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Assessing the risk of malaria on the basis of evidence: the South East Asian

Le raccomandazioni in tema prevention of malaria in travelers can be formulated in different ways:

a) through the data on the geographic distribution of the parasite

or

b) integrating data from various sources, such as surveillance of malaria in the local population, the opinion of experts, the incidence of the disease in returning travelers.

often not described in the official recommendations to the methodology used, in particular, the data on the quality and reliability sources. This makes it difficult to balance between the risk of contracting malaria on the one hand and the risk of adverse events due to other pharmacological prophylaxis. For some destinations the recommendation to carry out the prophylaxis might be replaced by the adoption of measures alone antivettoriali, supplemented or not by the stand-by treatment (treatment of presumptive malaria), but how to find the path to reaching such a decision?

Ron Behrens has coordinated a group of experts with the aim of providing evidence about the extent of the risk of malaria in Southeast Asia, according to data on the incidence of illness in travelers.

The question is the current practice of recommending chemoprophylaxis based on the geographical distribution of the parasite is an expression of the real risk of malaria in the traveler?

The results were published on October 4 on Malaria Journal. The full text of the article is freely accessible via the following link:

http://malariajournal.com/content/9/1/266

Methods

Analysis and comparison of data for the period 2003-2008 from two sources:

a) surveillance of malaria from 12 European countries (including the ' Italy) and the United States of America. These countries are defined in the study as source countries (source countries). E 'was calculated the incidence of malaria per 100,000 travelers per year for each destination;

b) WHO data on the geographic distribution of malaria in the countries visited and the impact of the local population, expressed as number of cases of malaria/1000 person / year (Annual Parasite Index, API).

The denominator of the incidence in travelers has been obtained from the statistics relating to tourism and immigration provided by the source country.

Results

The results are reported in detail in tables contained in the article, which we refer. We are particularly interested in Table 2, which provides data of great importance. As can be seen from the table, only four countries that have an impact > 1:100,000 travelers: Myanmar (Burma), Indonesia, Cambodia and Laos. Moreover, with regard to the latter two countries, the incidence has fallen below 1:100,000 in 2007-2008.

E 'is also obvious that there is generally no correspondence between the incidence of the local population (column "National Mean API") and the incidence in travelers (column "Mean incidence cases: 100,000 visits ). In other words, risk assessment based on the impact of the local population is not trusted.

The highest incidence was aimed at travelers in Myanmar (Burma) and Indonesia. E 'should be noted that with regard to Indonesia, a country where only a part of the territory is at risk, you get a higher incidence using as a denominator only the number of travelers who have visited the provinces where malaria is endemic (19/100.000 vs considering only the endemic areas. 3.69/100.000 for the whole country).

What does this study teach us?

Data analysis incidence of malaria in travelers reveals important differences in the risk of acquiring the infection. The authors propose a threshold of 1:100,000 travelers per year , below which would be excluded from chemoprophylaxis recommendations. Another criterion could be the proportion of cases of malaria caused by Plasmodium vivax : in fact, in areas where P. vivax is the predominant species (for example, over 70% of the total), chemoprophylaxis may not be the best solution, since it is able to suppress the first attack but not to prevent recurrences.

In conclusion This study shows that most valuable, for assessing the risk of malaria, it is possible to produce analysis based on the incidence of malaria in travelers rather than on the transmission of the disease among the local population. On this basis can be made recommendations regarding malaria prophylaxis evidence-based.

Bibliographic Reference

Ron H Behrens, Bernadette Carroll, Urban Hellgren, Leo G Visser, Heli Siikamäki, Lasse S Vestergaard, Guido Calleri, Thomas Janisch, Bjørn Myrvang, Joaquim Gascon and Christoph Hatz. The incidence of malaria in travelers to South-East Asia : local malaria transmission is a useful risk indicator?
Malaria Journal 2010, 9:266 doi: 10.1186/1475-2875-9-266
http://malariajournal.com/content/9/1/266