An incidental tourist
Claudia C. dos Santos and colleagues [abstract/résumé]1 highlight how few travellers departing from Toronto to India used appropriate malaria chemoprophylaxis or other recommended preventive measures. Although their study was conducted in 1995, there is no reason to think that the situation has improved to any significant degree. The continuing rise in the rate of imported malaria supports this view.
There is also no reason to think that travellers from other parts of Canada are any more likely to use preventive measures. In 1995 all of the 103 malaria cases reported to the South Fraser Health Region, an urban health region in BC's lower mainland, were reviewed in detail.2 Of these, 37 were local residents who had recently travelled overseas (92% to India), 58 had recently immigrated to Canada, 5 had both these risk factors, and 4 had no documented risk factors. Among those with recent travel as a risk factor, only a third had obtained pretravel medical advice and fewer than 10% had taken a full course of antimalarial medication. Insect repellant had been used by 16%, and 64% had stayed where there were screens on doors and windows.
While the number of Canadians travelling overseas continues to increase, the incidence of malaria and other imported infectious diseases can also be expected to rise. As dos Santos and colleagues point out, the need to examine and overcome the barriers to seeking and following appropriate pre-travel advice is of critical importance.
Robert Strang MD, MHSc