Travel Clinic, Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland.
Infectious Diseases Service, Department of Medicine, University Hospital and University of Lausanne, Lausanne, Switzerland.
Malar J. 2017 Oct 28;16(1):436. doi: 10.1186/s12936-017-2079-2.
The WHO recommends that all suspect malaria cases be tested before receiving treatment. Rapid diagnostic tests (RDT) for malaria can be performed reliably by community health workers with no formal medical background and thus, RDTs could also be provided to travellers for self-diagnosis during visits to endemic regions.
RDTs were proposed during pre-travel consultations to pre-defined categories of travellers. A training run on their own blood was performed and, if carried out correctly, the traveller was given a written procedure on how to perform the test and act on its result. The travellers were then proposed to buy a malaria RDT kit and were interviewed upon their return.
From February 2012 to February 2017, 744 travellers were proposed RDTs and 692 performed the training run (one could not complete it due to a hand tremor). Among the 691 subjects included, 69% travelled to moderate- or low-risk areas of malaria, 18% to high-risk areas and 13% to mixed-risk areas. The two most frequent categories of travellers to whom RDTs were proposed were long-term travellers (69%) and those travelling to remote areas (57%). 543 travellers (79%) were interviewed upon return. During their trip, 17% (91/543) had a medical problem with fever and 12% (65/543) without fever. Among 91 febrile patients, 57% (52/91) performed an RDT, 22% (20/91) consulted immediately without using the test, and 21% (19/91) did neither. Four RDTs (4/52; 8%) were positive: 2 in low-risk and 2 in high-risk areas (0.7% attack rate of self-documented malaria). Two travellers could not perform the test correctly and attended a facility or took standby emergency treatment. Four travellers with negative results repeated the test after 24 h; all were still negative. Carrying RDTs made travellers feel more secure, especially when travelling with children.
1/6 travellers experienced fever and 4/5 of those reacted appropriately: more than half used RDTs and a quarter consulted immediately. Four travellers (including 2 from low-risk areas) diagnosed themselves with malaria and self-treated successfully. This strategy allows prompt treatment for malaria in high-risk groups and may avoid over-diagnosis (and subsequent inappropriate treatment) of malaria on-site.
世界卫生组织建议在治疗前对所有疑似疟疾病例进行检测。社区卫生工作者可以可靠地进行快速诊断检测（RDT），而无需正规的医学背景，因此也可以向旅行者提供 RDT，以便他们在前往流行地区时进行自我诊断。
在旅行前咨询时向预先定义的旅行者类别提出 RDT。对他们自己的血液进行了一次训练测试，如果操作正确，旅行者将获得一份关于如何进行测试以及如何根据测试结果采取行动的书面程序。然后向旅行者提出购买疟疾 RDT 试剂盒的建议，并在他们返回后进行访谈。
从 2012 年 2 月至 2017 年 2 月，共向 744 名旅行者提出 RDT 建议，其中 692 人完成了训练测试（由于手部震颤，1 人未能完成）。在纳入的 691 名受试者中，69%前往疟疾中、低风险地区，18%前往高风险地区，13%前往混合风险地区。最常向 RDT 建议的两类旅行者是长期旅行者（69%）和前往偏远地区的旅行者（57%）。543 名旅行者（79%）在返回后接受了访谈。在旅行期间，17%（91/543）出现发热的医疗问题，12%（65/543）无发热。在 91 名发热患者中，57%（52/91）进行了 RDT，22%（20/91）未使用该检测立即就诊，21%（19/91）两者都未做。4 个 RDT（4/52；8%）呈阳性：2 个在低风险地区，2 个在高风险地区（自我记录疟疾的发病率为 0.7%）。有 2 名旅行者无法正确进行测试，他们去了医疗机构或接受了备用紧急治疗。4 名检测结果为阴性的旅行者在 24 小时后重复检测；结果仍为阴性。携带 RDT 让旅行者感到更安全，尤其是当他们与儿童一起旅行时。
1/6 的旅行者出现发热，其中 4/5 人反应适当：超过一半的人使用了 RDT，四分之一的人立即就诊。有 4 名旅行者（包括 2 名来自低风险地区）自我诊断为疟疾，并成功进行了自我治疗。该策略可使高危人群及时治疗疟疾，并可能避免现场过度诊断（和随后不适当的治疗）疟疾。
