Malaria 3 - LITFL series Malaria 1 Clinical Tropical Medicine Malaria 2 Clinical Parasitology Malaria 3 Public Health, Travel & Expedition Medicine Malaria 4 Clinical Entomology

Malaria 3

Public Health, Travel & Expedition Medicine FACTM Pt 1

Tim Inglis Division 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 Medicine Johnson C et al. 2008, Oxford

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

Blog http://micrognome.priobe.net Web www.priobe.net FACTM http://lifeinthefastlane.com/exams/actm-fellowship/

Outline  

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

journey aftermath preparation

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

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

Epidemiology  

•  What, how & where •  Who, when

Pre-­‐travel  prepara8on  

•  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

Expedi8on  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 aftermath preparation

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