PMID- 25443997
OWN - NLM
STAT- MEDLINE
DCOM- 20150908
LR  - 20161125
IS  - 1873-0442 (Electronic)
IS  - 1477-8939 (Linking)
VI  - 12
IP  - 6 Pt B
DP  - 2014 Nov-Dec
TI  - Comparative benefit of malaria chemoprophylaxis modelled in United Kingdom 
      travellers.
PG  - 726-32
AB  - BACKGROUND: Chemoprophylaxis against falciparum malaria is recommended for 
      travellers from non-endemic countries to malarious destinations, but debate 
      continues on benefit, especially with regard to mefloquine. Quantification of 
      benefit for travellers from the United Kingdom (UK) was modelled to assist 
      clinical and public health decision making. METHODS: The model was constructed 
      utilising: World Tourism Organization data showing total number of arrivals from 
      the UK in countries with moderate or high malaria risk; data from a retrospective 
      UK Clinical Practice Research Datalink (CPRD) drug utilisation study; additional 
      information on chemoprophylaxis, case fatality and tolerability were derived from 
      the travel medicine literature. Chemoprophylaxis with the following agents was 
      considered: atovaquone-proguanil (AP), chloroquine with and without proguanil (C 
      +/- P), doxycycline (Dx), mefloquine (Mq). The model was validated for the most 
      recent year with temporally matched datasets for UK travel destinations and 
      imported malaria (2007) against UK Health Protection Agency data on imported 
      malaria. RESULTS: The median (mean) duration of chemoprophylaxis for each agent 
      in weeks (CPRD) was: AP 3.3 (3.5), C +/- P 9 (12.1), Dx 8 (10.3), Mq 9 (12.3): the 
      maximum duration of use of all regimens was 52 weeks. The model correctly 
      predicted falciparum malaria deaths and gave a robust estimate of total 
      cases--model: 5 deaths from 1118 cases; UK Health Protection Agency: 5 deaths 
      from 1153 cases. The number needed to take chemoprophylaxis (NNP) to prevent a 
      case of malaria considered against the 'background' reported incidence in 
      non-users of chemoprophylaxis deemed in need of chemoprophylaxis was: C +/- P 272, 
      Dx 269, Mq 260, AP 252; the NNP to prevent a UK traveller malaria death was: C +/- 
      P 62613, Dx 61923, Mq 59973, AP 58059; increasing the 'background' rate by 50% 
      yielded NNPs of: C +/- P 176, Dx 175, Mq 171, AP 168. The impact of substituting 
      atovaquone-proguanil for all mefloquine usage resulted in a 2.3% decrease in 
      estimated infections. The number of travellers experiencing moderate adverse 
      events (AE) or those requiring medical attention or drug withdrawal per case 
      prevented is as follows: C +/- P 170, Mq 146, Dx 114, AP 103. CONCLUSIONS: The 
      model correctly predicted the number of malaria deaths, providing a robust and 
      reliable estimate of the number of imported malaria cases in the UK, and giving a 
      measure of benefit derived from chemoprophylaxis use against the likely adverse 
      events generated. Overall numbers needed to prevent a malaria infection are 
      comparable among the four options and are sensitive to changes in the background 
      infection rates. Only a limited impact on the number of infections can be 
      expected if Mq is substituted by AP.
FAU - Toovey, Stephen
AU  - Toovey S
FAU - Nieforth, Keith
AU  - Nieforth K
FAU - Smith, Patrick
AU  - Smith P
FAU - Schlagenhauf, Patricia
AU  - Schlagenhauf P
FAU - Adamcova, Miriam
AU  - Adamcova M
FAU - Tatt, Iain
AU  - Tatt I
FAU - Tomianovic, Danitza
AU  - Tomianovic D
FAU - Schnetzler, Gabriel
AU  - Schnetzler G
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - Netherlands
TA  - Travel Med Infect Dis
JT  - Travel medicine and infectious disease
JID - 101230758
RN  - 0 (Antimalarials)
RN  - 0 (Drug Combinations)
RN  - 0 (atovaquone, proguanil drug combination)
RN  - 886U3H6UFF (Chloroquine)
RN  - N12000U13O (Doxycycline)
RN  - S61K3P7B2V (Proguanil)
RN  - TML814419R (Mefloquine)
RN  - Y883P1Z2LT (Atovaquone)
SB  - IM
MH  - Antimalarials/*therapeutic use
MH  - Atovaquone/adverse effects/therapeutic use
MH  - *Chemoprevention/methods
MH  - Chloroquine/adverse effects/therapeutic use
MH  - Doxycycline/adverse effects/therapeutic use
MH  - Drug Combinations
MH  - Drug Therapy, Combination
MH  - Drug Utilization/statistics & numerical data
MH  - Humans
MH  - Malaria/*epidemiology/mortality/*prevention & control
MH  - Malaria, Falciparum/*epidemiology/mortality/*prevention & control
MH  - Mefloquine/adverse effects/therapeutic use
MH  - Models, Statistical
MH  - Proguanil/adverse effects/therapeutic use
MH  - Retrospective Studies
MH  - Risk
MH  - *Travel
MH  - United Kingdom
EDAT- 2014/12/03 06:00
MHDA- 2015/09/09 06:00
CRDT- 2014/12/03 06:00
PHST- 2014/03/06 00:00 [received]
PHST- 2014/07/30 00:00 [revised]
PHST- 2014/08/07 00:00 [accepted]
PHST- 2014/12/03 06:00 [entrez]
PHST- 2014/12/03 06:00 [pubmed]
PHST- 2015/09/09 06:00 [medline]
AID - S1477-8939(14)00157-4 [pii]
AID - 10.1016/j.tmaid.2014.08.005 [doi]
PST - ppublish
SO  - Travel Med Infect Dis. 2014 Nov-Dec;12(6 Pt B):726-32. doi: 
      10.1016/j.tmaid.2014.08.005.