote settings. In the absence of a vaccine, robust diagnostic tests and specific treatment, this medical issue appeared initially to have no medical, but only operational answers. Options chosen in terms of staff management, treatment abilities and evacuation capacities will be discussed. In conclusion, the importance of appropriate communication and accurate information will be analysed to help corporations make appropriate decisions in such challenging circumstances.

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