Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Jun;102(6):1351-1357.
doi: 10.4269/ajtmh.19-0592.

Malaria Disease and Chemoprophylaxis Usage among Israeli Travelers to Endemic Countries

Reut Harel  1 , Bibiana Chazan  2 , Eli Schwartz  3
Affiliations

Malaria Disease and Chemoprophylaxis Usage among Israeli Travelers to Endemic Countries

Reut Harel et al. Am J Trop Med Hyg. 2020 Jun.

Abstract

Prevention of malaria in travelers to endemic countries is one of the complex challenges of travel medicine. Israel has a widespread culture of travel to developing countries, but information regarding malaria prevention is limited so far. Our study, conducted in Sheba Medical Center, Israel, during the years 2008-2018 examined malaria chemoprophylaxis usage and malaria cases in a large group of Israeli travelers returning from endemic countries with any medical complaint. Data were collected regarding travel destinations, conditions, duration of stay, and pretravel consultation. Altogether, 4,708 travelers were included in our study. Travel destinations included Asia (51%), Latin America (31%), and sub-Saharan Africa (SSA) (17%). Median travel duration was 26 days. Only 11.9% reported taking malaria chemoprophylaxis. Of the travelers to SSA, 41.3% took prophylaxis as opposed to only 6% outside of Africa. During the study years, 136 cases of malaria were diagnosed; among them, 82 (60%) were infected with Plasmodium falciparum, of whom all but two were from SSA and none adhered to prophylaxis. Malaria chemoprophylaxis usage was found to be negligible in travel to many countries still considered endemic. Higher prophylaxis usage was found among travelers to SSA, but numbers are still lower than recommended. The low number of malaria cases seen in destinations outside SSA, as documented in our cohort, is likely to represent travel to low risk areas and not high prophylaxis usage. We urge re-evaluation of current CDC and Israeli guidelines which still recommend using chemoprophylaxis in many low-risk countries, as focus on high-risk countries may increase adherence.

PubMed Disclaimer

Conflict of interest statement

Disclosure: This study was completed and presented to the Israeli Medical Scientific Council by R. H., as part of the requirements to receive a specialist degree in Internal Medicine.

Figures

Figure 1.
Figure 1.
Enrollment flow chart. * Patients who visited the clinic multiple times—only the first visit was counted.
Figure 2.
Figure 2.
Malaria chemoprophylaxis usage by travel destination.
Figure 3.
Figure 3.
Adherence flow chart of years 2012–2018. * Patients who visited the clinic multiple times—only the first visit was counted.
Figure 4.
Figure 4.
Malaria cases by species.
Figure 5.
Figure 5.
Plasmodium falciparum cases by travel destination.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. World Health Organization , 2017. International Travel and Health–Malaria Update 2017. Available at: http://www.who.int/ith/2017-ith-chapter7.pdf?ua=1. Accessed Septmber 19, 2019.
    1. Berko-Ball J, 2007. A Profile of Israeli Travelers to Endemic Countries: A National Survey. Annual Meeting of the Israeli Society for Parasitology, Protozoology and Tropical Diseases, Ramat Gan, Israel, 10–12, 32.
    1. Centers for Disease Control and Prevention , 2019. CDC Yellow Book 2020: Health Information for International Travel. New York, NY: Oxford University Press.
    1. Israel Center for Disease Control (ICDC), Division of Epidemiology Public Health Services , 2012. Notifiable Infectious Diseases in Israel 1951–2010. Ramat Gan, Israel: Ministry of Health; Publication 342.
    1. Berger S, 2019. Infectious Diseases of Israel. Los Angeles, CA: Global Infectious Diseases and Epidemiology ON-line, Gideon Informatics, Inc; Available at: http://www.gideononline.com. Accessed September 6, 2019.