Response to fever and utilization of standby emergency treatment (SBET) for malaria in travellers to Southeast Asia: a questionnaire-based cohort study

Abstract

BackgroundGuidelines in several European countries recommend standby emergency treatment (SBET) for travellers to regions with low or medium malaria transmission instead of continuous chemoprophylaxis: travellers are advised to seek medical assistance within 24 h in case of fever and to self-administer SBET only if they are not able to consult a doctor within the time period specified. Data on healthcare-seeking behaviour of febrile travellers and utilization of SBET is however scarce as only two studies were performed in the mid-1990s. Since tourism is constantly increasing and malaria epidemiology has dramatically changed in the meantime more knowledge is urgently needed.MethodsSome 876 travellers to destinations in South and Southeast Asia with low or medium malaria transmission were recruited in the travel clinic of the University Medical Center Hamburg-Eppendorf. Demographic and travel-related data were collected by using questionnaires. Pre-travel advice was carried out and SBET was prescribed in accordance to national guidelines. Post-travel phone interviews were performed to assess health incidents during travel and individual responses of travellers to febrile illness.ResultsOut of 714 patients who were monitored, 130 (18%) reported onset of fever during travel or 14 days after return. Of those travellers who reported fever, 100 (80%) carried SBET during travel. The vast majority of 79 (79%) febrile travellers who carried SBET did not seek medical assistance. Overall, 14 (14%) febrile patients who carried SBET and six (20%) patients who did not carry SBET took the correct measure (doctor visit or timely SBET administration) as a response to febrile illness, respectively. Only two travellers self-administered SBET, but both of them applied the wrong regimen.ConclusionsIn view of declining malaria transmission and improving medical infrastructure in most countries of Southeast Asia and obvious obstacles concerning SBET as shown in this study the current strategy should be re-evaluated. Pre-travel advice concerning malaria in SEA should focus on appropriate mosquito bite protection and clearly emphasize the need to see a doctor within 24 h after onset of fever.

Retrospective clinical case series study in 2017 identifies Plasmodium knowlesi as most frequent Plasmodium species in returning travellers from Thailand to Germany

“…In addition, in cases with a persistent suspicion of a malaria infection but with negative smear and RDT results, a differential PCR comprising P. knowlesi should be considered as a means of diagnosis of a possible P. knowlesi infection presenting with a low parasitaemia. However, the extremely low incidence of only two cases of malaria across all species in an annual 761,000 travels from Germany to Thailand may provoke a reconsideration of current travel recommendations with regard to malaria prevention, especially in light of reports of inadequate use of anti-malarial standby medication [ 29 ].…”

Self-diagnosis of malaria by travellers: a cohort study on the use of malaria rapid diagnostic tests provided by a Swiss travel clinic

“…A recent study analysed 748 travellers to South and Southeast Asia with low or medium malaria transmission who had received SBET in a pre-travel consultation. Among the 100 febrile travellers carrying SBET during travel, only 14% took the correct measures (doctor visit or timely SBET administration) [ 23 ]. In the present study, the reasons for neither consulting nor performing the test were reasonable (diarrhoea and/or symptoms lasting a few hours only).…”

Notfallmäßige Selbstbehandlung für Reisende in Malariagebiete mit geringem Transmissionsrisiko

“…Anfang 2017 haben wir nun eine Reevaluation der SBET-Praxis veröffentlicht. In der reisemedizinischen Sprechstunde des Universitätsklinikums Hamburg-Eppendorf wurden insgesamt 714 Reisende in Gebiete Süd-und Südost asiens mit niedriger bis mittlerer Malariatransmission eingeschlossen [14]. Alle Teilnehmer der Untersuchung erhielten eine reisemedizinische Beratung und die SBET wurde gemäß geltender Empfehlungen verschrieben.…”