Mefloquine at the crossroads? Implications for malaria chemoprophylaxis in Europe.

Since its introduction to the market in 1985, mefloquine has been used for malaria chemoprophylaxis by more than 35 million travellers. In Europe, in 2014, the European Medicines Agency (EMA) issued recommendations on strengthened warnings, prescribing checklists and updates to the product information of mefloquine. Some malaria prevention advisors question the scientific basis for the restrictions and suggest that this cost-effective, anti-malarial drug will be displaced as a first-line anti-malaria medication with the result that vulnerable groups such as VFR and long-term travellers, pregnant travellers and young children are left without a suitable alternative chemoprophylaxis. This commentary looks at the current position of mefloquine prescribing and the rationale of the new EMA recommendations and restrictions. It also describes the new recommendations for malaria prophylaxis that have been adapted by Switzerland, Germany, Austria and Italy where chemoprophylaxis use is restricted to high-risk malaria-endemic areas.

[Medical clearance for missions abroad (EEU): definitions, recommendations for use and performance]. / Entsendungseignungsuntersuchung (EEU): Definition, Empfehlungen zum Untersuchungsaufwand und Einsatz.

Standards for medical clearance for private or business missions abroad are--at least in the German speaking countries--not clearly defined and mostly derived from the old terminus "Tropentauglichkeit" which means fit for mission in the tropics. The authors now define a new standard, called "Entsendungstauglichkeitsuntersuchung" which means clearance of fitness for all types of missions abroad, independent of distinct climatic zones. To meet the inhomogenous requirements of different institutions and different types of missions the medical examination proposed follows a modular structure to optimize economic and medical use of resources. Moreover, as Austria, Germany and Switzerland have different legal and economic postulates, the medical examination has to be adapted to the different premises. The definition and description of this special type of "medical clearance for missions abroad" is supplemented by recommendations for definitions of clients who should undergo such an investigation and the professionals who should perform this type of investigation. Additionally, results of this type of medical clearance are defined and prophylactic aspects in terms of pre-travel advice are mentioned.

[Travel vaccination recommendations for Central and Eastern European countries based on country-specific risk profiles]. / Länderspezifische Risikoprofile als Basis für reisemedizinische Impfprävention in Mittel-, Ost- und Südosteuropa.

Within the last years, an increasing trend of voyages to Central and Eastern European destinations could be observed. However, Europeans travelling within their own continent do not consider themselves as travellers exposed to possibly travel-associated infections since problem awareness among tourists as well as consulting doctors is rather scanty. The objective of this expert statement is to outline country-specific risk profiles as well as guidelines with regard to relevant travel immunizations for this region. These recommendations are mainly based on risk estimates according to national incidences and prevalences of vaccine-preventable diseases such as hepatitis A, hepatitis B, typhoid fever, meningococcal meningitis, rabies, and tick-borne encephalitis.