Risk of malaria in British residents returning from malarious areas
OBJECTIVES--To identify which British residents travelling abroad are at greatest risk of malaria infection, and to determine the efficacy of malaria chemoprophylaxis for preventing P falciparum infections in tropical Africa. DESIGN--Prospective cohort study (case-base linkage) with routine national...
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Published in | BMJ Vol. 300; no. 6723; pp. 499 - 503 |
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Main Authors | , , , |
Format | Journal Article |
Language | English |
Published |
London
British Medical Journal Publishing Group
24.02.1990
British Medical Association BMJ Publishing Group LTD |
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Abstract | OBJECTIVES--To identify which British residents travelling abroad are at greatest risk of malaria infection, and to determine the efficacy of malaria chemoprophylaxis for preventing P falciparum infections in tropical Africa. DESIGN--Prospective cohort study (case-base linkage) with routine national surveillance systems. Denominators (base population) were obtained from monitoring a random sample of returning British travellers with the international passenger survey. Numerators (cases) were obtained from reports of malaria infections in British residents, through the Malaria Reference Laboratory network. SETTING--International passenger survey conducted at passport control of international airports in Britain. Malaria reports received nationally were collated centrally in London. SUBJECTS--2948 British residents (0.2%) returning to Britain in 1987 randomly selected and questioned and 1052 British residents with microscopically confirmed malaria infections in 1987, whose case reports were reviewed and on whom additional data were collected by postal survey. MAIN OUTCOME MEASURES--Annual incidence subdivided by categories of risk. Chemoprophylactic efficacy for east and west Africa by principal regimens and compliance. RESULTS--Annual rates of reported infection per 100,000 travellers to Oceania were 4100; to west and east Africa were 375 and 172 respectively; to Latin America, the Far East, and the Middle East were 12, 2, and 1 respectively. Immigrants visiting friends and relatives in Ghana and Nigeria were at greatest risk (1303 and 952 per 100,000 respectively) in west Africa. Business travellers to Kenya experienced the highest attack rates in east Africa (465 per 100,000). Age-sex specific attack rates varied by region. No prophylaxis was reported to have been used by 23% of British visitors to west Africa, 17% to east Africa, 46% to central or southern Africa, and 58% visiting south Asia. The efficacy of chloroquine plus proguanil against P falciparum infection was 73% and 54% in west and east Africa respectively. Lower values were obtained for chloroquine alone and proguanil alone. The efficacy of Maloprim (pyrimethamine-dapsone) was 61% in west Africa, but only 9% in east Africa. Visitors to west Africa who did not comply with their chemoprophylactic regimen were at a 2.5-fold higher risk of infection than fully compliant users. Non-compliant visitors to east Africa had similar rates of infection as non-drug users. CONCLUSIONS--In 1987 chloroquine plus proguanil was the preferred chemoprophylactic regimen for P falciparum infection in Africa; antimalarial drugs must be taken regularly to be effective. |
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AbstractList | OBJECTIVESTo identify which British residents travelling abroad are at greatest risk of malaria infection, and to determine the efficacy of malaria chemoprophylaxis for preventing P falciparum infections in tropical Africa.DESIGNProspective cohort study (case-base linkage) with routine national surveillance systems. Denominators (base population) were obtained from monitoring a random sample of returning British travellers with the international passenger survey. Numerators (cases) were obtained from reports of malaria infections in British residents, through the Malaria Reference Laboratory network.SETTINGInternational passenger survey conducted at passport control of international airports in Britain. Malaria reports received nationally were collated centrally in London.SUBJECTS2948 British residents (0.2%) returning to Britain in 1987 randomly selected and questioned and 1052 British residents with microscopically confirmed malaria infections in 1987, whose case reports were reviewed and on whom additional data were collected by postal survey.MAIN OUTCOME MEASURESAnnual incidence subdivided by categories of risk. Chemoprophylactic efficacy for east and west Africa by principal regimens and compliance.RESULTSAnnual rates of reported infection per 100,000 travellers to Oceania were 4100; to west and east Africa were 375 and 172 respectively; to Latin America, the Far East, and the Middle East were 12, 2, and 1 respectively. Immigrants visiting friends and relatives in Ghana and Nigeria were at greatest risk (1303 and 952 per 100,000 respectively) in west Africa. Business travellers to Kenya experienced the highest attack rates in east Africa (465 per 100,000). Age-sex specific attack rates varied by region. No prophylaxis was reported to have been used by 23% of British visitors to west Africa, 17% to east Africa, 46% to central or southern Africa, and 58% visiting south Asia. The efficacy of chloroquine plus proguanil against P falciparum infection was 73% and 54% in west and east Africa respectively. Lower values were obtained for chloroquine alone and proguanil alone. The efficacy of Maloprim (pyrimethamine-dapsone) was 61% in west Africa, but only 9% in east Africa. Visitors to west Africa who did not comply with their chemoprophylactic regimen were at a 2.5-fold higher risk of infection than fully compliant users. Non-compliant visitors to east Africa had similar rates of infection as non-drug users.CONCLUSIONSIn 1987 chloroquine plus proguanil was the preferred chemoprophylactic regimen for P falciparum infection in Africa; antimalarial drugs must be taken regularly to be effective. To identify which British residents travelling abroad are at greatest risk of malaria infection, and to determine the efficacy of malaria chemoprophylaxis for preventing P falciparum infections in tropical Africa. Prospective cohort study (case-base linkage) with routine national surveillance systems. Denominators (base population) were obtained from monitoring a random sample of returning British travellers with the international passenger survey. Numerators (cases) were obtained from reports of malaria infections in British residents, through the Malaria Reference Laboratory network. International passenger survey conducted at passport control of international airports in Britain. Malaria reports received nationally were collated centrally in London. 2948 British residents (0.2%) returning to Britain in 1987 randomly selected and questioned and 1052 British residents with microscopically confirmed malaria infections in 1987, whose case reports were reviewed and on whom additional data were collected by postal survey. Annual incidence subdivided by categories of risk. Chemoprophylactic efficacy for east and west Africa by principal regimens and compliance. Annual rates of reported infection per 100,000 travellers to Oceania were 4100; to west and east Africa were 375 and 172 respectively; to Latin America, the Far East, and the Middle East were 12, 2, and 1 respectively. Immigrants visiting friends and relatives in Ghana and Nigeria were at greatest risk (1303 and 952 per 100,000 respectively) in west Africa. Business travellers to Kenya experienced the highest attack rates in east Africa (465 per 100,000). Age-sex specific attack rates varied by region. No prophylaxis was reported to have been used by 23% of British visitors to west Africa, 17% to east Africa, 46% to central or southern Africa, and 58% visiting south Asia. The efficacy of chloroquine plus proguanil against P falciparum infection was 73% and 54% in west and east Africa respectively. Lower values were obtained for chloroquine alone and proguanil alone. The efficacy of Maloprim (pyrimethamine-dapsone) was 61% in west Africa, but only 9% in east Africa. Visitors to west Africa who did not comply with their chemoprophylactic regimen were at a 2.5-fold higher risk of infection than fully compliant users. Non-compliant visitors to east Africa had similar rates of infection as non-drug users. In 1987 chloroquine plus proguanil was the preferred chemoprophylactic regimen for P falciparum infection in Africa; antimalarial drugs must be taken regularly to be effective. To identify which British residents travelling abroad are at greatest risk of malaria infection, and to determine the efficacy of malaria chemoprophylaxis for preventing Plasmodium falciparum infections in tropical Africa. Annual rates of reported infection per 100,000 travellers to Oceania were 4100; to west and east Africa were 375 and 172 respectively; to Latin America, the Far East, and the Middle East were 12, 2, and 1 respectively. Immigrants visiting friends and relatives in Ghana and Nigeria were at greatest risk (1303 and 952 per 100,000 respectively) in west Africa. Business travellers to Kenya experienced the highest attack rates in east Africa (465 per 100,000). Age-sex specific attack rates varied by region. No prophylaxis was reported to have been used by 23% of British visitors to west Africa, 17% to east Africa, 46% to central or southern Africa, and 58% visiting south Asia. Objectives—To identify which British residents travelling abroad are at greatest risk of malaria infection, and to determine the efficacy of malaria chemoprophylaxis for preventing P falciparum infections in tropical Africa. Design—Prospective cohort study (case-base linkage) with routine national surveillance systems. Denominators (base population) were obtained from monitoring a random sample of returning British travellers with the international passenger survey. Numerators (cases) were obtained from reports of malaria infections in British residents, through the Malaria Reference Laboratory network. Setting—International passenger survey conducted at passport control of international airports in Britain. Malaria reports received nationally were collated centrally in London. Subjects—2948 British residents (0.2%) returning to Britain in 1987 randomly selected and questioned and 1052 British residents with microscopically confirmed malaria infections in 1987, whose case reports were reviewed and on whom additional data were collected by postal survey. Main outcome measures—Annual incidence subdivided by categories of risk. Chemoprophylactic efficacy for east and west Africa by principal regimens and compliance. Results—Annual rates of reported infection per 100 000 travellers to Oceania were 4100; to west and east Africa were 375 and 172 respectively; to Latin America, the Far East, and the Middle East were 12, 2, and 1 respectively. Immigrants visiting friends and relatives in Ghana and Nigeria were at greatest risk (1303 and 952 per 100 000 respectively) in west Africa. Business travellers to Kenya experienced the highest attack rates in east Africa (465 per 100 000). Age-sex specific attack rates varied by region. No prophylaxis was reported to have been used by 23% of British visitors to west Africa, 17% to east Africa, 46% to central or southern Africa, and 58% visiting south Asia. The efficacy of chloroquine plus proguanil against P falciparum infection was 73% and 54% in west and east Africa respectively. Lower values were obtained for chloroquine alone and proguanil alone. The efficacy of Maloprim (pyrimethamine-dapsone) was 61% in west Africa, but only 9% in east Africa. Visitors to west Africa who did not comply with their chemoprophylactic regimen were at a 2.5-fold higher risk of infection than fully compliant users. Non-compliant visitors to east Africa had similar rates of infection as non-drug users. Conclusions—In 1987 chloroquine plus proguanil was the preferred chemoprophylactic regimen for P falciparum infection in Africa; antimalarial drugs must be taken regularly to be effective. |
Author | Bradley, D J Phillips-Howard, P A Mitchell, J Radalowicz, A |
AuthorAffiliation | Department of Epidemiology and Population Sciences, London School of Hygiene and Tropical Medicine |
AuthorAffiliation_xml | – name: Department of Epidemiology and Population Sciences, London School of Hygiene and Tropical Medicine |
Author_xml | – sequence: 1 givenname: P A surname: Phillips-Howard fullname: Phillips-Howard, P A – sequence: 2 givenname: A surname: Radalowicz fullname: Radalowicz, A – sequence: 3 givenname: J surname: Mitchell fullname: Mitchell, J – sequence: 4 givenname: D J surname: Bradley fullname: Bradley, D J |
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Copyright | Copyright 1990 British Medical Journal 1993 INIST-CNRS Copyright BMJ Publishing Group LTD Feb 24, 1990 |
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References | Pthillips-Howard, P.A.; Mitchell, J.; Bradley, D.J. (ref_5) press,).; 12 Kirkwoud, B. (ref_6); 1988 D)J, Bradley (ref_1) 1989; 82 Lobel, H.O. (ref_3); 7 (ref_7) 1989; 299 lEA, Peto; CF, Gilks (ref_2) 1986; i Harrics Al), Forcshav (C. J Friedti HM (ref_4) 1988; 82 |
References_xml | – volume: 299 start-page: 1087 year: 1989 ident: ref_7 article-title: Prophylaxis agaitist malaria for travcllcrs from the United Kingdiom publication-title: lr.lli-dj – volume: i: start-page: 1256 year: 1986 ident: ref_2 article-title: Stratcgies for the prevention of malaria in travellers: comparisoni ot' drug regimens hv mcans of risk henefit analysis. LIancet' contributor: fullname: lEA, Peto; CF, Gilks – volume: 7 start-page: 820 issue: 1988 ident: ref_3 article-title: Phillips-Howard 1'A, Brandling-Bcnnctt AD, ei al. Malaria incidencc and prevention among huro ati and North American trav, cllcrs to Kcnya publication-title: Br Med; Nalaria chemoproph\ylaxis in travcllers to cast Af'rica: a comparative prospective study of chloroquicte pltis progtianil with chloroquine ptiis sulfadoxinc-pyrimethaminc contributor: fullname: Lobel, H.O. – volume: 82 start-page: 69 year: 1988 ident: ref_4 article-title: Malaria prophylaxis atnoligst British residtits of Lilonigwc and Kastingit districts, Mialawi. Irans R Soc Trop contributor: fullname: Harrics Al), Forcshav (C. J Friedti HM – volume: 1988 start-page: 366 ident: ref_6 article-title: IEssentials of medical sailisuics. Oxfiord: Blackw, cll Scicntilic Publications, 1988: 174-S. 14 Phillips-Howard I'A. [h'le cpidcmiologv of' malaria in Britaill lI'hl) thesis]. Lontidon: Univcrsitv oif publication-title: Londoti contributor: fullname: Kirkwoud, B. – volume: 82 start-page: 17 year: 1989 ident: ref_1 article-title: Current trends in malaria in Britain..7 R publication-title: Soc. Aled contributor: fullname: D)J, Bradley – volume: 12 start-page: 1 year: press,). ident: ref_5 article-title: Validation ol malaria stirvillaticc rcports: implicatiotis fuor sttdies of' malaria risk. j I.pidemlo/ (Couluniiltvis' publication-title: Health in; Shnrt tcrm travel to toalariotis arcas; malaria risk in UK travellers. lravel, M1dicinti contributor: fullname: Pthillips-Howard, P.A.; Mitchell, J.; Bradley, D.J. |
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Snippet | OBJECTIVES--To identify which British residents travelling abroad are at greatest risk of malaria infection, and to determine the efficacy of malaria... Objectives—To identify which British residents travelling abroad are at greatest risk of malaria infection, and to determine the efficacy of malaria... To identify which British residents travelling abroad are at greatest risk of malaria infection, and to determine the efficacy of malaria chemoprophylaxis for... OBJECTIVESTo identify which British residents travelling abroad are at greatest risk of malaria infection, and to determine the efficacy of malaria... |
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StartPage | 499 |
SubjectTerms | Adolescent Adult Africa - epidemiology Aged Animals Antimalarials Antimalarials - therapeutic use Asia, Southeastern - epidemiology Biological and medical sciences Case-Control Studies Chemoprevention Child Child, Preschool Confidence interval Female Holiday travel Humans Infant Infant, Newborn Infections Infectious diseases Malaria Malaria - epidemiology Malaria - prevention & control Male Medical sciences Medication adherence Middle Aged Parasitic diseases Passengers Patient Compliance Plasmodium falciparum Prescription drugs Prospective Studies Risk Factors Travel United Kingdom - epidemiology |
Title | Risk of malaria in British residents returning from malarious areas |
URI | http://dx.doi.org/10.1136/bmj.300.6723.499 https://api.istex.fr/ark:/67375/NVC-0XT444HF-V/fulltext.pdf https://www.jstor.org/stable/29707021 https://www.ncbi.nlm.nih.gov/pubmed/2107927 https://www.proquest.com/docview/1776427808/abstract/ https://search.proquest.com/docview/15610129 https://search.proquest.com/docview/79686007 https://pubmed.ncbi.nlm.nih.gov/PMC1662322 |
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