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Rodriguez-Valero N, Ledesma-Carbayo MJ, Martí-Soler H, Cuadrado Sanchez D, Vladimirov A, Camprubí-Ferrer D, Pinazo MJ, Losada I, Almuedo-Riera A, Romero L, Roman A, Vera I, Roldan-Torralvo M, Ferrer E, de Alba T, Jimenez A, Gómez-Valverde JJ, Muñoz J, Luengo Oroz M. A Smartphone App for Real-Time Assessment of Malaria Prophylaxis Adverse Events. Telemed J E Health 2024; 30:1436-1442. [PMID: 38215269 DOI: 10.1089/tmj.2023.0200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2024] Open
Abstract
Background: Growth of international travel to malarial areas over the last decades has contributed to more travelers taking malaria prophylaxis. Travel-related symptoms may be wrongly attributed to malaria prophylaxis and hinder compliance. Here, we aimed to assess the frequency of real-time reporting of symptoms by travelers following malaria prophylaxis using a smartphone app. Method: Adult international travelers included in this single-center study (Barcelona, Spain) used the smartphone Trip Doctor® app developed by our group for real-time tracking of symptoms and adherence to prophylaxis. Results: Six hundred four (n = 604) international travelers were included in the study; 74.3% (449) used the app daily, and for one-quarter of travelers, malaria prophylaxis was prescribed. Participants from the prophylaxis group traveled more to Africa (86.7% vs. 4.3%; p < 0.01) and to high travel medical risk countries (60.8% vs. 18%; p < 0.01) and reported more immunosuppression (30.8% vs. 23.1% p < 0.01). Regarding symptoms, no significant intergroup differences were observed, and no relationship was found between the total number of malarial pills taken and reported symptoms. Conclusions: In our cohort, the number of symptoms due to malaria prophylaxis was not significantly higher than in participants for whom prophylaxis was not prescribed, and the overall proportion of symptoms is higher compared with other studies.
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Affiliation(s)
- Natalia Rodriguez-Valero
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic, Department of International Health, Universitat de Barcelona, Barcelona, Spain
| | - Maria Jesus Ledesma-Carbayo
- Biomedical Image Technology, Electronic Engineering, Universidad Politécnica de Madrid and CIBER-BBN, Madrid, Spain
| | - Helena Martí-Soler
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic, Department of International Health, Universitat de Barcelona, Barcelona, Spain
| | - Daniel Cuadrado Sanchez
- Biomedical Image Technology, Electronic Engineering, Universidad Politécnica de Madrid and CIBER-BBN, Madrid, Spain
| | | | - Daniel Camprubí-Ferrer
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic, Department of International Health, Universitat de Barcelona, Barcelona, Spain
| | - Maria Jesus Pinazo
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic, Department of International Health, Universitat de Barcelona, Barcelona, Spain
| | - Irene Losada
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic, Department of International Health, Universitat de Barcelona, Barcelona, Spain
| | - Alex Almuedo-Riera
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic, Department of International Health, Universitat de Barcelona, Barcelona, Spain
| | - Lucia Romero
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic, Department of International Health, Universitat de Barcelona, Barcelona, Spain
| | - Anna Roman
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic, Department of International Health, Universitat de Barcelona, Barcelona, Spain
| | - Isabel Vera
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic, Department of International Health, Universitat de Barcelona, Barcelona, Spain
| | - Montserrat Roldan-Torralvo
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic, Department of International Health, Universitat de Barcelona, Barcelona, Spain
| | - Elisabeth Ferrer
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic, Department of International Health, Universitat de Barcelona, Barcelona, Spain
| | - Teresa de Alba
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic, Department of International Health, Universitat de Barcelona, Barcelona, Spain
| | - Alejandra Jimenez
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic, Department of International Health, Universitat de Barcelona, Barcelona, Spain
| | - Juan Jose Gómez-Valverde
- Biomedical Image Technology, Electronic Engineering, Universidad Politécnica de Madrid and CIBER-BBN, Madrid, Spain
| | - Jose Muñoz
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic, Department of International Health, Universitat de Barcelona, Barcelona, Spain
| | - Miguel Luengo Oroz
- Biomedical Image Technology, Electronic Engineering, Universidad Politécnica de Madrid and CIBER-BBN, Madrid, Spain
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Suryapranata FS, Overbosch FW, Matser A, Grobusch MP, McCall MB, van Rijckevorsel GG, Prins M, Sonder GJ. Malaria in long-term travelers: Infection risks and adherence to preventive measures – A prospective cohort study. Travel Med Infect Dis 2022; 49:102406. [DOI: 10.1016/j.tmaid.2022.102406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/07/2022] [Accepted: 07/25/2022] [Indexed: 11/27/2022]
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Belete TM. Recent Progress in the Development of New Antimalarial Drugs with Novel Targets. Drug Des Devel Ther 2020; 14:3875-3889. [PMID: 33061294 PMCID: PMC7519860 DOI: 10.2147/dddt.s265602] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 09/09/2020] [Indexed: 01/04/2023] Open
Abstract
Malaria is a major global health problem that causes significant mortality and morbidity annually. The therapeutic options are scarce and massively challenged by the emergence of resistant parasite strains, which causes a major obstacle to malaria control. To prevent a potential public health emergency, there is an urgent need for new antimalarial drugs, with single-dose cures, broad therapeutic potential, and novel mechanism of action. Antimalarial drug development can follow several approaches ranging from modifications of existing agents to the design of novel agents that act against novel targets. Modern advancement in the biology of the parasite and the availability of the different genomic techniques provide a wide range of novel targets in the development of new therapy. Several promising targets for drug intervention have been revealed in recent years. Therefore, this review focuses on the progress made on the latest scientific and technological advances in the discovery and development of novel antimalarial agents. Among the most interesting antimalarial target proteins currently studied are proteases, protein kinases, Plasmodium sugar transporter inhibitor, aquaporin-3 inhibitor, choline transport inhibitor, dihydroorotate dehydrogenase inhibitor, isoprenoid biosynthesis inhibitor, farnesyltransferase inhibitor and enzymes are involved in lipid metabolism and DNA replication. This review summarizes the novel molecular targets and their inhibitors for antimalarial drug development approaches.
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Affiliation(s)
- Tafere Mulaw Belete
- Department of Pharmacology, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Johnson TN, Cleary Y, Parrott N, Reigner B, Smith JR, Toovey S. Development of a physiologically based pharmacokinetic model for mefloquine and its application alongside a clinical effectiveness model to select an optimal dose for prevention of malaria in young Caucasian children. Br J Clin Pharmacol 2018; 85:100-113. [PMID: 30198595 DOI: 10.1111/bcp.13764] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 07/20/2018] [Accepted: 08/09/2018] [Indexed: 12/01/2022] Open
Abstract
AIMS To predict the optimal chemoprophylactic dose of mefloquine in infants of 5-10 kg using physiologically based pharmacokinetic (PBPK) and clinical effectiveness models. METHODS The PBPK model was developed in Simcyp version 14.1 and verified against clinical pharmacokinetic data in adults; the final model, accounting for developmental physiology and enzyme ontogeny was then applied in the paediatric population. The clinical effectiveness model utilized real-world chemoprophylaxis data with stratification of output by age and including infant data from the UK population. RESULTS PBPK simulations in infant populations depend on the assumed fraction of mefloquine metabolized by CYP3A4 (0.47, 0.95) and on the associated CYP3A4 ontogeny (Salem, Upreti). However, all scenarios suggest that a dose of 62.5 mg weekly achieves or exceeds the exposure in adults following a 250 mg weekly dose and results in a minimum plasma concentration of 620 ng ml-1 , which is considered necessary to achieve 95% prophylactic efficacy. The clinical effectiveness model predicts a 96% protective efficacy from mefloquine chemoprophylaxis at 62.5 mg weekly. CONCLUSIONS The PBPK and clinical effectiveness models are mutually supportive and suggest a prophylactic dose of 62.5 mg weekly in the Caucasian 5-10 kg infant population travelling to endemic countries. This dual approach offers a novel route to dose selection in a vulnerable population, where clinical trials would be difficult to conduct.
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Affiliation(s)
- Trevor N Johnson
- Certara UK Limited (Simcyp) Level 2-Acero, 1 Concourse Way, Sheffield, UK
| | - Yumi Cleary
- Pharma Research & Early Development, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Neil Parrott
- Pharma Research & Early Development, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Bruno Reigner
- Pharma Research & Early Development, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - James R Smith
- Pharma Research & Early Development, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd, Basel, Switzerland
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Rolling T, Mühlenpfordt M, Addo MM, Cramer JP, Vinnemeier CD. Pre-travel advice at a crossroad: Medical preparedness of travellers to South and Southeast-Asia - The Hamburg Airport Survey. Travel Med Infect Dis 2017; 18:41-45. [PMID: 28733254 DOI: 10.1016/j.tmaid.2017.07.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 07/06/2017] [Accepted: 07/17/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND Specific travel-related recommendations exist for the prevention or self-treatment of infectious diseases contracted by travellers to the tropics. In the current study, we assessed the medical preparedness per these recommendations, focusing on whether travellers carried antidiarrheal and antimalarial medication with them stratified by type of pre-travel advice. METHODS We surveyed travellers departing from Hamburg International Airport to South or Southeast Asia, using a questionnaire on demographic, medical and travel characteristics. RESULTS 975 travellers were analysed - the majority (817, 83%) being tourists. A large proportion packed any antidiarrheal medication (612, 63%) - most frequently loperamide (440, 72%). Only 176 of 928 (19%) travellers to destinations with low-to medium risk for malaria packed a recommended antimalarial medication. The majority (162, 17%) of them carried antimalarials as stand-by emergency treatment (SBET). 468 (48%) travellers had a pre-travel medical consultation. This lead to higher odds of carrying SBET- with the highest odds associated with a consultation at a travel medicine specialist (OR 7.83 compared to no consultation). CONCLUSIONS Attending a travel medicine specialist was associated with better adherence to current recommendations concerning the carriage of stand-by emergency treatment of malaria. However, the proportion of travellers seeking pre-travel health advice was overall low in our population. Promoting pre-travel consultations may, therefore, lead to higher adherence to the current recommendations in travel medicine.
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Affiliation(s)
- Thierry Rolling
- I. Medical Department, Sections Infectious Diseases and Tropical Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany; Clinical Research Group, Bernhard Nocht Institute for Tropical Medicine (BNITM), Hamburg, Germany.
| | - Melina Mühlenpfordt
- I. Medical Department, Sections Infectious Diseases and Tropical Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Marylyn M Addo
- I. Medical Department, Sections Infectious Diseases and Tropical Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany; German Center for Infection Research (DZIF), Partner Site, Hamburg-Lübeck-Borstel, Germany
| | - Jakob P Cramer
- I. Medical Department, Sections Infectious Diseases and Tropical Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany; Clinical Research Group, Bernhard Nocht Institute for Tropical Medicine (BNITM), Hamburg, Germany
| | - Christof D Vinnemeier
- I. Medical Department, Sections Infectious Diseases and Tropical Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany; Clinical Research Group, Bernhard Nocht Institute for Tropical Medicine (BNITM), Hamburg, Germany
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Vinnemeier CD, Rothe C, Kreuels B, Addo MM, Vygen-Bonnet S, Cramer JP, Rolling T. Response to fever and utilization of standby emergency treatment (SBET) for malaria in travellers to Southeast Asia: a questionnaire-based cohort study. Malar J 2017; 16:44. [PMID: 28122576 PMCID: PMC5264331 DOI: 10.1186/s12936-017-1678-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 01/04/2017] [Indexed: 11/10/2022] Open
Abstract
Background Guidelines in several European countries recommend standby emergency treatment (SBET) for travellers to regions with low or medium malaria transmission instead of continuous chemoprophylaxis: travellers are advised to seek medical assistance within 24 h in case of fever and to self-administer SBET only if they are not able to consult a doctor within the time period specified. Data on healthcare-seeking behaviour of febrile travellers and utilization of SBET is however scarce as only two studies were performed in the mid-1990s. Since tourism is constantly increasing and malaria epidemiology has dramatically changed in the meantime more knowledge is urgently needed. Methods Some 876 travellers to destinations in South and Southeast Asia with low or medium malaria transmission were recruited in the travel clinic of the University Medical Center Hamburg-Eppendorf. Demographic and travel-related data were collected by using questionnaires. Pre-travel advice was carried out and SBET was prescribed in accordance to national guidelines. Post-travel phone interviews were performed to assess health incidents during travel and individual responses of travellers to febrile illness. Results Out of 714 patients who were monitored, 130 (18%) reported onset of fever during travel or 14 days after return. Of those travellers who reported fever, 100 (80%) carried SBET during travel. The vast majority of 79 (79%) febrile travellers who carried SBET did not seek medical assistance. Overall, 14 (14%) febrile patients who carried SBET and six (20%) patients who did not carry SBET took the correct measure (doctor visit or timely SBET administration) as a response to febrile illness, respectively. Only two travellers self-administered SBET, but both of them applied the wrong regimen. Conclusions In view of declining malaria transmission and improving medical infrastructure in most countries of Southeast Asia and obvious obstacles concerning SBET as shown in this study the current strategy should be re-evaluated. Pre-travel advice concerning malaria in SEA should focus on appropriate mosquito bite protection and clearly emphasize the need to see a doctor within 24 h after onset of fever.
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Affiliation(s)
- Christof D Vinnemeier
- I. Department of Medicine, Section Tropical Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Clinical Research Group, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Camilla Rothe
- I. Department of Medicine, Section Tropical Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Benno Kreuels
- I. Department of Medicine, Section Tropical Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Marylyn M Addo
- I. Department of Medicine, Section Tropical Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sabine Vygen-Bonnet
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Jakob P Cramer
- Clinical Research Group, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Thierry Rolling
- I. Department of Medicine, Section Tropical Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. .,Clinical Research Group, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.
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