International comparison of selected European malaria recommendations for travellers

Benz, Ursula (2024): International comparison of selected European malaria recommendations for travellers. Dissertation, LMU München: Medizinische Fakultät

Abstract

Background: Malaria ranks among the most frequently imported tropical diseases in Europe. It is potentially lethal. Many European countries therefore issue recommendations on malaria prevention to protect their travellers. However, the recommendations exhibit significant differences in both scope and content. Objectives: This thesis intends to compare European malaria recommendations for travellers, analysing the differences. The aim is to lay the foundations for future efforts to harmonise a European guideline. Methods: Internet research gathered malaria recommendations for European travellers by screening the web using the specific terms “recommendations”, “malaria”, and “travellers” in different European languages and reviewing national tropical medicine society websites. Selection criteria focused on detailed, accessible recommendations, considering historical links to malaria-endemic regions and high numbers of imported cases. Seven national recommendations from the UK, Germany, the Netherlands, Belgium, France, Spain, and Italy, published before 31 December 2020, were compared. The results were compiled in an Excel data sheet using Microsoft Office 2019 Professional Plus, version 2206. Findings: Key findings included discrepancies in the definitions of malaria risk areas, with significant differences in the data used on the distribution of Plasmodium species in different countries and regions. In addition, there were differences in chemoprophylaxis recommendations and in advice on the procedure of emergency self-treatment. Furthermore, there were discrepancies in recommendations for pregnant and breastfeeding women and for children. Recommendations on mosquito repellents and clothing colour also differed. Conclusions: European malaria recommendations for travellers vary due to a non-standardised and largely non-transparent methodology. In addition, the use of national data on imported malaria cases and incomplete epidemiological information from developing countries leads to varied interpretations among professional societies and regulatory bodies. Differences in the national approvals of medicines and repellents also lead to inconsistent recommendations. This underlines the need for improved communication within Europe to enable comprehensive data exchange for harmonisation. Enhanced education, particularly for the most significant risk group of travellers “visiting friends and relatives” in their country of origin (VFRs), is essential as most imported malaria cases result from traveller non-compliance rather than ineffective medication. Two issues could contribute to knowledge transfer: differences in repellents regarding age limits for children and use during pregnancy appear to depend more on the specific product as a whole and its co-formulants, which affect absorption, than on the concentration of the active substance itself. Furthermore, wearing light-coloured clothing in tropical areas to protect against various mosquitoes, including nocturnal species, appears to be a sensible recommendation.

• Dokumententyp: Dissertationen (Dissertation, LMU München)
• Keywords: Malaria Recommendation, Travel Medicine, Traveller
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften ; 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• Fakultäten: Medizinische Fakultät
• Sprache der Hochschulschrift: Englisch
• Datum der mündlichen Prüfung: 5. Dezember 2024
• 1. Bericht­erstatter:in: Rothe, Camilla