Malaria Prevention in Travellers
A 34 year old man plans a six week business trip to rural Nigeria, an area with intense year round Plasmodium falciparum transmission. He has no chronic illness and takes no medications. He asks the travel clinic what single measure will best protect him against malaria during the trip. Which of the following is the most appropriate recommendation?
- A.Preexposure malaria vaccination
- B.Intramuscular immunoglobulin prophylaxis
- C.Atovaquone plus proguanil chemoprophylaxisCorrect
- D.Postponing travel to endemic regions
Explanation
Chemoprophylaxis is the cornerstone of malaria prevention for non immune travellers going to areas of ongoing transmission. Effective regimens for chloroquine resistant Plasmodium falciparum areas such as West Africa include atovaquone plus proguanil, doxycycline or mefloquine, each begun before departure and continued for the required period after leaving. Atovaquone plus proguanil is started 1 to 2 days before arrival and continued for 7 days after departure, which makes it convenient for short and medium trips. Chemoprophylaxis is combined with bite avoidance measures such as insecticide treated bed nets, permethrin treated clothing and repellents containing DEET, because no drug is fully protective. Malaria vaccines now exist, but RTS,S/AS01 and R21/Matrix M are deployed for young children living in endemic countries and are not recommended for adult travellers. Passive immunoglobulin has no role at all in malaria prevention. Simply telling a traveller to avoid endemic areas does not address a trip that will go ahead for work. Any fever occurring during or within a year of travel must be investigated urgently with blood films or a rapid antigen test, since falciparum malaria can be fatal within days.
Why each option
- A.
- Licensed malaria vaccines target children in endemic countries and are not indicated or available for adult travellers.
- B.
- Immunoglobulin provides no protection against Plasmodium species and has no role in travel medicine for malaria.
- C.
- Correct. Drug prophylaxis appropriate to the destination resistance pattern, together with bite avoidance, is the recommended approach.
- D.
- Avoiding endemic areas is theoretically protective but is not a workable recommendation for a traveller whose trip is planned.
Reference: CDC Yellow Book 2024: Health Information for International Travel, Malaria chapter; WHO Guidelines for Malaria, 2023
This is one of 3,306 questions in the MedBoardSA SMLE bank, with timed test mode, tutor mode, and progress tracking by topic.
Practise the full bank