1. Malaria 3
Public Health, Travel & Expedition Medicine
FACTM Pt 1
Tim Inglis
Division of Microbiology & Infectious Diseases,
PathWest Laboratory Medicine, WA

2. Malaria series
Malaria 1 Clinical Tropical Medicine
Malaria 2 Clinical Parasitology
Malaria 3 Public Health, Travel & Expedition Medicine
Malaria 4 Clinical Entomology

3. Study materials
Manual of Travel Medicine & Health.
3rd
Edition, Steffen R et al. 2007. Decker.
Oxford Handbook of Expedition & Wilderness Medicine
Johnson C et al. 2008, Oxford
• FACTM study notes
• Specialist review articles
• Self-assessment questions
Blog http://micrognome.priobe.net
Web www.priobe.net
FACTM http://lifeinthefastlane.com/exams/actm-fellowship/

4. Outline
• Timeline
• Epidemiology
• Pre-travel risk assessment & planning
• Expedition contingencies
journey aftermathpreparation

5. Risk atlas
• Global distribution
• Regional distribution
• Australian receptive zone
Source = WHO Roll Back malaria Programme; http://www.who.int/entity/health_mapping

6. Epidemiology

7. Pre-travel preparation
• Risk assessment: location, activities, duration, complexity
• Personal measures: clothing, repellent, bed nets, activity
• Chemoprophylaxis:
– options include
• Atovaquone/proguanil; Mefloquine; Doxycycline …
– Specific issues
• Short notice
• Pregnant women
• Children
• Long stay

8. Expedition Medicine
• Personal measures
– Personal protection
– Chemoprophylaxis
• Group measures
– Group prophylaxis
– Area control measures
– Rapid tests
– Antimalarial therapy, SBET
• Local people
• Medevac arrangements

9. On return
• May present after interval, up to 1yr after end of journey
• Exclude malaria in anyone with fever who has travelled to an
endemic area
• Detailed history of location, duration & intensity of exposure
to biting insects, PPM and CPx used
– Thai/Myanmar border area; PNG
– Other arthropod borne infections in DD
– Indications of resistance
– Compliance, esp after arrival in Aus
journey aftermathpreparation

10. Emerging Issues
• Highland malaria
• Unusual malaria transmission methods
• Malaria & air travel
• Changing resistance
• Use for portable rapid diagnostic methods
• SBET in pregnancy
• CPx for long stay
• Prep for AUSMAT members