Malaria remains a leading global health challenge, with an\u00a0estimated 219 million clinical malaria cases and 1.24\u00a0million deaths attributed to Plasmodium falciparum infection\u00a0reported annually. Malaria remains endemic in 104 countries, primarily located in Africa and Asia. Rates of international travel to malaria-endemic regions have increased\u00a0drastically, with 233.6 million travelers visiting Asia and the\u00a0Pacific, and 52.4 million travelers visiting Africa in 2012.\u00a0Falciparum malaria remains a leading cause of acute and\u00a0potentially life-threatening illness among Western travelers. With increased international travel and continued endemicity of malaria around the world, the number of travelers\u00a0exposed to malaria is rising, and travelers need to be informed\u00a0of effective measures to protect themselves from this potentially\u00a0life-threatening disease.<\/p>\n
There are significant risks associated with Plasmodium\u00a0infection, especially with P. falciparum and Plasmodium\u00a0vivax infection. Although the majority of infected individuals\u00a0develop uncomplicated malaria and can be effectively managed with prompt diagnosis and treatment with appropriate\u00a0anti-malarials, a subset may progress to severe disease. Severe\u00a0malaria can manifest in a variety of forms, including cerebral\u00a0malaria (malaria with coma and without other identifiable\u00a0cause), severe malarial anemia, respiratory distress, metabolic\u00a0acidosis and multi-organ failure. Life threatening infections\u00a0can develop within 24 h of disease onset and, despite the use\u00a0of first-line anti-malarials, fatality rates for severe malaria\u00a0complications, such as cerebral malaria, remain high, at 15\u201330 %. Due to the risk of severe morbidity and mortality\u00a0associated with malaria, prevention is a priority strategy for\u00a0disease management. This review will emphasize two of the\u00a0key principles for malaria prevention in travelers: bite avoidance and chemoprophylaxis, based on guidelines outlined by\u00a0the World Health Organization (WHO) \u2018ABCD\u2019 approach. It\u00a0is important to note that malaria prevention measures do not\u00a0provide complete protection and early diagnosis is important\u00a0for disease management. Physicians should inform patients of\u00a0the importance of seeking prompt medical attention if they\u00a0develop fever after entering a malaria-endemic area.\u00a0Prophylaxis measures themselves are not without risk; therefore, in order to determine an appropriate course of action, it is\u00a0important to weigh the relative risk of exposure and development of severe disease with the risk of\u00a0adverse events (AEs)\u00a0due to chemoprophylaxis.<\/p>\n
Pharmacologic Treatment
\nThere are two types of chemoprophylactic agents for the\u00a0prevention of malaria: suppressive and causal. The majority\u00a0of agents are suppressive and target the blood stages of malaria. This has important implications for the duration of\u00a0use required for these drugs after departing malaria-endemic\u00a0regions. Agents in the other category are causal in effect and\u00a0target both the liver and blood stages of malaria.\u00a0Currently, there are only two causal agents in use for the\u00a0prevention of malaria and only one drug that can kill the\u00a0dormant hypnozoites of P. vivax and P. Ovale.<\/p>\n