Last data update: Jan 27, 2025. (Total: 48650 publications since 2009)
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Query Trace: Davlantes EA[original query] |
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Malaria risk in travellers: a holistic approach is needed
Davlantes EA , Tan KR , Arguin PM . J Travel Med 2018 25 (1) In their response to our August 2017 editorial, Behrens et al.1 make assertions and assumptions that are not reflective of the main points of our editorial or our current methodologies for making prophylaxis recommendations. We would like to provide further clarification on these points. | | The authors may have misunderstood the main premise of our argument. We are not advocating that risk calculations for travellers be derived from malaria rates among the endemic population. What we were emphasizing were the perils of trying to calculate precise attack rates and risks, and that these numbers should not be seen as concrete values of risk when there are flaws with the numerators and denominators being used. Behrens and colleagues claim to be calculating rates among European travellers, but because they are not counting prevented cases or the cases not captured by surveillance, their rates are most likely underestimated. |
Quantifying malaria risk in travellers: a quixotic pursuit
Davlantes EA , Tan KR , Arguin PM . J Travel Med 2017 24 (6) Every year, millions of travellers visit countries in which malaria is endemic. To help inform prevention guidelines, there have been many attempts to quantify malaria risk in travellers. Unfortunately, the data needed to accurately calculate such risk do not exist. Current methods and datasets can provide approximations, but as we will explain, they greatly underestimate the true risk value. Presenting such underestimates as precise measurements and using them as the basis for policy decisions has the potential to cause real harm or death to travellers from a disease easily preventable by chemoprophylaxis. Instead, a more holistic approach to determining malaria risk is needed to best protect travellers. Such an approach could include a qualitative assessment of surveillance data and individual characteristics of the traveller. | It is common to use attack rates to estimate risk. However, in the travel medicine literature, the methods used to calculate malaria attack rates to approximate individual risk1–3 are flawed. For example, authors often determine the number of cases of imported malaria from an endemic area to non-endemic countries reported in national surveillance systems, divide by the estimated total number of travellers from non-endemic countries to this region, and use the resulting quotient to make recommendations on chemoprophylaxis for travellers. Such a calculation has limitations that have been acknowledged in passing, but as we will describe, these limitations are actually quite major and if overlooked can result in very dangerous and erroneous conclusions. |
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