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Thellier M, Simard F, Musset L, Cot M, Velut G, Kendjo E, Pradines B. Changes in malaria epidemiology in France and worldwide, 2000-2015. Med Mal Infect 2019; 50:99-112. [PMID: 31257063 DOI: 10.1016/j.medmal.2019.06.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 06/11/2019] [Indexed: 12/15/2022]
Abstract
In 2015, 212 million new cases of malaria were reported, causing 429,000 deaths. The World Health Organization (WHO) estimated a 41% decrease in the number of new cases worldwide between 2000 and 2015. The number of deaths from malaria fell by 62% worldwide and by 71% in Africa. In mainland France, malaria is mainly imported by travelers or migrants from endemic areas, in particular sub-Saharan Africa (95%). In France, the number of imported malaria cases, mainly due to Plasmodium falciparum (85%), was estimated at about 82,000 for the period 2000-2015. Over the same period, 6,468 cases of malaria were reported in the French armed forces, of which 2,430 cases (37.6%) were considered as imported because occurring outside of endemic areas. The number of malaria cases also fell between 2000 and 2015 in Mayotte and French Guiana, a malaria transmission zone. Mayotte has entered the elimination of malaria with less than 15 cases per year. In French Guiana, between 300 and 500 cases have been reported annually in recent years. The decline in morbidity and mortality is usually attributed to vector control measures and improved access to effective treatments. However, the Anopheles mosquitoes that transmit the disease have developed resistance against most insecticides. Similarly, malaria parasites have developed resistance against most of the antimalarial drugs used as prevention or treatment, even the latest marketed combinations such as artemisinin-based combination therapies.
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Affiliation(s)
- M Thellier
- Service de parasitologie-mycologie, Centre national de référence du paludisme, hôpital Pitié-Salpêtrière, Assistance publique Hôpitaux de Paris, 47, boulevard de l'Hôpital, 75013 Paris, France; UMRS 1136, iPLESP, institut Pierre-Louis d'épidémiologie et de santé publique, Sorbonne université, 27, rue Chaligny, 75571 Paris 12, France; UPMC, faculté de médecine, Sorbonne université, université Pierre-et-Marie-Curie, 91, boulevard de l'Hôpital, 75013 Paris, France
| | - F Simard
- MIVEGEC, IRD-CNRS-university Montpellier, 911, avenue Agropolis, BP 64501, 34394 Montpellier, France
| | - L Musset
- Laboratoire de parasitologie, Centre collaborateur OMS pour la surveillance des résistances aux antipaludiques, institut Pasteur de la Guyane, 23, avenue Louis Pasteur, 97300 Cayenne, France; Centre national de référence du paludisme, institut Pasteur de la Guyane, 23, avenue Louis Pasteur, 97300 Cayenne, France
| | - M Cot
- UMR2016, unité Mère et enfant face aux infections tropicales, institut de recherche pour le développement, 4, avenue de l'Observatoire, 75006 Paris, France
| | - G Velut
- Centre d'épidémiologie et de santé publique des armées, GSBdD Marseille Aubagne, BP 40026, 13568 Marseille cedex 02, France; Direction interarmées du service de santé des armées, Quartier La Madeleine, 97306 Cayenne, France
| | - E Kendjo
- Service de parasitologie-mycologie, Centre national de référence du paludisme, hôpital Pitié-Salpêtrière, Assistance publique Hôpitaux de Paris, 47, boulevard de l'Hôpital, 75013 Paris, France; UMRS 1136, iPLESP, institut Pierre-Louis d'épidémiologie et de santé publique, Sorbonne université, 27, rue Chaligny, 75571 Paris 12, France; UPMC, faculté de médecine, Sorbonne université, université Pierre-et-Marie-Curie, 91, boulevard de l'Hôpital, 75013 Paris, France
| | - B Pradines
- Unité parasitologie et entomologie, institut de recherche biomédicale des armées, institut hospitalo-universitaire Méditerranée Infection, 19-21, boulevard Jean-Moulin, 13005 Marseille, France; Aix Marseille université, IRD, AP-HM, SSA, VITROME, institut hospitalo-universitaire Méditerranée Infection, 19-21, boulevard Jean-Moulin, 13005 Marseille, France; Institut hospitalo-universitaire Méditerranée Infection, 19-21, boulevard Jean-Moulin, 13005 Marseille, France; Centre national de référence du paludisme, institut hospitalo-universitaire Méditerranée Infection, 19-21, boulevard Jean-Moulin, 13005 Marseille, France.
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Créach MA, Velut G, de Laval F, Briolant S, Aigle L, Marimoutou C, Deparis X, Meynard JB, Pradines B, Simon F, Michel R, Mayet A. Factors associated with malaria chemoprophylaxis compliance among French service members deployed in Central African Republic. Malar J 2016; 15:174. [PMID: 26987358 PMCID: PMC4797250 DOI: 10.1186/s12936-016-1219-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Accepted: 03/09/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Malaria is a public health concern in the French armed forces, with 400-800 cases reported every year and three deaths in the past 2 years. However, lack of chemoprophylaxis (CP) compliance is often reported among service members. The aim of this study was to explore factors associated with CP compliance. METHODS A retrospective study (1296 service members) was carried out among troops deployed in Central African Republic. Determinants of CP were collected by self-questionnaire. Socio-demographic variables, behavioural characteristics, belief variables, operational determinants such as troops in contact (TIC) and number of nights worked per week and peer-to-peer reinforcement were studied. Relationships between covariates and compliance were explored using logistic regressions (outcome: compliance as a dummy variable). RESULTS Chemoprophylaxis compliance was associated with other individual preventive measures against mosquito bites (bed net use, OR (odds ratio) = 1.41 (95% CI [1.08-1.84]), and insecticide on clothing, OR = 1.90 ([1.43-2.51]) and malaria-related behaviours (taking chemoprophylaxis at the same time every day, OR = 2.37 ([1.17-4.78]) and taking chemoprophylaxis with food, OR = 1.45 ([1.11-1.89])). High perceived risk of contracting malaria, OR = 1.59 ([1.02-2.50]), positive perception of CP effectiveness, OR = 1.62 ([1.09-2.40]) and the practice of peer-to-peer reinforcement, OR = 1.38 ([1.05-1.82]) were also associated with better compliance. No association was found with TIC and number of nights worked. CONCLUSIONS This study, which shows a positive relationship between peer-to-peer reinforcement and CP compliance, also suggests the existence of two main personality profiles among service members: those who seek risks and those who are health-conscious. Health education should be expanded beyond knowledge, know-how and motivational factors by using a comprehensive approach based on identification of health determinants, development of psychosocial skills and peer-to-peer reinforcement.
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Affiliation(s)
- Marie-Aude Créach
- French Armed Forces Centre for Epidemiology and Public Health (CESPA), GSBdD, Marseille Aubagne-111, Avenue de la Corse-P 40026, 13568, Marseille cedex 02, France.
| | - Guillaume Velut
- French Armed Forces Centre for Epidemiology and Public Health (CESPA), GSBdD, Marseille Aubagne-111, Avenue de la Corse-P 40026, 13568, Marseille cedex 02, France
| | - Franck de Laval
- French Armed Forces Centre for Epidemiology and Public Health (CESPA), GSBdD, Marseille Aubagne-111, Avenue de la Corse-P 40026, 13568, Marseille cedex 02, France.,INSERM, UMR912 (SESSTIM), 13006, Marseille, France
| | - Sébastien Briolant
- Inter-Army Health Service Directorate, Cayenne, French Guiana, France.,Parasitology Laboratory, Institut Pasteur of French Guiana, Cayenne, French Guiana, France.,Research Unit on Emerging Infectious and Tropical Diseases, Aix Marseille University, UM 63, CNRS 7278, IRD 198, Inserm 1095, Marseille, France
| | - Luc Aigle
- Operation Sangaris, Bangui, Central African Republic
| | - Catherine Marimoutou
- French Armed Forces Centre for Epidemiology and Public Health (CESPA), GSBdD, Marseille Aubagne-111, Avenue de la Corse-P 40026, 13568, Marseille cedex 02, France.,INSERM, UMR912 (SESSTIM), 13006, Marseille, France
| | - Xavier Deparis
- French Armed Forces Centre for Epidemiology and Public Health (CESPA), GSBdD, Marseille Aubagne-111, Avenue de la Corse-P 40026, 13568, Marseille cedex 02, France.,INSERM, UMR912 (SESSTIM), 13006, Marseille, France.,Ecole du Val-de-Grâce, Paris, France
| | - Jean-Baptiste Meynard
- French Armed Forces Centre for Epidemiology and Public Health (CESPA), GSBdD, Marseille Aubagne-111, Avenue de la Corse-P 40026, 13568, Marseille cedex 02, France.,INSERM, UMR912 (SESSTIM), 13006, Marseille, France.,Ecole du Val-de-Grâce, Paris, France
| | - Bruno Pradines
- Research Unit on Emerging Infectious and Tropical Diseases, Aix Marseille University, UM 63, CNRS 7278, IRD 198, Inserm 1095, Marseille, France.,Parasitology and Entomology Unit, Department of Infectious Diseases, Armed Forces Biomedical Research Institute, Brétigny sur Orge, France.,National Reference Centre for Malaria, Marseille, France
| | - Fabrice Simon
- Parasitology and Entomology Unit, Department of Infectious Diseases, Armed Forces Biomedical Research Institute, Brétigny sur Orge, France.,Department of Infectious and Tropical Diseases, Laveran Armed Forces Teaching Hospital, Marseille, France.,Ecole du Val-de-Grâce, Paris, France
| | - Rémy Michel
- French Armed Forces Centre for Epidemiology and Public Health (CESPA), GSBdD, Marseille Aubagne-111, Avenue de la Corse-P 40026, 13568, Marseille cedex 02, France.,Department of Infectious and Tropical Diseases, Laveran Armed Forces Teaching Hospital, Marseille, France
| | - Aurélie Mayet
- French Armed Forces Centre for Epidemiology and Public Health (CESPA), GSBdD, Marseille Aubagne-111, Avenue de la Corse-P 40026, 13568, Marseille cedex 02, France.,INSERM, UMR912 (SESSTIM), 13006, Marseille, France
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Pommier de Santi V, Girod R, Mura M, Dia A, Briolant S, Djossou F, Dusfour I, Mendibil A, Simon F, Deparis X, Pagès F. Epidemiological and entomological studies of a malaria outbreak among French armed forces deployed at illegal gold mining sites reveal new aspects of the disease's transmission in French Guiana. Malar J 2016; 15:35. [PMID: 26801629 PMCID: PMC4722744 DOI: 10.1186/s12936-016-1088-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 01/10/2016] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND In December 2010, a Plasmodium vivax malaria outbreak occurred among French forces involved in a mission to control illegal gold mining in French Guiana. The findings of epidemiological and entomological investigations conducted after this outbreak are presented here. METHODS Data related to malaria cases reported to the French armed forces epidemiological surveillance system were collected during the epidemic period from December 2010 to April 2011. A retrospective cohort study was conducted to identify presumed contamination sites. Anopheles mosquitoes were sampled at the identified sites using Mosquito Magnet and CDC light traps. Specimens were identified morphologically and confirmed using molecular methods (sequencing of ITS2 gene and/or barcoding). Anopheles infections with Plasmodium falciparum and P. vivax were tested by both enzyme-linked immunosorbent assay and real-time PCR. RESULTS Seventy-two P. vivax malaria cases were reported (three were mixed P. falciparum/P. vivax infections), leading to a global attack rate of 26.5% (72/272). Lack of compliance with vector control measures and doxycycline chemoprophylaxis was reported by patients. Two illegal gold mining sites located in remote areas in the primary forest were identified as places of contamination. In all, 595 Anopheles females were caught and 528 specimens were formally identified: 305 Anopheles darlingi, 145 Anopheles nuneztovari s.l., 63 Anopheles marajoara and 15 Anopheles triannulatus s.l. Three An. darlingi were infected by P. falciparum (infection rate: 1.1%) and four An. marajoara by P. vivax (infection rate: 6.4%). DISCUSSION The main drivers of the outbreak were the lack of adherence by military personnel to malaria prevention measures and the high level of malaria transmission at illegal gold mining sites. Anopheles marajoara was clearly implicated in malaria transmission for the first time in French Guiana. The high infection rates observed confirm that illegal gold mining sites must be considered as high level malaria transmission areas in the territory. CONCLUSIONS Illegal gold mining activities are challenging the control of malaria in French Guiana. Collaboration with neighbouring countries is necessary to take into account mobile populations such as gold miners. Malaria control strategies in the French armed forces must be adapted to P. vivax malaria and sylvatic Anopheles species.
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Affiliation(s)
- Vincent Pommier de Santi
- French Armed Forces Center for Epidemiology and Public Health (CESPA), Camp Militaire de Sainte Marthe, BP 40026, 13568, Marseille Cedex 02, France.
- Direction Interarmées du Service de Santé en Guyane, Quartier La Madeleine, BP 6019, 97306, Cayenne Cedex, French Guiana.
| | - Romain Girod
- Medical Entomology Unit, Institut Pasteur de la Guyane, 23 Avenue Pasteur, BP 6010, 97306, Cayenne Cedex, French Guiana.
| | - Marie Mura
- Institut de Recherche Biomédicale des Armées, BP 73, 91223, Brétigny sur Orge Cedex, France.
| | - Aissata Dia
- French Armed Forces Center for Epidemiology and Public Health (CESPA), Camp Militaire de Sainte Marthe, BP 40026, 13568, Marseille Cedex 02, France.
| | - Sébastien Briolant
- Direction Interarmées du Service de Santé en Guyane, Quartier La Madeleine, BP 6019, 97306, Cayenne Cedex, French Guiana.
- Institut de Recherche Biomédicale des Armées, BP 73, 91223, Brétigny sur Orge Cedex, France.
- Laboratory of Parasitology, Institut Pasteur de la Guyane, 23 Avenue Pasteur, BP 6010, 97306, Cayenne Cedex, French Guiana.
| | - Félix Djossou
- Unit of Infectious and Tropical Diseases, Andrée Rosemon Hospital, Avenue des Flamboyants, Cayenne, French Guiana.
| | - Isabelle Dusfour
- Medical Entomology Unit, Institut Pasteur de la Guyane, 23 Avenue Pasteur, BP 6010, 97306, Cayenne Cedex, French Guiana.
| | - Alexandre Mendibil
- Antenne médicale de Castres, Quartier Fayolle - 68 avenue J. Desplat, CS 50025, 81108, Castres Cedex, France.
| | - Fabrice Simon
- Department of Infectious Diseases and Tropical Medicine, Laveran Military Teaching Hospital, 34 Boulevard Laveran, BP 50, 13013, Marseille, France.
| | - Xavier Deparis
- French Armed Forces Center for Epidemiology and Public Health (CESPA), Camp Militaire de Sainte Marthe, BP 40026, 13568, Marseille Cedex 02, France.
| | - Frédéric Pagès
- Cire Océan Indien, Institut de Veille Sanitaire, 2 bis, av Georges Brassens, CS 61002, 97743, Saint-Denis Cedex 9, Réunion, France.
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Mura M, Briolant S, Donato D, Volney B, Pelleau S, Musset L, Legrand E. Absence of correlation between ex vivo susceptibility to doxycycline and pfteQ-pfmdt gene polymorphism in French Guiana. Malar J 2015. [PMID: 26206143 PMCID: PMC4513625 DOI: 10.1186/s12936-015-0788-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background In French Guiana, doxycycline is used for both chemoprophylaxis and the treatment of malaria. The presence of isolates with reduced ex vivo susceptibility to doxycycline in French Guiana makes it critical to identify any genetic determinants contributing to the chemosusceptibility level of Plasmodium falciparum to doxycycline, such as pfmdt and pftetQ, which were recently identified as potential molecular markers in African isolates. Methods A Bayesian statistical approach was used to define different ex vivo doxycycline phenotypes. The pfmdt and pftetQ gene copy numbers were quantified by quantitative real-time polymerase chain reaction in 129 P. falciparum isolates collected between 2000 and 2010, and pftetQ, pfrps7, pfssurRNA, and pflsurRNA sequences were analysed after amplification by polymerase chain reaction. Results PftetQ and pfmdt copy numbers were not associated with reduced susceptibility to doxycycline in P. falciparum within French Guiana. Sequence analysis of the genes revealed five known single nucleotide polymorphisms. Three new SNPs were identified
in the apicoplast ribosomal RNA long sub-unit (pflsurRNA): C740T, A1875C and A1875T. These polymorphisms were not associated with reduced chemosusceptibility to doxycycline. Conclusions The present study does not validate pfmdt and pftetQ genes as molecular markers of decreased susceptibility to doxycycline in P. falciparum isolates in French Guiana.
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Affiliation(s)
- Marie Mura
- Laboratoire de Parasitologie, Centre National de Référence du Paludisme aux Antilles, Guyane, Institut Pasteur de la Guyane, Cayenne Cedex, France. .,Direction Interarmées du Service de Santé en Guyane, Quartier La Madeleine, BP 6019, 97306, Cayenne Cedex, French Guiana.
| | - Sébastien Briolant
- Laboratoire de Parasitologie, Centre National de Référence du Paludisme aux Antilles, Guyane, Institut Pasteur de la Guyane, Cayenne Cedex, France. .,Direction Interarmées du Service de Santé en Guyane, Quartier La Madeleine, BP 6019, 97306, Cayenne Cedex, French Guiana. .,Institut de Recherche Biomédicale des Armées, BP 73, 91223, Brétigny sur Orge Cedex, France.
| | - Damien Donato
- Laboratoire de Parasitologie, Centre National de Référence du Paludisme aux Antilles, Guyane, Institut Pasteur de la Guyane, Cayenne Cedex, France.
| | - Béatrice Volney
- Laboratoire de Parasitologie, Centre National de Référence du Paludisme aux Antilles, Guyane, Institut Pasteur de la Guyane, Cayenne Cedex, France.
| | - Stéphane Pelleau
- Laboratoire de Parasitologie, Centre National de Référence du Paludisme aux Antilles, Guyane, Institut Pasteur de la Guyane, Cayenne Cedex, France.
| | - Lise Musset
- Laboratoire de Parasitologie, Centre National de Référence du Paludisme aux Antilles, Guyane, Institut Pasteur de la Guyane, Cayenne Cedex, France.
| | - Eric Legrand
- Laboratoire de Parasitologie, Centre National de Référence du Paludisme aux Antilles, Guyane, Institut Pasteur de la Guyane, Cayenne Cedex, France. .,Unité de Recherche Génétique et Génomique des Insectes Vecteurs, Institut Pasteur, 25-28 rue du Dr Roux, 75724, Paris Cedex 15, France.
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Heslop IM, Bellingan M, Speare R, Glass BD. Pharmaceutical care model to assess the medication-related risks of travel. Int J Clin Pharm 2014; 36:1196-204. [PMID: 25266664 DOI: 10.1007/s11096-014-0016-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 09/16/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND People are at greater risk of health problems when travelling and a significant number of travel-related health problems are associated with the effects of travel on pre-existing chronic diseases. Medications play a key role in the management of these conditions. However, there is a notable lack of research evaluating the potential medication-related risks associated with travel. OBJECTIVE To apply a systematic pharmaceutical care model developed to evaluate potential pharmaceutical risks (PPRs) and pharmaceutical care issues (PCIs) in travellers. SETTING Adult travellers leaving Cairns International Airport, Australia, for an international destination. METHOD A cross-sectional survey using semi-structured interviews, including a systematic medication history, followed by the application of a pharmaceutical care model to evaluate each participant for PPRs and PCIs. MAIN OUTCOME MEASURE Evaluation of standard clinical and travel-related PPRs and PCIs. RESULTS Medications for chronic diseases were being taken by 47.7% of the 218 travellers interviewed. Although 75.2% of participants presented with no PPRs, a total of 274 PCIs were identified across 61.5% of the participants, with an average of 2.04 PCIs per participant. The most prevalent PCIs related to the inadequate precautions taken by some travellers visiting malaria-endemic regions. Although 91 participants recognised that they were travelling to malaria-endemic regions, 65.9% of these participants were not using malarial chemoprophylaxis, and only 16.5% were using chemoprophylaxis that fully complied with standard recommendations. The second most prevalent PCI was the need for 18.8% of participants to be educated about their medications. Other PCIs identified have the potential to increase the risk of acute, travel-related conditions, and complicate the care of travellers, if they inadvertently became unwell while overseas. CONCLUSION PPRs and PCIs were not identified in all participants. However, the impact of many of the identified medication-related issues could be substantial to the traveller. This study represents the novel application of a pharmaceutical care model to identify potential PPRs and PCIs in travellers that may not be identified by other pre-travel risk assessment methods.
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Affiliation(s)
- Ian M Heslop
- Pharmacy (Building 47), College of Medicine and Dentistry, James Cook University, Townsville, QLD, 4811, Australia,
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Michel R, Demoncheaux JP, Créach MA, Rapp C, Simon F, Haus-Cheymol R, Migliani R. Prevention of infectious diseases during military deployments: a review of the French armed forces strategy. Travel Med Infect Dis 2014; 12:330-40. [PMID: 25052855 DOI: 10.1016/j.tmaid.2014.07.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Revised: 06/24/2014] [Accepted: 07/02/2014] [Indexed: 11/18/2022]
Abstract
Military personnel in operations have always paid a high toll to infections. In the 21st century some of these diseases still cause outbreaks with significant morbidity and impact on deployments. The new configuration of the French Armed Forces requires the permanent preparedness of deployable units. During deployments, soldiers are at least exposed to the infectious diseases that are observed in travellers, but with a potentially severe impact for the combatting strengths and a risk for cancelation or failure of the operational durability. The most common disabling infections during military deployments are faeco-oral transmitted diseases including diarrhoea. Preventing infectious diseases during deployments is of great concern and the French medical service has established a strategy based on different components; risk assessment and preparation, immunizations, protective measures and chemoprophylaxis, health education, health surveillance, outbreak investigations and medical tracking. In this review, the authors present the context of deployment of the French Armed Forces, the main health risks they are exposed to and develop the key points of the force health protection strategy, focused on infections related to military deployments.
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Affiliation(s)
- R Michel
- Centre d'épidémiologie et de santé publique des armées, Marseille, France; Ecole du Val-de-Grace, Paris, France.
| | - J P Demoncheaux
- Centre médical des armées de Nîmes-Orange-Laudun, Antenne vétérinaire de Nîmes, France
| | - M A Créach
- Centre d'épidémiologie et de santé publique des armées, Marseille, France
| | - C Rapp
- Hôpital d'instruction des armées Bégin, Saint Mandé, France; Ecole du Val-de-Grace, Paris, France
| | - F Simon
- Ecole du Val-de-Grace, Paris, France; Hôpital d'instruction des armées Laveran, Marseille, France
| | - R Haus-Cheymol
- Direction centrale du Service de santé des armées, Vincennes, France
| | - R Migliani
- Ecole du Val-de-Grace, Paris, France; Direction centrale du Service de santé des armées, Vincennes, France
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Warne B, Weld LH, Cramer JP, Field VK, Grobusch MP, Caumes E, Jensenius M, Gautret P, Schlagenhauf P, Castelli F, Lalloo DG, Ursing J, Chappuis F, von Sonnenburg F, López-Vélez R, Rapp C, Smith KC, Parola P, Gkrania-Klotsas E. Travel-related infection in European travelers, EuroTravNet 2011. J Travel Med 2014; 21:248-54. [PMID: 24750378 DOI: 10.1111/jtm.12120] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 12/06/2013] [Accepted: 12/11/2013] [Indexed: 12/01/2022]
Abstract
BACKGROUND Limited data exist on infectious diseases imported to various locations in Europe, particularly after travel within the continent. METHODS To investigate travel-related disease relevant to Europe that is potentially preventable through pre-travel intervention, we analyzed the EuroTravNet database of 5,965 ill travelers reported by 16 centers in "Western" Europe in 2011. RESULTS There were 54 cases of vaccine-preventable disease, mostly hepatitis A (n = 16), typhoid fever (n = 11), and measles (n = 8); 6 cases (including 3 measles cases) were associated with travel within "Western" Europe. Malaria was the most commonly diagnosed infection (n = 482, 8.1% of all travel-related morbidity). Among patients with malaria, the military most commonly received pre-travel advice (95%), followed by travelers for missionary, volunteer, research, or aid work (81%) but travelers visiting friends and relatives (VFRs) were least likely to receive pre-travel advice (21%). The vast majority (96%) of malaria patients were resident in "Western" Europe, but over half (56%) were born elsewhere. Other significant causes of morbidity, which could be reduced through advice and behavioral change, include Giardia (n = 221, 3.7%), dengue (n = 146, 2.4%), and schistosomiasis (n = 131, 2.2%). Of 206 (3.5%) travelers with exposure in "Western" Europe, 75% were tourists; the highest burden of disease was acute gastrointestinal infection (35% cases). Travel from "Eastern" Europe (n = 132, 2.2%) was largely associated with migration-related travel (53%); among chronic infectious diseases, tuberculosis was frequently diagnosed (n = 20). Travelers VFRs contributed the largest group of malaria patients (46%), but also had the lowest documented rate of pre-travel health advice in this subset (20%). Overall, 44% of nonimmigrant ill travelers did not receive pre-travel advice. CONCLUSION There is a burden of infectious diseases in travelers attending European health centers that is potentially preventable through comprehensive pre-travel advice, chemoprophylaxis, and vaccination. Targeted interventions for high-risk groups such as travelers VFRs and migration-associated travelers are of particular importance.
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Affiliation(s)
- Ben Warne
- Department of Infectious Diseases, Addenbrooke's Hospital, Cambridge, UK
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8
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Migliani R, Pradines B, Michel R, Aoun O, Dia A, Deparis X, Rapp C. Malaria control strategies in French armed forces. Travel Med Infect Dis 2014; 12:307-17. [PMID: 25069406 DOI: 10.1016/j.tmaid.2014.05.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Revised: 05/11/2014] [Accepted: 05/13/2014] [Indexed: 10/25/2022]
Abstract
Each year, 40,000 French soldiers deploy or travel through malaria-endemic areas. Despite the effective control measures that were successively implemented, malaria remains a public health concern in French armed forces with several important outbreaks and one lethal case every two years. This article describes the malaria control strategy in French armed forces which is based on three combined strategies: i) Anopheles vector control to prevent infection with the implementation of personal protection against vectors (PPAV) adapted to the field living conditions of the troops. ii) Chemoprophylaxis (CP) to prevent the disease based on prescription of effective and well tolerated doxycycline. iii) Management of cases through early diagnosis and appropriate treatment to prevent death. In isolated conditions in endemic areas, rapid diagnosis tests (RDT) are used as first-line tests by military doctors. Treatment of uncomplicated Plasmodium falciparum (P. falciparum) malaria is based either on the piperaquine tetraphosphate-dihydroartemisinin association since 2013, or on the atovaquone-proguanil association. First-line treatment of severe P. falciparum malaria is based on IV artesunate. These measures are associated with constant education of the military, epidemiological surveillance of malaria cases and monitoring of parasite chemosensitivity.
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Affiliation(s)
| | - B Pradines
- Institut de recherche biomédicale des armées, Brétigny-sur-Orge, France; Aix Marseille Université, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, UM 63, CNRS 7278, IRD 198, Inserm 1095, Marseille, France
| | - R Michel
- Centre d'épidémiologie et de santé publique des armées, Marseille, France
| | - O Aoun
- Service des maladies infectieuses et tropicales, Hôpital d'instruction des armées Bégin, Saint-Mandé, France
| | - A Dia
- Centre d'épidémiologie et de santé publique des armées, Marseille, France
| | - X Deparis
- Ecole du Val de Grâce, Paris, France; Centre d'épidémiologie et de santé publique des armées, Marseille, France
| | - C Rapp
- Ecole du Val de Grâce, Paris, France; Service des maladies infectieuses et tropicales, Hôpital d'instruction des armées Bégin, Saint-Mandé, France
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9
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Boggild A, Brophy J, Charlebois P, Crockett M, Geduld J, Ghesquiere W, McDonald P, Plourde P, Teitelbaum P, Tepper M, Schofield S, McCarthy A. Summary of recommendations for the prevention of malaria by the Committee to Advise on Tropical Medicine and Travel (CATMAT). CANADA COMMUNICABLE DISEASE REPORT = RELEVE DES MALADIES TRANSMISSIBLES AU CANADA 2014; 40:118-132. [PMID: 29769893 PMCID: PMC5864439 DOI: 10.14745/ccdr.v40i07a01] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND On behalf of the Public Health Agency of Canada, the Committee to Advise on Tropical Medicine and Travel (CATMAT) developed the Canadian Recommendations for the Prevention and Treatment of Malaria Among International Travellers for Canadian health care providers who are preparing patients for travel to malaria-endemic areas and treating travellers who have returned ill. OBJECTIVE To provide guidelines on risk assessment and prevention of malaria. METHODS CATMAT reviewed all major sources of information on malaria prevention, as well as recent research and national and international epidemiological data, to tailor guidelines to the Canadian context. The evidence-based medicine recommendations were developed with associated rating scales for the strength and quality of the evidence. RECOMMENDATIONS Used together and correctly, personal protective measures (PPM) and chemoprophylaxis very effectively protect against malaria infection. PPM include protecting accommodation areas from mosquitoes, wearing appropriate clothing, using bed nets pre-treated with insecticide and applying topical insect repellant (containing 20%-30% DEET or 20% icaridin) to exposed skin. Selecting the most appropriate chemoprophylaxis involves assessment of the traveller's itinerary to establish his/her malaria risk profile as well as potential drug resistance issues. Antimalarials available on prescription in Canada include chloroquine (or hydroxychloroquine), atovaquone-proguanil, doxycycline, mefloquine and primaquine.
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Affiliation(s)
- A Boggild
- University Health Network, Toronto General Hospital (Toronto, ON)
| | - J Brophy
- Division of Infectious Diseases, Children’s Hospital of Eastern Ontario (Ottawa, ON)
| | - P Charlebois
- Internal Medicine, Canadian Forces Health Services Centre (Atlantic) (Halifax, NS)
| | - M Crockett
- Paediatrics and Child Health, University of Manitoba (Winnipeg, MB)
| | - J Geduld
- Infectious Disease Prevention and Control Branch, Public Health Agency of Canada (Ottawa, ON)
| | - W Ghesquiere
- Infectious Diseases and Internal Medicine, University of British Columbia (Victoria, BC)
| | - P McDonald
- Therapeutic Products Directorate, Health Canada (Ottawa, ON)
| | - P Plourde
- Faculty of Medicine, University of Manitoba (Winnipeg, MB)
| | | | - M Tepper
- Communicable Disease Control Program, Directorate of Forces Health Protection (Ottawa, ON)
| | - S Schofield
- Pest Management Entomology, Directorate of Forces Health Protection (Ottawa, ON)
| | - A McCarthy
- Tropical Medicine and International Health Clinic, Division of Infectious Disease, Ottawa Hospital General Campus (Ottawa, ON)
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10
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Malaria in tunisian military personnel after returning from external operation. Malar Res Treat 2013; 2013:359192. [PMID: 23766922 PMCID: PMC3676906 DOI: 10.1155/2013/359192] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2012] [Revised: 04/21/2013] [Accepted: 04/27/2013] [Indexed: 11/17/2022] Open
Abstract
Introduction. Malaria had been eliminated in Tunisia since 1979, but there are currently 40 to 50 imported cases annually. Soldiers are no exception as the incidence of imported malaria is increasing in Tunisian military personnel after returning from malaria-endemic area, often in Sub-Saharan Africa. Methods. We retrospectively analyzed the clinical and biological presentations, treatment, and outcomes of 37 Tunisian military personnel hospitalized at the Department of Internal Medicine, the Military Hospital of Tunis, between January 1993 and January 2011, for imported malaria. The clinical and laboratory features were obtained from the medical records and a questionnaire was filled by the patients about the compliance of malaria prophylaxis. Results. Thirty-seven male patients, with a mean age of 41 years, were treated for malaria infection. Twenty-two were due to Plasmodium falciparum. The outcome was favourable for all patients, despite two severe access. The long-term use of chemoprophylaxis has been adopted by only 21 (51%) of expatriate military for daily stresses. Moreover, poor adherence was found in 32 patients. Conclusion. The risk of acquiring malaria infection in Tunisian military personnel can largely be prevented by the regular use of chemoprophylactic drugs combined with protective measures against mosquito bites.
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11
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Texier G, Machault V, Barragti M, Boutin JP, Rogier C. Environmental determinant of malaria cases among travellers. Malar J 2013; 12:87. [PMID: 23496931 PMCID: PMC3599338 DOI: 10.1186/1475-2875-12-87] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Accepted: 02/26/2013] [Indexed: 11/10/2022] Open
Abstract
Background Approximately 125 million travellers visit malaria-endemic countries annually and about 10,000 cases of malaria are reported after returning home. Due to the fact that malaria is insect vector transmitted, the environment is a key determinant of the spread of infection. Geo-climatic factors (such as temperature, moisture, water quality) determine the presence of Anopheles breeding sites, vector densities, adult mosquito survival rate, longevity and vector capacity. Several studies have shown the association between environmental factors and malaria incidence in autochthonous population. The association between the incidence of clinical malaria cases among non-immune travellers and environmental factors is yet to be evaluated. The objective of the present study was to identify, at a country scale (Ivory Coast), the environmental factors that are associated with clinical malaria among non-immune travellers, opening the way for a remote sensing-based counselling for malaria risk prevention among travellers. Methods The study sample consisted in 87 cohorts, including 4,531 French soldiers who travelled to Ivory Coast, during approximately four months, between September 2002 and December 2006. Their daily locations were recorded during the entire trip. The association between the incidence of clinical malaria and other factors (including individual, collective and environmental factors evaluated by remote sensing methods) was analysed in a random effect mixed Poisson regression model to take into account the sampling design. Results One hundred and forty clinical malaria cases were recorded during 572,363 person-days of survey, corresponding to an incidence density of 7.4 clinical malaria episodes per 1,000 person-months under survey. The risk of clinical malaria was significantly associated with the cumulative time spent in areas with NDVI > 0.35 (RR = 2,42), a mean temperature higher than 27°C (RR = 2,4), a longer period of dryness during the preceding month (RR = 0,275) and the cumulative time spent in urban areas (RR = 0,52). Conclusions The present results suggest that remotely-sensed environmental data could be used as good predictors of the risk of clinical malaria among vulnerable individuals travelling through African endemic areas.
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Affiliation(s)
- Gaëtan Texier
- Public Health and Epidemiology Centre of the French Army (CESPA) &SESSTIM UMR912, Allée du Médecin Colonel Jamot, Parc du Pharo, BP60109,13262 Marseille cedex 07, France
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12
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Frickmann H, Schwarz NG, Holtherm HU, Maassen W, Vorderwülbecke F, Erkens K, Fischer M, Morwinsky T, Hagen RM. Compliance with antimalarial chemoprophylaxis in German soldiers: a 6-year survey. Infection 2013; 41:311-20. [PMID: 23371855 DOI: 10.1007/s15010-013-0411-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Accepted: 01/15/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE Since 1992, German soldiers have been deployed in areas where malaria is endemic. Antimalarial chemoprophylaxis (CP) is directed according to the assessed risk and is provided free of charge. Compliance is crucial if its effect is to be reliable. This study analysed compliance with directed CP in German soldiers as well as its determinants. METHODS Between 2003 and 2009, standardized questionnaire-based interviews were performed with 2,149 out of approximately 100,000 German soldiers who were deployed during this period in areas where malaria is endemic. The questionnaires dealt with information that the soldiers had received about malaria prior to their missions, with their adherence to mosquito-protective and antimalarial chemoprophylactic procedures, and their estimations of their individual level of exposure. RESULTS About 1,308 out of 2,149 interviewed soldiers had been ordered to take CP, allowing for an assessment of the outcome parameter "CP-compliance". About 76.9 % out of 1,308 soldiers to whom regular CP was directed took it regularly. The exposure variables "age", "satisfaction with malaria counselling", "perceived threat due to insects or mosquitoes" and "use of insect repellents" were positively associated with compliance with directed antimalarial CP. CONCLUSIONS The study confirms the findings of the French and US armies that even free-of-charge access to antimalarial medication will not lead to 100 % acceptance. The compliance problem is aggravated by the generally low age of deployed soldiers. Adequate counselling is crucial to increase adherence to antimalarial CP.
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Affiliation(s)
- H Frickmann
- Department of Tropical Medicine at the Bernhard Nocht Institute, German Armed Forces Hospital of Hamburg, Bernhard Nocht Street 74, 20359, Hamburg, Germany.
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13
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Bouldouyre MA, De Verdière NC, Pavie J, De Castro N, Ponscarme D, Hamane S, Rachline A, Ferret S, Molina JM. Quality of travel health advice in a French travel medicine and vaccine center: a prospective observational study. J Travel Med 2012; 19:76-83. [PMID: 22414031 DOI: 10.1111/j.1708-8305.2011.00591.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The number of international trips undertaken by French citizens is rising and we wished to assess the appropriateness of advices given to travelers in a vaccine and travel medicine center in France. METHODS We conducted a 3-month prospective study in one center in Paris where prescriptions and advice to travelers are given by trained physicians in travel medicine who have access to a computerized decision support system (Edisan). A questionnaire was used to record trip characteristics, patients' demographics, and prescriptions. Main outcome measure was the adequacy of prescriptions for malaria prophylaxis, yellow fever, and hepatitis A vaccines to French guidelines. RESULTS A total of 730 subjects were enrolled in this study, with a median age of 28 years. Travel destinations were sub-Saharan Africa (58%), Asia (21%), and South America (18%). Among the 608 patients (83%) traveling to malaria-endemic areas, malaria prophylaxis was in accordance with guidelines in 578/608 patients (95.1%, 95% CI: 93-96.5), and doxycycline was the regimen of choice (48%). Inappropriate malaria prophylaxis was given to eight patients, one of whom developed plasmodium falciparum malaria. All 413 patients (100%, 95% CI: 99-100) traveling to yellow fever-endemic areas who needed vaccination were correctly vaccinated. However, three patients received yellow fever vaccination without indication. Also, 442 of 454 patients (97.4%, 95% CI: 95.4-98.5) eligible to receive hepatitis A vaccination were immunized. CONCLUSION Appropriate advice for malaria prophylaxis, yellow fever, and hepatitis A vaccinations was provided in a travel medicine and vaccine center where trained physicians used a computerized decision support system. Even in this setting, however, errors can occur and professional practices should be regularly assessed to improve health care.
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14
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Sagui E, Resseguier N, Machault V, Ollivier L, Orlandi-Pradines E, Texier G, Pages F, Michel R, Pradines B, Briolant S, Buguet A, Tourette-Turgis C, Rogier C. Determinants of compliance with anti-vectorial protective measures among non-immune travellers during missions to tropical Africa. Malar J 2011; 10:232. [PMID: 21831319 PMCID: PMC3176253 DOI: 10.1186/1475-2875-10-232] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2011] [Accepted: 08/10/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The effectiveness of anti-vectorial malaria protective measures in travellers and expatriates is hampered by incorrect compliance. The objective of the present study was to identify the determinants of compliance with anti-vectorial protective measures (AVPMs) in this population that is particularly at risk because of their lack of immunity. METHODS Compliance with wearing long clothing, sleeping under insecticide-impregnated bed nets (IIBNs) and using insect repellent was estimated and analysed by questionnaires administered to 2,205 French military travellers from 20 groups before and after short-term missions (approximately four months) in six tropical African countries (Senegal, Ivory Coast, Chad, Central African Republic, Gabon and Djibouti). For each AVPM, the association of "correct compliance" with individual and collective variables was investigated using random-effect mixed logistic regression models to take into account the clustered design of the study. RESULTS The correct compliance rates were 48.6%, 50.6% and 18.5% for wearing long clothing, sleeping under bed nets and using repellents, respectively. Depending on the AVPM, correct compliance was significantly associated with the following factors: country, older than 24 years of age, management responsibilities, the perception of a personal malaria risk greater than that of other travellers, the occurrence of life events, early bedtime (i.e., before midnight), the type of stay (field operation compared to training), the absence of medical history of malaria, the absence of previous travel in malaria-endemic areas and the absence of tobacco consumption.There was no competition between compliance with the different AVPMs or between compliance with any AVPM and malaria chemoprophylaxis. CONCLUSION Interventions aimed at improving compliance with AVPMs should target young people without management responsibilities who are scheduled for non-operational activities in countries with high risk of clinical malaria. Weak associations between compliance and history of clinical malaria or variables that pertain to threat perception suggest that cognition-based interventions referencing a "bad experience" with clinical malaria could have only a slight impact on the improvement of compliance. Further studies should focus on the cognitive and behavioural predictors of compliance with AVPMs.
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Affiliation(s)
- Emmanuel Sagui
- Field Infectiology Department, Institute for Biomedical Research of the French Armed Forces (IRBA) & URMITE UMR6236, Allée du Médecin Colonel Jamot, Parc du Pharo, BP60109, 13262 Marseille Cedex 07, France
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15
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Mayet A, Lacassagne D, Juzan N, Chaudier B, Haus-Cheymol R, Berger F, Romand O, Ollivier L, Verret C, Deparis X, Spiegel A. Malaria outbreak among French army troops returning from the Ivory Coast. J Travel Med 2010; 17:353-5. [PMID: 20920059 DOI: 10.1111/j.1708-8305.2010.00437.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In 2006, a French Army unit reported 39 malaria cases among service persons returning from Ivory Coast. Thirty, including three serious forms, occurred after the return to France. The risk of post-return malaria was higher than the risk in Ivory Coast. Half of the imported cases had stopped post-return chemoprophylaxis early.
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Affiliation(s)
- Aurélie Mayet
- Department of Epidemiology and Public Health, Northern Sector, Val-de-Grâce School of Military Medicine, Paris, France. aurelie
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DePetrillo JC, Singer C, Bergagnini IA, Kolakowski P, Edwards B, Smith MA. Assessment of adherence to atovaquone-proguanil prophylaxis in travelers. J Travel Med 2010; 17:217-20. [PMID: 20636593 DOI: 10.1111/j.1708-8305.2010.00426.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Malaria continues to be a serious, world-wide infection. Atovaquone-proguanil is one of the prophylactic agents recommended for travelers to endemic regions. However, little information is available regarding adherence with this medication. A large proportion of malaria cases reported from travelers is due to non-adherence to prescribed regimens. This study was undertaken to analyze adherence with atovaquone-proguanil prophylaxis and specific factors contributing to non-adherence. METHODS Men and non-pregnant women > or = 18 years of age were eligible for inclusion. Enrolled travelers received a prescription for atovaquone-proguanil prophylaxis and were contacted by telephone within 3 weeks of return to the United States. A questionnaire was prepared by the authors to determine if subjects were adherent with the medication. Additional data included demographics, duration of malarious travel, previous use of prophylactic agents, underlying medical conditions, concurrent medications, and reasons for non-adherence. RESULTS Complete data were available for 104/124 (84%) participants: 49 (47%) men, 55 (53%) women. Average duration of malarious travel was 12 days, and 19 (18%) travelers reported previous travel to a malarious region. Ninety-two (89%) subjects were completely adherent with their prophylactic atovaquone-proguanil course. Adverse effects were seen in 6 (5%) travelers. CONCLUSIONS Adherence with atovaquone-proguanil malaria prophylaxis is high among travelers from a non-endemic region. Adverse effects are minimal. Non-adherence was primarily attributable to travelers' perception of need.
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Affiliation(s)
- John C DePetrillo
- Division of Infectious Diseases, Department of Medicine, Long Island Jewish Medical Center, New Hyde Park, NY 11040, USA.
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Resseguier N, Machault V, Ollivier L, Orlandi-Pradines E, Texier G, Pradines B, Gaudart J, Buguet A, Tourette-Turgis C, Rogier C. Determinants of compliance with malaria chemoprophylaxis among French soldiers during missions in inter-tropical Africa. Malar J 2010; 9:41. [PMID: 20128921 PMCID: PMC2829034 DOI: 10.1186/1475-2875-9-41] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2009] [Accepted: 02/03/2010] [Indexed: 11/10/2022] Open
Abstract
Background The effectiveness of malaria chemoprophylaxis is limited by the lack of compliance whose determinants are not well known. Methods The compliance with malaria chemoprophylaxis has been estimated and analysed by validated questionnaires administered before and after the short-term missions (about four months) in five tropical African countries of 2,093 French soldiers from 19 military companies involved in a prospective cohort study. "Correct compliance" was defined as "no missed doses" of daily drug intake during the entire mission and was analysed using multiple mixed-effect logistic regression model. Results The averaged prevalence rate of correct compliance was 46.2%, ranging from 9.6%to 76.6% according to the companies. Incorrect compliance was significantly associated with eveningness (p = 0.028), a medical history of clinical malaria (p < 0.001) and a perceived mosquito attractiveness inferior or superior to the others (p < 0.007). Correct compliance was significantly associated with the systematic use of protective measures against mosquito bites (p < 0.001), the type of military operations (combat vs. training activities, p < 0.001) and other individual factors (p < 0.05). Conclusions The identification of circumstances and profiles of persons at higher risk of lack of compliance would pave the way to specifically targeted strategies aimed to improve compliance with malaria chemoprophylaxis and, therefore, its effectiveness.
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Affiliation(s)
- Noémie Resseguier
- Institute for Biomedical Research of the French Army & URMITE UMR6236, Allée du Médecin Colonel Jamot, Parc du Pharo, Marseille cedex 07, France
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Ollivier L, Romand O, Marimoutou C, Michel R, Pognant C, Todesco A, Migliani R, Baudon D, Boutin JP. Use of short message service (SMS) to improve malaria chemoprophylaxis compliance after returning from a malaria endemic area. Malar J 2009; 8:236. [PMID: 19852811 PMCID: PMC2771031 DOI: 10.1186/1475-2875-8-236] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2009] [Accepted: 10/23/2009] [Indexed: 11/30/2022] Open
Abstract
Background Malaria chemoprophylaxis compliance is suboptimal among French soldiers despite the availability of free malaria chemoprophylaxis and repeated health education before, during and after deployment to malaria endemic areas. Methods In 2007, a randomized controlled study was performed among a cohort of French soldiers returning from Côte d'Ivoire to assess the feasibility and acceptability of sending a daily short message service (SMS) reminder message via mobile device to remind soldiers to take their malaria chemoprophylaxis, and to assess the impact of the daily reminder SMS on chemoprophylaxis compliance. Malaria chemoprophylaxis consisted of a daily dose of 100 mg doxycycline monohydrate, which began upon arrival in Côte d'Ivoire and was to be continued for 28 days following return to France. Feasibility and acceptability were assessed by questionnaire. Cohort members were followed for a 28 day period, with compliance assessed by use of an electronic medication monitoring device, from which several indicators were developed: daily proportion of compliant individuals, average number of pills taken, and early discontinuation. Results Among 424 volunteers randomized to the study, 47.6% were assigned to the SMS group and 52.3% to the control group. Approximately 90% of subjects assigned to the SMS group received a daily SMS at midday during the study. Persons of the SMS group agreed more frequently that SMS reminders were very useful and that the device was not annoying. Compliance did not vary significantly between groups across the compliance indicators. Conclusion SMS did not increase malaria chemoprophylaxis compliance above baseline, likely because the persons did not benefit from holidays after the return and stayed together. So the reminder by SMS was noted by all subjects of the study. Another study should be done to confirm these results on soldiers going on holidays from employment after return or with individual travellers.
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Affiliation(s)
- Lénaïck Ollivier
- Institut de médecine tropicale du Service de santé des armées, Département d'épidémiologie et de santé publique Sud, Marseille, France.
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