Malaria and travelers--practical aspects.

As international air travel becomes more and more common, we are witnessing an increase in the incidence of imported malaria caused by Plasmodium falciparum, a fatal variety resistant to antimalarial drugs. With the development of drug resistance, travelers can no longer rely on chemoprophylaxis alone for absolute protection against malaria; they need to take a number of complementary measures. The most important among these are steps to prevent mosquito bites (mosquito screens and nets impregnated with insecticide, insecticides and repellents in various formulations; nocturnal air-conditioning) which can be instituted anywhere. Chemoprophylaxis must be adapted in each case with regard to individual characteristics (laboratory and medical status), the drug used (contraindications, side effects) and the travel itinerary (departure date, places to be visited, duration of journey). The back-up treatment prescribed for a traveler before his departure is intended as cover in the event that the chemoprophylaxis used should prove to be ineffective. If people planning trips to malarious regions are to apply preventive measures, they have to be informed, aware and motivated. Information is an integral part of prevention. Objective, scientifically accurate information is provided by specialized centres and official bodies in the form of recommendations subject to regular updating. A recommendation of a nonmedical nature must be given by travel agents and tour operators, by airlines and shipping companies, embassies and consulates, and also by the media at peak periods of travel to the tropics. Information disseminated on this scale will produce the required degree of awareness, and the travelers targeted will then probably consult a doctor for the chemoprophylaxis they need.