Durrheim D N, Braack L E, Waner S, Gammon S
Communicable Disease Control, Mpumalanga Department of Health, South Africa.
J Travel Med. 1998 Dec;5(4):173-7. doi: 10.1111/j.1708-8305.1998.tb00502.x.
The risk of malaria to visitors to South Africa's nature reserves is unknown. Current recommendations for travelers are based on malaria incidence rates in local communities. These rates may well overestimate travelers' malaria risk and lead to unnecessary use of antimalarial prophylaxis with associated drug-related adverse events. This study investigated the incidence of malaria in visitors to South Africa's Kruger National Park (KNP).
Postal questionnaires were sent to the cohort of visitors staying in the KNP during April 1996, 6 to 8 weeks after they returned to their homes. Nonrespondents received duplicate questionnaires 8 weeks later. Responses from 3267 groups, representing 11,107 visitors (56. 8%) allowed determination of the malaria attack rate in this group of travelers and assessment of associations between malaria risk and a number of factors, including type of accommodation used during the visit; duration of stay; use of chemoprophylaxis; and use of personal protection measures. All travelers indicating that they had suffered an episode of malaria following their visit were telephonically contacted and their health providers traced to determine the basis of diagnosis and clinical outcome.
One clinically suspected and four confirmed cases of Plasmodium falciparum malaria among the visitors suggest a low attack rate of 4. 5 cases per 10,000 visitors during April, the highest risk month for malaria in South Africa. No association was found between malaria risk and accommodation type, duration of stay, use and type of chemoprophylaxis, and use and number of personal protection measures.
These findings confirm the importance of careful assessment of local malaria risk before individualized advice is provided to travelers.
前往南非自然保护区的游客感染疟疾的风险尚不清楚。目前针对旅行者的建议是基于当地社区的疟疾发病率。这些发病率很可能高估了旅行者感染疟疾的风险，并导致不必要地使用抗疟疾预防药物，从而引发相关的药物不良事件。本研究调查了前往南非克鲁格国家公园（KNP）的游客中疟疾的发病率。
向1996年4月期间入住KNP的游客群体邮寄调查问卷，在他们回家6至8周后进行。未回复者在8周后收到重复问卷。来自3267个群体的回复，代表11107名游客（56.8%），由此可以确定这组旅行者的疟疾发病率，并评估疟疾风险与多种因素之间的关联，包括访问期间使用的住宿类型；停留时间；化学预防措施的使用；以及个人防护措施的使用。所有表示在访问后感染疟疾的旅行者都通过电话联系，并追踪他们的医疗服务提供者，以确定诊断依据和临床结果。
在游客中，有1例临床疑似和4例确诊的恶性疟原虫疟疾病例，这表明在4月这个南非疟疾风险最高的月份，发病率较低，为每10000名游客中有4.5例。在疟疾风险与住宿类型、停留时间、化学预防措施的使用和类型，以及个人防护措施的使用和数量之间未发现关联。
这些发现证实了在向旅行者提供个性化建议之前，仔细评估当地疟疾风险的重要性。
