Journal of travel medicine
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Background: Climate change is not only increasing ambient temperature but also accelerating the frequency, duration and intensity of extreme weather and climate events, such as heavy precipitation and droughts, and causing sea level rise, which can lead to population displacement. Climate change-related reductions in land productivity and habitability and in food and water security can also interact with demographic, economic and social factors to increase migration. In addition to migration, climate change has also implications for travel and the risk of disease. This article discusses the impact of climate change on migration and travel with implications for public health practice.
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Tafenoquine, an 8-aminoquinoline, is now indicated for causal prophylaxis against all human malarias and as radical curative (anti-relapse) treatment against Plasmodium vivax and Plasmodium ovale. As with other 8-aminoquinolines, tafenoquine causes hemolysis in individuals with glucose-6-phosphate dehydrogenase (G6PD) deficiency (hemizygous males and homozygous females) and is contraindicated in this population. Those with intermediate G6PD activity (heterozygous females) are also at risk for hemolysis. Awareness of how to prescribe tafenoquine in relation to G6PD status is needed so it can be used safely. ⋯ Attention to G6PD status is required for safe prescription of tafenoquine. A high index of suspicion is needed if hemolysis occurs. Clinicians should seek evidence-based information for the management and treatment of iatrogenicy hemolysis caused by 8-aminoquinolines.
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Artemisinin-based combination therapy (ACT) is the global standard of care for uncomplicated falciparum malaria. First reports of ACT resistance came from western Cambodia and the Thailand-Cambodia border in 2002-2004. The subsequent emergence and expansion of Plasmodium falciparum strains resistant to the artemisinin component and ACT are now threatening the efficacy of falciparum malaria treatment. ⋯ Multidrug resistant malaria is a rapidly increasing problem, but fortunately still limited to Southeast Asia, in particular to the GMS. In the long-term it may threaten global progress in malaria control but is not yet of concern with regards to malaria prophylaxis, as ACTs are not used for prevention in travellers, current ACT regimens are still effective in most malaria endemic areas outside the GMS and the preferred travellers' prophylaxis atovaquone-proguanil and doxycycline remain protective. However, artemsinin resistance in the GMS is of real concern to travellers as it will affect the choice of malaria treatment including standby-emergence treatment.
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Malaria prevention methods for travellers to low or moderate malaria risk areas vary and remain controversial. Standby emergency treatment (SBET) for malaria is one possible strategy increasingly recommended since 1988 with little evidence on its effectiveness or how it is truly being used. ⋯ Adherence to the proposed recommendations for SBET use, notably the response to fever, was poor. If the use of SBET is to be pursued, modifications to the current SBET strategy should be considered, such as better selection of travellers at higher risk for malaria and the potential addition of mRDTs.