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Correspondence
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Volume 359:2293-2294 November 20, 2008 Number 21
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Malaria Prevention in Short-Term Travelers

 

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To the Editor: In his Clinical Practice article on malaria prevention in short-term travelers, Freedman (Aug. 7 issue)1 offers clinical advice for the family of three described in the vignette. For the 29-year-old wife, who is 15 weeks pregnant and has won a trip to Zambia in a corporate sales competition, it might be best to provide a medical letter that she could give to corporate sales, advising postponement of her trip for a year. In addition, Table 3 of the article, which lists prophylactic drug regimens, does not mention the latest artemisinin-based combination therapy.2


Thomas L. Kurt, M.D., M.P.H.
University of Texas Southwestern Medical Center
Dallas, TX 75390
tomkurtmd{at}comcast.net

References

  1. Freedman DO. Malaria prevention in short-term travelers. N Engl J Med 2008;359:603-612. [Free Full Text]
  2. White NJ. Quinhaosu (artemisinin): the price of success. Science 2008;320:330-334. [Free Full Text]
 
The author replies: Artemisinin derivatives have revolutionized malaria treatment programs worldwide and are the drugs of choice for falciparum malaria in most countries where it is endemic. No artemisinin compound is currently licensed in the United States. Intravenous artesunate is available from the Centers for Disease Control and Prevention (CDC) for emergency use for severe and complicated falciparum malaria (www.cdc.gov/malaria; telephone, 770-488-7788) under an investigational-new-drug (IND) application. An oral combination drug containing artemether and lumefantrine for the treatment of uncomplicated falciparum malaria is currently under expedited review by the Food and Drug Administration. Unfortunately, the extremely short half-life of the artemisinin drugs precludes their use as chemoprophylactic agents.

The advice of the CDC, the World Health Organization, and myself that pregnant women not travel to areas with malaria is stated in the article. Many possible approaches to dissuading a determined traveler who already has firm plans and tickets in hand are conceivable. The most frequently successful strategy is a change of destination to one allowing a similar experience but without the malaria risk. A specialized travel medicine clinic (listings at www.istm.org and www.astmh.org) would have access to country-by-country malaria maps and would also be familiar with common and practical destinations. Many game parks in South Africa are outside the malaria zone, though the itinerary described in the vignette is by far the most popular. Delaying the trip by a year would involve exposing an infant to malaria, an equally risky situation, or separating mother and child by thousands of miles for a significant period. Despite our best efforts, pregnant women travel not infrequently to malaria zones, and we need to offer them information on the best possible prevention strategies.


David O. Freedman, M.D.
University of Alabama at Birmingham
Birmingham, AL 35294-2170


 

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by Freedman, D. O.
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