— Beginwithchemoprophylaxisatthelatestonetotwoweeksbeforetravel-
ingtoamalariousarea.Duringthisperiod,potentialsideeffectscanbe
recognizedandcountermeasurescanbetakenorthemedicationchanged
asnecessary.
— Durationofchemoprophylaxis:duringandfourweeksafterthetraveler’s
stayinthemalariousarea(withatovaquone/proguanilonlyoneweek).
Thismeasureisintendedtopreventmalariatropicaanddoesnotaffect
hypnozoitesofP.vivaxandP.ovale(treatmentwith8-aminoquinolinesas
requiredtopreventrelapse,seeabove).
— Thedrugsareswallowedwithliquidaftermeals.Thedosages,intervals
betweenintakeandanyrestrictions(e.g.,forpregnantwomen)mustbe
strictlycompliedwith.
&Examplesofchemoprophylaxisanduseofemergencystand-bydrugs.The
modifiedandsupplementedWHOrecommendationsareusedasexamples
here(Table9. 7 ).NB:recommendationsinsomecountriesmaydifferconsid-
erablyfromtheinformationinthetable!Thenecessarymeasuresdifferinthe
differentriskzones(Fig.9. 19 )andapplytobriefstaysinmalariousareasofup
tothreemonthsfornonimmunepersons.Forlongerstays(morethanthree
months),theprophylaxisshouldbestartedasforashorterstay,thenaphy-
sicianintheendemicareashouldbeconsultedconcerninglong-termmea-
sures.
Diseasecontrol.ThemainmethodsappliedareAnophelescontrolbyspray-
inghousesandstableswithinsecticides(indoorspraying),environmental
sanitationmeasurestoeliminatemosquito-breedingplaces,andtheusage
ofinsecicide-impregnatedbednetstoreducevector-humancontacts.Further
measuresinendemicareasareearlydiagnosisandtreatmentofmalariacases
aswellaschemoprophylaxisinselectedpopulationgroups.Antimalaria
vaccinesarenotavailableyet.Plasmodium 5379Kayser, Medical Microbiology © 2005 Thieme