[旅行者和军事人员疟疾预防的现状与未来展望]

[Current situation and future perspectives for malaria prophylaxis among travellers and military personnel].

作者信息

Touze Jean-Etienne, Debonne Jean-Marc, Boutin Jean-Paul

机构信息

Institut de Médecine Tropicale du Service de Santé des armées, Le Pharo, BP : 46, 13998-Marseille armées.

出版信息

Bull Acad Natl Med. 2007 Oct;191(7):1293-302; discussion 1302-3.

DOI:
Abstract

Malaria remains a major public health problem, both for travellers and for the 40,000 French soldiers deployed each year to endemic areas. Epidemiological data show that imported malaria (IM) is on the increase, and that migrants account for more than 60% of malaria cases notified each year in France. The increase in IM among French military personnel is explained by prematurely terminated chemoprophylaxis on return, repeated short missions, and more cases of P. vivax and P. ovale infection. The choice of chemoprophylaxis depends mainly on the level of chloroquine resistance in the country visited. The atovaquone-proguanil combination is well tolerated and only requires 7 days of intake on return from the endemic area. Doxycycline monohydrate is cheaper and better-tolerated than mefloquine, and is thus preferred for French military personnel. However, its short half-life necessitates very good compliance. Chemoprophylaxis should be combined with vector control measures and with personal protection (impregnated bednets, protective clothing, repellents, and indoor insecticide spraying). The need for these measures should be clearly explained before departure, during the stay, and after return.

摘要

疟疾仍然是一个重大的公共卫生问题,对旅行者以及每年部署到疟疾流行地区的40000名法国士兵来说都是如此。流行病学数据表明,输入性疟疾(IM)呈上升趋势,而且在法国每年通报的疟疾病例中,移民占60%以上。法国军事人员中输入性疟疾增加的原因是回国后预防性化疗提前终止、短期任务频繁,以及间日疟原虫和卵形疟原虫感染病例增多。预防性化疗药物的选择主要取决于前往国家的氯喹耐药水平。阿托伐醌-氯胍组合耐受性良好,从流行地区回国后只需服用7天。一水合多西环素比甲氟喹便宜且耐受性更好,因此更适合法国军事人员。然而,其半衰期短,需要非常好的依从性。预防性化疗应与病媒控制措施和个人防护措施(浸药蚊帐、防护服、驱虫剂和室内喷洒杀虫剂)相结合。在出发前、停留期间和回国后,都应清楚地解释采取这些措施的必要性。

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