Canada s Malaria Recommendations CATMAT

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1 Canada s Malaria Recommendations CATMAT

2 Disclosure of Potential Conflict of Interest Peter Teitelbaum, MD CATMAT Malaria Recommendations FINANCIAL DISCLOSURE Grants/Research Support: None Speakers Bureau/Honoraria: None Consulting Fees: None Other: None

3 Canada s Malaria Recommendations CATMAT

4 Committee to Advise on Tropical Medicine and Travel Working Groups Malaria Subcommittee Secretariat

8 How are recommendations made? Canadian statistics International statistics WHO and CDC recommendations European recommendations Other sources Destination malaria data Specific research

9 Canadian Statistics A notifiable disease but missing important information

13 How are recommendations made? Canadian statistics International statistics WHO and CDC recommendations European recommendations Other sources Destination malaria data Specific research

20 GeoSentinel is a worldwide communication and data collection network for the surveillance of travelrelated morbidity. It was initiated in 1995 by the International Society of Travel Medicine (ISTM) with support from the US Centers for Disease Control (CDC) as a network of ISTM member travel/tropical medicine clinics. GeoSentinel is based on the concept that these clinics are ideally situated to effectively detect geographic and temporal trends in morbidity among travelers, immigrants and refugees.

21 How are recommendations made? Canadian statistics International statistics WHO and CDC recommendations European recommendations Other sources Destination malaria data Specific research

24 Estimated relative risk of malaria: very low Incidence of P. falciparum: nil to very low Two-week length-of-stay threshold is suggested Estimated relative risk of malaria: very low Incidence of P. falciparum higher One-week length-of-stay threshold is suggested Estimated relative risk of malaria: low malaria Incidence of P falciparum: nil to low One-week length-of-stay threshold is suggested

26 How are recommendations made? Canadian statistics International statistics WHO and CDC recommendations European recommendations Other sources Destination malaria data Specific research

28 European Recommendations Denmark Spain Sweden Italy Norway Germany Scotland Switzerland England France

31 Canada

32 USA

33 Quebec

34 WHO

35 Travax

36 Spain

37 France

38 Chemoprophylaxis for dark red areas only Scotland

39 Denmark

40 England

41 Norway

42 Sweden

43 Switzerland

44 Germany

45 We follow a process that where the traveller incidence of P falciparum is <1:100,000 we don t recommend prophylaxis. Most of Europe doesn t give chemoprophylaxis to SE Asia and S America now, (except France) but still recommends standby as the alternative to chemoprophylaxis. We simply used the data we have for each country (estimation of the degree of risk, % falciparum) and we take into account the fact that the minimum incubation period for malaria is 7 days. We do have figures of a lack of increase of malaria cases for Thailand since 1987, and we monitor carefully the imported cases from all countries where malaria occurs.

46 We have tried to evaluate whether the risk for an individual traveller is at least 1/10,000 in which case prophylaxis recommended, between 1/10,000 and 1/50,000 in which case self treatment can be considered and less than 1/50,000 in which only repellents etc are warranted. We looked into recent risk information from others and supplemented these with our own data on malaria in returning travellers over the years which prove that the rare use of prophylaxis in our travellers is valid. The standby policy was first introduced in 2003 following the Swiss experience The nation-wide surveillance of notified cases shows clearly that there has been no increase (even a slight decrease) since the time less chemoprophylaxis was promoted.

47 How are recommendations made? Canadian statistics International statistics WHO and CDC recommendations European recommendations Other sources Destination malaria data Specific research

49 How are recommendations made? Canadian statistics International statistics WHO and CDC recommendations European recommendations Other sources Destination malaria data Specific research

50 Destination Malaria Data Malaria incidence in the local population

54 How are recommendations made? Canadian statistics International statistics WHO and CDC recommendations European recommendations Other sources Destination malaria data Specific research

55 The Case of Venezuela

57 The Way Forward Better data collection on travellers Meds Compliance Cases Better data collection on travel Destination Duration Type of travel International sharing and pooling of data

increase and accelerated expansion of the 2015 malaria epidemic has reached

58 This was communicated in a statement from the Venezuelan Society of Public Health's Epidemiology Defense Network, which reads that the uncontrolled increase and accelerated expansion of the 2015 malaria epidemic has reached cases, a record high in the 75 years since reliable records have been kept.

Eli Schwartz MD,DTMH

DENGUE FEVER in INTERNATIONL TRAVELERS Eli Schwartz MD,DTMH The Center of Geographic Medicine & Tropical Diseases Sheba Medical Center, Tel-Hashomer Sackler Faculty of Medicine, Tel-Aviv univ. ISRAEL World