Standby Emergency Treatment of Malaria in Travelers

Experience to Date and New Developments

Patricia Schlagenhauf; Eskild Petersen

Disclosures

Expert Rev Anti Infect Ther. 2012;10(5):537-546. 

In This Article

Experience With the SBET Approach

Some European countries (Switzerland, Germany, Austria) consider most of Asia and South America to be minimal risk areas and have recommended the SBET approach for travelers to these destinations for more than a decade, so considerable experience with the SBET approach is available. Studies have shown that SBET is unlikely to be overused by travelers who visit low-risk areas, and a review of the experience to date shows that fewer than 1% of travelers carrying an SBET will actually use their medication if they are in a low-risk area (Table 3).[20,21,33] A study on the use of SBET in travelers showed that 10% of travelers will become ill with symptoms that are indicative of a possible malaria infection. Most travelers can, however, reach medical attention within 24 h, but approximately 1% of travelers will use their SBET. Of these, only a fraction will actually have malaria. In the cited study, only one in six SBET users actually had malaria.[21] Thus, SBET is sometimes used in situations where the traveler suspects malaria but does not actually have malaria.

This aforementioned study highlights the fact that travelers' behavior is difficult to predict and that febrile travelers often do not seek medical attention within 24 h as instructed.

In Switzerland, a review of imported malaria cases from 2003 to 2008 from southeast Asia (where SBET is recommended) shows no increase in imported malaria cases despite a large increase in traveler numbers. In 2003, there were three cases imported (one malaria case in 38,776 travelers) compared with two cases in 2008 (one malaria case in 71,509 travelers to Thailand; data from the Swiss Office for Public Health). The Swiss airline (formerly Swissair) changed their malaria guidelines for crews visiting low-risk areas from continuous chemoprophylaxis to the carriage of SBET as a stand alone strategy with no increase in malaria cases registered and a low usage of the SBET by the crews (1%).[20] Malaria incidence in travelers based on notifications of malaria in their country of residence will not register malaria cases treated abroad and will thus underestimate the true incidence. The Swiss airline survey picked up cases treated abroad and therefore did not have this bias.

Another concern with the use of SBET is that the presumed malaria diagnosis is wrong, thus delaying proper diagnosis and leading to the use of inappropriate treatments and subdosages, which theoretically could put the traveler at risk of severe malaria or other undiagnosed infections.

However, the experience so far as discussed above shows that with proper written instructions and the carriage of a quality malaria medication to be used if possible under local medical supervision, the traveler is actually in a better position compared with a situation where he or she must rely on uncertain diagnostics and poor-quality antimalarials.

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