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Question 29#

A businessman traveling around the world asks about prevention of malaria. He will travel to India and the Middle East and plans to visit several small towns. What is the most appropriate advice for the traveler? 

A. Common sense measures to avoid malaria such as use of insect repellants, bed nets, and suitable clothing have not really worked in preventing malaria
B. The decision to use drugs effective against resistant P falciparum malaria will depend on the knowledge of local patterns of resistance and the patient’s very specific travel plans
C. Prophylaxis should be started the day of travel
D. Chemoprophylaxis has been proven to be entirely reliable
E. He should stay inside at the noon as this is the mosquito’s peak feeding time

Correct Answer is B


Whether or not to use drugs such as atovaquone-proguanil, mefloquine, or primaquine for resistant P falciparum will depend on knowledge of specific local patterns of drug sensitivity of plasmodia. Specific information can be obtained from the CDC malaria hotline or the CDC emergency operation center. The common sense measures described are extremely important and part of the overall worldwide plan to contain the spread of malaria. Prophylaxis should begin 2 days to 2 weeks before departure in order to have adequate levels of drug on arrival and to identify potential side effects before leaving. Chemoprophylaxis is not entirely reliable, and malaria should always be in the differential diagnosis of a febrile illness in a traveler to endemic regions, even if the drug regimen has been faithfully followed. Mosquito peak feeding periods are dawn and dusk.