Lalani Tahaniyat, Yun Heather, Tribble David, Ganesan Anuradha, Kunz Anjali, Fairchok Mary, Schnaubelt Elizabeth, Fraser Jamie, Mitra Indrani, Kronmann Karl C, Burgess Timothy, Deiss Robert G, Riddle Mark S, Johnson Mark D
Department of Preventive Medicine and Biostatistics, Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
Division of Infectious Diseases, Naval Medical Center Portsmouth, Portsmouth, VA, USA.
J Travel Med. 2016 Jul 4;23(5). doi: 10.1093/jtm/taw043. Print 2016 May.
There is limited information on compliance rates with anti-vectorial protective measures (AVPMs) during travel to countries with risk of dengue and chikungunya. We evaluated differences in mosquito exposures, and factors associated with AVPM compliance in travellers going to countries where the principal mosquito-borne infectious disease threat is falciparum malaria and those where risk of dengue or chikungunya predominates.
Department of Defence beneficiaries with planned travel to regions where the predominant mosquito-borne infection is falciparum malaria, and those with predominantly dengue or chikungunya risk, were included. Regions were divided into three groups: 'high-risk falciparum malaria', 'low-risk falciparum malaria' and 'chikungunya/dengue risk'. Demographics, trip characteristics, arthropod exposure and AVPM compliance were captured using pre- and post-travel surveys. Skin repellent compliance was defined as self-reported use, categorized as 'often/every day'. A logistic regression model was used to estimate factors associated with AVPM compliance.
183 (9%), 185 (9%) and 149 (7%) travelled to high and low falciparum malaria risk regions, and chikungunya/dengue risk regions, respectively. Overall, 53% (95% CI: 48-57%) and 16% (95% CI: 12-19%) were compliant with repellent use on skin and clothing, respectively. Daytime bites were reported more frequently in chikungunya/dengue risk regions than high malaria risk regions (37% vs. 10%), while night time bites were frequently in high malaria risk regions (53% vs 20%; P < 0.001). Compliance with skin repellents was associated with female gender [RR: 1.54 (95% CI: 1.05-2.28)], observing mosquitoes during travel [RR: 2.77 (95% CI: 1.76-4.36)] and travel during the rainy season [RR: 2.45 (95% CI: 1.66-3.71)]).
Poor AVPM compliance was observed in the overall cohort. Compliance with skin repellent use was associated with female gender, observing mosquitoes and travelling during the rainy season, and was not associated with the risk of malaria or chikungunya/dengue at the travel destination.
前往有登革热和基孔肯雅热风险国家旅行期间，关于抗媒介防护措施（AVPMs）依从率的信息有限。我们评估了前往主要蚊媒传染病威胁为恶性疟原虫疟疾的国家以及登革热或基孔肯雅热风险为主的国家的旅行者在蚊虫暴露方面的差异，以及与AVPM依从性相关的因素。
纳入计划前往主要蚊媒感染为恶性疟原虫疟疾地区以及主要有登革热或基孔肯雅热风险地区旅行的国防部受益人。地区分为三组：“高风险恶性疟原虫疟疾”、“低风险恶性疟原虫疟疾”和“基孔肯雅热/登革热风险”。通过旅行前和旅行后的调查获取人口统计学、旅行特征、节肢动物暴露情况和AVPM依从性信息。皮肤驱蚊剂依从性定义为自我报告的使用情况，分为“经常/每天”。使用逻辑回归模型估计与AVPM依从性相关的因素。
分别有183人（9%）、185人（9%）和149人（7%）前往高风险和低风险恶性疟原虫疟疾地区以及基孔肯雅热/登革热风险地区。总体而言，分别有53%（95%CI：48 - 57%）和16%（95%CI：12 - 19%）的人在皮肤和衣物上使用驱蚊剂方面符合要求。在基孔肯雅热/登革热风险地区，白天被叮咬的报告频率高于高疟疾风险地区（37%对10%），而在高疟疾风险地区夜间被叮咬的情况更为频繁（53%对20%；P < 0.001）。皮肤驱蚊剂的依从性与女性性别[RR：1.54（95%CI：1.05 - 2.28）]、旅行期间观察到蚊子[RR：2.77（95%CI：1.76 - 4.36）]以及雨季旅行[RR：2.45（95%CI：1.66 - 3.71）]有关。
在整个队列中观察到AVPM依从性较差。皮肤驱蚊剂的使用依从性与女性性别、观察到蚊子以及雨季旅行有关，与旅行目的地的疟疾或基孔肯雅热/登革热风险无关。
