Success of malaria chemoprophylaxis for outbound civil and military travellers in prevention of reintroduction of malaria in Sri Lanka

Fernando, Sumadhya Deepika; Ranaweera, Dewanee; Weerasena, Methnie S; Booso, Rahuman; Wickramasekara, Thamara; Madurapperuma, Chirath P; Danansuriya, Manjula; Rodrigo, Chaturaka; Herath, Hemantha

doi:10.1093/inthealth/ihz094

Cited by 4 publications

(5 citation statements)

References 18 publications

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“…Prevention of malaria in Sri Lankan travellers is yet another strategy being implemented by the AMC to reduce incidence, morbidity and mortality due to imported malaria. Studies have shown that malaria chemoprophylaxis is well tolerated by travellers with a protective efficacy of 100% amongst those who complied [ 14 ]. The AMC provides malaria chemoprophylaxis free-of-charge to any traveller destined for a malaria endemic country.…”

Section: Discussionmentioning

confidence: 99%

“…The AMC provides malaria chemoprophylaxis free-of-charge to any traveller destined for a malaria endemic country. Yet, despite the wide availability of anti-malarial chemoprophylaxis at the AMC Headquarters and Offices of the Regional Malaria Officer travellers to malaria endemic countries rarely obtain these medicines, and even when they do, adherence to the prophylaxis regime has been poor [ 14 , 44 ]. Between 2015 and 2023, of the 30 patients who developed severe malaria, only five had obtained prophylaxis and they too had not taken it as advised (Supplementary Table 1).…”

Section: Discussionmentioning

confidence: 99%

“…The key strategies implemented by the Anti Malaria Campaign (AMC) in the PoR phase include increasing awareness amongst physicians to suspect malaria in individuals with a travel history to a malaria endemic country so as to lead to early diagnosis and treatment, proactive case detection amongst high risk groups [ 13 ], providing chemoprophylaxis for travellers to malarious countries free of charge [ 14 , 15 ] and vector surveillance and control [ 9 ]. These strategies implemented by the AMC have enabled Sri Lanka to sustain zero transmission of malaria and zero deaths due to malaria for a decade.…”

Section: Introductionmentioning

confidence: 99%

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An epidemiological analysis of severe imported malaria infections in Sri Lanka, after malaria elimination

Seneviratne,

Fernando,

Wickremasinghe

et al. 2024

Malar J

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Background Imported malaria continues to be reported in Sri Lanka after it was eliminated in 2012, and a few progress to life-threatening severe malaria. Methods Data on imported malaria cases reported in Sri Lanka from 2013 to 2023 were extracted from the national malaria database maintained by the Anti Malaria Campaign (AMC) of Sri Lanka. Case data of severe malaria as defined by the World Health Organization were analysed with regard to patients’ general characteristics and their health-seeking behaviour, and the latter compared with that of uncomplicated malaria patients. Details of the last three cases of severe malaria in 2023 are presented. Results 532 imported malaria cases were diagnosed over 11 years (2013–2023); 46 (8.6%) were severe malaria, of which 45 were Plasmodium falciparum and one Plasmodium vivax. Most severe malaria infections were acquired in Africa. All but one were males, and a majority (87%) were 26–60 years of age. They were mainly Sri Lankan nationals (82.6%). Just over half (56.5%) were treated at government hospitals. The average time between arrival of the person in Sri Lanka and onset of illness was 4 days. 29 cases of severe malaria were compared with 165 uncomplicated malaria cases reported from 2015 to 2023. On average both severe and uncomplicated malaria patients consulted a physician equally early (mean = 1 day) with 93.3% of severe malaria doing so within 3 days. However, the time from the point of consulting a physician to diagnosis of malaria was significantly longer (median 4 days) in severe malaria patients compared to uncomplicated patients (median 1 day) (p = 0.012) as was the time from onset of illness to diagnosis (p = 0.042). All severe patients recovered without sequelae except for one who died. Conclusions The risk of severe malaria among imported cases increases significantly beyond 5 days from the onset of symptoms. Although patients consult a physician early, malaria diagnosis tends to be delayed by physicians because it is now a rare disease. Good access to expert clinical care has maintained case fatality rates of severe malaria at par with those reported elsewhere.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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An epidemiological analysis of severe imported malaria infections in Sri Lanka, after malaria elimination

Seneviratne,

Fernando,

Wickremasinghe

et al. 2024

Malar J

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“…Some studies reported that compliance in military troops was worse than civilians [ 32 ], as seen in studies of Marie-Aude Creach et al in which the prophylaxis compliance in troops was 56.6% [ 42 ]. In contrast, there was a different result seen in a Sri Lankan study with a compliance rate 90.3% in the civilian group and 100% in the military group [ 43 ]. In our study, the compliance rate (59.6%) is much lower than civilian compliance rates seen in previous studies.…”

Section: Discussionmentioning

confidence: 99%

Questionnaire-Based Analysis of Adverse Events and Compliance with Malaria Chemoprophylaxis in Taiwan

Lin

Chang

2023

JPM

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Malaria was eradicated in Taiwan in 1952; however, imported malaria cases are reported every year. The subtropical climate in Taiwan permits mosquito propagation and possible outbreaks of mosquito-borne diseases. The aim of this study was to investigate travelers’ compliance and side effects of malaria prophylaxis to prevent a malaria outbreak in Taiwan. In this prospective study, we enrolled travelers who visited our travel clinic before going to malarious areas. A total of 161 questionnaires were collected and analyzed. Associations between the occurrence of side effects and compliance with antimalarial drugs were analyzed. Adjusted odds ratios were calculated after adjusting for potential risk factors in multiple logistic regression analysis. Of the 161 enrolled travelers, 58 (36.0%) reported side effects. Insomnia, somnolence, irritability, nausea, and anorexia were associated with poor compliance. Mefloquine was not associated with more neuropsychological side effects than doxycycline. Multiple logistic regression analysis showed that chemoprophylaxis compliance was affected by a younger age, visiting friends and relatives, visiting the travel clinic more than 1 week before the trip, and preferring to use the same antimalarial regimen on the next trip. Our findings could provide information to travelers besides labeled side effects to improve compliance with malaria prophylaxis and consequently help to prevent malaria outbreaks in Taiwan.

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“…Chemoprophylaxis is an effective tool to minimize the risk of malaria while resident in an endemic area, 2 and may be offered to non-immune travelers moving from a non-endemic area (for malaria transmission) to an endemic area, permanent residents of endemic areas where disease transmission is seasonal, or for special subgroups (children, pregnant women) in areas with year-round malaria transmission. 3 For non-immune travelers, chemoprophylaxis may be given as primary prophylaxis (a schizonticide agent given before, during, and after travel in an endemic area) or as terminal prophylaxis (hypnozoiticide agent against P. vivax given after leaving the endemic area).…”

Section: Introductionmentioning

confidence: 99%

<p>Compliance with Primary Malaria Chemoprophylaxis: Is Weekly Prophylaxis Better Than Daily Prophylaxis?</p>

Rodrigo¹,

Rajapakse²,

Fernando³

2020

PPA

Self Cite

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Background: Chemoprophylaxis is an effective tool for individuals to minimize their risk of contracting malaria and serves an important public health role in preventing imported malaria. Yet, it is only effective if the traveller is fully compliant with the prescribed regimen. For many destinations, a choice of prophylactic agents is available, so historical compliance data can be helpful for both physicians and travellers to make an informed decision. Methods: We analyzed the historical self-reported compliance data for six chemoprophylactic agents currently recommended by CDC for primary malaria chemoprophylaxis by searching PubMed, Embase, CINAHL, Web of Science, and Scopus for observational studies reporting on travelers within the last 25 years. The quality of data was graded as "good" or "poor" using the NIH quality assessment tool for cohort and cross-sectional studies. Cumulative compliance data were compiled for all studies (gross compliance) and the subgroup of studies with "good" quality evidence (refined compliance). Subgroup analyses were performed for weekly vs daily administered regimens, between military and civilian travelers, and across each prophylactic agent. Results: Twenty-four eligible studies assessed compliance for mefloquine (n=20), atovaquone-proguanil (n=11), doxycycline (n=13), and chloroquine (n=3). No studies were found for primaquine or tafenoquine. Both gross and refined compliance were significantly better for weekly regimens than daily regimens (P<0.0001). Stopping chemoprophylaxis due to adverse events was significantly more for doxycycline (P<0.0001) compared to other drugs. Compliance was significantly worse in military travelers, but they were also more likely to be prescribed doxycycline. Conclusion: Malaria chemoprophylaxis for a traveler should depend on prevailing resistance patterns at destination, current national guidelines, and patient preferences. However, when there is a choice, historical compliance data are useful to select a regimen that the traveler is more likely to comply with.

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Success of malaria chemoprophylaxis for outbound civil and military travellers in prevention of reintroduction of malaria in Sri Lanka

Cited by 4 publications

References 18 publications

An epidemiological analysis of severe imported malaria infections in Sri Lanka, after malaria elimination

An epidemiological analysis of severe imported malaria infections in Sri Lanka, after malaria elimination

Questionnaire-Based Analysis of Adverse Events and Compliance with Malaria Chemoprophylaxis in Taiwan

<p>Compliance with Primary Malaria Chemoprophylaxis: Is Weekly Prophylaxis Better Than Daily Prophylaxis?</p>

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