Malaria prevention recommendations for risk groups visiting sub-Saharan Africa: a survey of European expert opinion and international recommendations

Malaria prevention can be complex due to the individual characteristics of the traveller, travel destination, duration of stay and type of travel. Our aim in this study was to document malaria chemoprophylaxis recommendations provided by travel-medicine experts in Europe for specific risk groups of travellers visiting malaria-endemic areas of sub-Saharan Africa.; Travel medicine experts in Europe were asked to complete an online questionnaire, a 28-item Survey Monkey survey, on 11 malaria prevention scenarios. We also reviewed the recommendations of the UK, U.S. CDC, Germany, Switzerland, WHO and the electronic Medicines Compendium (eMC) for malaria prevention in risk groups.; The questionnaire was sent to 110 travel medicine experts in 19 countries. The response rate was 44.55%. The experts would recommend, as first choice, malaria chemoprophylaxis atovaquone/proguanil for an adult traveller with no co-morbidities travelling for 2 weeks (91.67% of experts) and for 2 months (51.06%), for a healthy tourist child travelling for two weeks (68.09%) and for an adult traveller with liver cirrhosis (57.78%). Mefloquine was the first choice for a healthy tourist child travelling for 2 months (59.57%), for a tourist infant (8 kg) travelling for 2 weeks (59.57%) and for 2 months (68.09%), for a pregnant VFR (74.47%), for a breast-feeding mother with her 5 kg infant (72.34%) and for a VFR family with limited budget (63.83%). For an adult traveller with renal impairment the experts recommended mefloquine (42.22%) or doxycycline (37.78%). All experts (100%) recommended mosquito repellents. Mosquito nets were recommended routinely by 95.35% of the experts, air-conditioning by 83.72% and impregnated clothing by 81.40%.; The European experts differ in pre-travel anti-malarial recommendations for risk groups visiting malaria endemic areas of sub-Saharan Africa. Contraindications are not always observed and there are no uniform recommendations for high-risk groups. 9 experts would recommend atovaquone/proguanil to a traveller with severe renal impairment although most reviewed national recommendations consider this a contraindication. Discordance in recommendations, a lack of key data and few chemoprophylaxis options limit choices for pre-travel health advisors.