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A healthy 22-year-old Peace Corps volunteer arrives in your office seeking health care advice before embarking on a 6-month trip to West Africa, where she will work in a medical clinic. She tells you that she has traveled abroad extensively and within the last 3 years received vaccination for yellow fever, hepatitis A and B, typhoid fever, and meningococcus, as well as malaria prophylaxis with mefloquine. She is worried about malaria and yellow fever, both of which are endemic to the area. At this time, which of the following is the most appropriate prophylactic treatment for this patient?
A. Chloroquine
B. Doxycycline
C. Tetracycline
D. Typhoid vaccine
E. Yellow fever vaccine
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The correct answer is B. This patient is traveling to an area with endemic malaria, where chloroquine-resistant strains of plasmodia, most commonly, P. falciparum, are common. Doxycycline, mefloquine, and atovaquone/proguanil (Malarone) are recommended prophylactic treatments for travelers in areas with chloroquine-resistant malaria. These medications do not induce immunity and must be taken for each trip. Doxycycline is the cheapest of the three medications, though it requires daily dosing. Additionally, it can cause photosensitivity, a difficult side effect for travelers expecting to spend most of their time outdoors. Tetracycline (choice C), though similar in its antibacterial spectrum, is not indicated for malaria prophylaxis.
Chloroquine (choice A) is rarely recommended to travelers from industrialized countries. Given the high rates of resistance and the availability of other medications, there is little reason to use this for prophylaxis.
Typhoid and yellow fever vaccines (choices D and E) are good vaccines to have when traveling in endemic areas. She has had both recently, however. Typhoid boosters are required every 3 years. Yellow fever immunity probably lasts a lifetime, but the manufacturer suggests boosters every 10 years.
