Supplement

Canadian Recommendations for the Prevention and Treatment of Malaria Among International Travellers

Appendix IV

Checklist for Travellers to Malarial Areas

The following is a checklist of key issues to be considered in advising travellers. The numbers in parentheses refer to those pages in the text where these issues are discussed in detail.

a) Risk of malaria (Appendix I)

Travellers should be informed about their individual risk of malaria infection and the presence of drug-resistant P. falciparum malaria in their areas of destination. Those who are pregnant, travelling with young children, or who have medical conditions that put them at increased risk (see Section 4) should question the necessity of the trip.

b) Anti-mosquito measures

Travellers should be instructed on how to protect themselves against mosquito bites.

c) Chemoprophylaxis

Travellers should be

1. questioned about medical conditions, drug allergies and other contraindications for drug use.
2. advised to start chemoprophylaxis before travel as directed, and to use prophylaxis continuously while in malaria-endemic areas and for 4 weeks after leaving such areas (except for atovaquone/proguanil and primaquine, which are taken for 1 week after leaving such areas).
3. informed that antimalarial drugs can cause side effects; if these side effects are serious, medical help should be sought promptly and use of the drug discontinued. Mild nausea, occasional vomiting or loose stools should not prompt discontinuation of chemoprophylaxis, but medical advice should be sought if symptoms persist.
4. warned that they may acquire malaria even if they use malaria chemoprophylaxis.
5. warned that they may receive conflicting information regarding antimalarial drugs overseas, but that they should continue their prescribed medication unless they are experiencing moderate to severe adverse effects.

d) In case of illness (Section 6)

Travellers should be informed that

1. symptoms of malaria may be mild, and that they should suspect malaria if they experience a fever or ‘flu like illness (unexplained fever).
2. malaria may be fatal if treatment is delayed.
3. medical help should be sought promptly if malaria is suspected, and a blood film should be taken and examined for malaria parasites on one or more occasions (if possible, blood smears should be brought home for review).
4. self-treatment (if prescribed) should be taken only if prompt medical care is not available and medical advice should still be sought as soon as possible after self-treatment.
5. there is a need to continue to take chemoprophylaxis in cases of suspect or proven malaria.

e) Special hosts (Section 4)

Pregnant women, young children and those with underlying medical conditions require special attention because of the potential effects of malaria illness and the contraindication of certain drugs (for example, doxycycline in pregnant women and young children).

(Adapted from International Travel and Health, World Health Organization, Geneva, 1999).

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