Malaria 3Public Health, Travel & Expedition Medicine

FACTM Pt 1

Tim InglisDivision of Microbiology & Infectious Diseases,

PathWest Laboratory Medicine, WA

Malaria series

Malaria 1 Clinical Tropical Medicine

Malaria 2 Clinical Parasitology

Malaria 3 Public Health, Travel & Expedition Medicine

Malaria 4 Clinical Entomology

Study materials

Manual of Travel Medicine & Health. 3rd Edition, Steffen R et al. 2007. Decker.

Oxford Handbook of Expedition & Wilderness MedicineJohnson C et al. 2008, Oxford

• FACTM study notes• Specialist review articles• Self-assessment questions

Blog http://micrognome.priobe.netWeb www.priobe.netFACTM http://lifeinthefastlane.com/exams/actm-fellowship/

Outline

• Timeline• Epidemiology• Pre-travel risk assessment & planning• Expedition contingencies

journey aftermathpreparation

Risk atlas• Global distribution• Regional distribution• Australian receptive zone

Source = WHO Roll Back malaria Programme; http://www.who.int/entity/health_mapping

Epidemiology

Pre-travel preparation

• Risk assessment: location, activities, duration, complexity• Personal measures: clothing, repellent, bed nets, activity• Chemoprophylaxis:

– options include • Atovaquone/proguanil; Mefloquine; Doxycycline …

– Specific issues• Short notice• Pregnant women• Children• Long stay

Expedition Medicine

• Personal measures– Personal protection– Chemoprophylaxis

• Group measures– Group prophylaxis– Area control measures– Rapid tests– Antimalarial therapy, SBET

• Local people• Medevac arrangements

On return

• May present after interval, up to 1yr after end of journey• Exclude malaria in anyone with fever who has travelled to an

endemic area• Detailed history of location, duration & intensity of exposure

to biting insects, PPM and CPx used– Thai/Myanmar border area; PNG

– Other arthropod borne infections in DD

– Indications of resistance

– Compliance, esp after arrival in Aus

journey aftermathpreparation

Emerging Issues • Highland malaria• Unusual malaria transmission methods• Malaria & air travel• Changing resistance• Use for portable rapid diagnostic methods• SBET in pregnancy• CPx for long stay• Prep for AUSMAT members