Health information given by Swiss travel agencies.

BACKGROUND: Many of the 1 million Swiss traveling to tropical or subtropical countries book their trip through travel agencies every year. These agencies are thus an important source of information about malaria and other important health risks and little is known about the appropriate health information provided by these. METHOD: A study was conducted to assess health-related information in members of the Swiss Federation of Travel Agencies in the metropolitan area of Zurich, Switzerland. A covert investigator (F.M.S.) visited these agencies and requested information on a package holiday for 2 or 3 weeks to Kenya. Following an in-person interview, the investigator recorded any health-related information provided on a pretested form. If none was mentioned, the agent was prompted using a standardized procedure. RESULTS: A total of 88 agencies were visited. Spontaneous health advice was given in 44% of all visits. After prompting, 99% of all travel agents mentioned preventive measures against malaria, but only 69% indicated the need for vaccinations against other diseases. Spontaneous advice on malaria risk and vaccinations was better than advice given upon prompting. One fifth of all travel agents neither mentioned malaria prevention measures spontaneously nor recommended seeing a health specialist. CONCLUSIONS: Overall, travel medicine knowledge of travel agents in the Zurich area needs improvement as many tended to draw attention to health risks only when prompted. Attitude, personal knowledge, and experience of individual travel agents were key to the health information given. Up-to-date and readily available information on health risks should be provided to travel agencies and structured training given in collaboration with health professionals.

Factors influencing the pattern of imported malaria.

BACKGROUND: Data on imported malaria in industrialized areas are known to be incomplete because of underreporting and lack of homogeneity. These facts and the complexity of factors influencing the transmission of malaria render their interpretation difficult. The relevance of various factors is usually not fully considered, although their impact on recommendations for chemoprophylaxis may be important. METHODS: All malaria cases imported from Kenya from 1988 to 1996 that were reported to the Federal Office of Public Health of Switzerland were analyzed. The reciprocal impact on data interpretation with regard to Plasmodium species, chemoprophylaxis, onset of first symptoms after return, male or female sex, seasonal fluctuation, duration of stay, nationality groups, and fatal outcome was analyzed. RESULTS: Multivariate analysis showed a significant impact of Plasmodium species, regular chemoprophylaxis, and long duration of stay on the latency of malaria attacks. African origin and repeated stays were confounders with regard to adherence to chemoprophylaxis. The local situation of malaria transmission and the development of tourist figures were found to influence the evolution of malaria rates. These factors must be analyzed simultaneously to prevent errors in data interpretation. A higher proportion of tertian malaria cases (caused by Plasmodium vivax or Plasmodium ovale) than in previous reports was recorded owing to the impact of chemoprophylaxis and longer outbreak latencies. Seventy-five percent of tertian malaria cases were diagnosed within 6 months after return. CONCLUSIONS: Factors influencing the pattern of imported malaria must be assessed in relation to each other, especially if data from different countries and various chemoprophylaxis regimens are compared. Furthermore, regular malaria chemoprophylaxis with mefloquine given until 4 weeks after return from an endemic area is not adequate to prevent tertian malaria. Regular chemoprophylaxis was found to cause longer latencies for all malaria species.