BELGIAN CONSENSUS MEETING on TRAVEL MEDICINE June 20, … · Vaccinations, on 26-06-2014 • Responsable final redaction : A. Van Gompel. 5/11/2014 2 PART 1 • 1.a - Vaccination

5/11/2014

1

BELGIANCONSENSUS MEETINGon TRAVEL MEDICINE

June 20, 2014

Belgian Scientific Study Group on Travel

Medicine

Pr. A. Van Gompel (ITG)Pr. F. Jacobs (Hôp. Erasme, ULB)

Pr. P. Lacor (UZ-Brussel) Dr. Ph. Leonard (CHU-ULg)

Pr. W. Peetermans (U.Z. - K.U.Leuven) Pr. S. Callens(UZ.- U.Gent) Dr. S.Quoilin (iph.fgov.be)

Dr.P. Soentjens (Belgian Defence)Pr. B. Vandercam (CHU. St. Luc, UCL)

Pr. Y. Van Laethem (CHU. St. Pierre, ULB)PART 1b malaria version 05/11/2014

REPORTBELGIAN CONSENSUS MEETING on TRAVEL MEDICINE

June 20, 2014 – PART 1b

2014

• The consensus meeting was chaired by A. Van Gompeland Y, Van Laethem

• A preliminary PowerPoint, prepared by A. Van Gompel, was presented

• The discussion and recommendations of the meeting are included in this finale presentation.

• The ESSENTIAL SLIDES (pdf-version) & the CONSENSUS BROCHURE (in Dutch and French) highlighting the proposals for changes will been sent to all participants. May be used for teaching.

• These documents will serve as a proposal for approval by the governmental Belgian Health Council – section Vaccinations, on 26-06-2014

• Responsable final redaction : A. Van Gompel

5/11/2014

2

PART 1• 1.a - Vaccination for Yellow Fever• 1.b - Malaria

PART 2• 2.A - Other vaccinations• 2.B - TD, other infections, …., • 2.C - VARIA

2014

5/11/2014

3

Malaria

Only these chapters are updated

They are freely downloadable

http://www.who.int/ith/en/ Only a few chapters are updated 2014

WHO 29-04-2014

5/11/2014

4

Malaria The guidelines for malaria have not really changed in 2014

2014

2014

5/11/2014

5

A

C

C

zone

A

2014

2014

2011 = 2012 = 2013

2014

the Belgian guidelines are not changing yet

5/11/2014

6

WHO 2014

2012 = 2013 = 2014

5/11/2014

7

2012 = 2013 = 2014

Low risk malaria areas

5/11/2014

8

http://www.sbimc.org/Malaria%20low%20risk%20areas.pdf

TO DOWNLOAD http://www.sbimc.org/Malaria%20low%20risk%20areas.pdf

5/11/2014

9

In low risk malaria areas ?

Switzerland / Germany / Austria :

• SBET = Standby emergency treatment

• Noodbehandeling• Traitement d’urgence

Belgium :

• Prevention “d’urgence” ???• “Noodpreventie” ???Is not correct,

Better : • Chimioprophylaxie /

Chemoprofylaxe

“on demand”

Switzerland – Germany – Austria ….SBET only since more than 10-15 years

5/11/2014

10

Switzerland – Germany – Austria ….SBET only since more than 10-15 years

Lectures on Malaria India NECTM 5 – Bergen Norway

• Malaria-risk for the local population in India is grossly underestimated by official WHO – numbers

• However for most travelers the risk is very low to negligibleBreakpoint = Areas of low transmission = where the reported malaria case incidence from all species was < 1 per 1000 (persons within the local population) per year

• “we should adopt the malariaguidelines of the German speaking countries”

5/11/2014

11

Lectures on Malaria in India NECTM5 – Bergen Norway

5/11/2014

12

Rigid USA position about e.g. Mumbai - India ….but David Shlim is a wise American

From: Travel Medicine Clinical Discussion List [mailto:[email protected]] On Behalf Of David Shlim Sent: woensdag 14 mei 2014 1:17Subject: ….. about whether to recommend malaria prophylaxis for a visitor to Mumbai and Agra in October

The discussion is illustrative of one of the key unresolved issues in travel medicine. Merely knowing the risk— or the potential for risk—is not enough. There is a threshold of risk for some diseases that remains subjective. Is the goal of malaria prophylaxis :• to prevent any possible case of malaria (as has been the thrust of CDC

advice), • or is it to strike a balance of protection and likelihood when the risk is very low?

When one takes into account the actual likelihood of malaria, then one has to confront the concept of threshold—at what level of risk is it worthwhile to recommend prophylaxis. Is it a risk of 1/1000, 1/10,000, 1/100,000, or 1/1,000,000?

Rigid USA position about e.g. Mumbai - India ….but David Shlim is a wise American

From: Travel Medicine Clinical Discussion List [mailto:[email protected]] On Behalf Of David Shlim Sent: woensdag 14 mei 2014 1:17Subject: ….. about whether to recommend malaria prophylaxis for a visitor to Mumbai and Agra in October

It would seem that the traveler should be a participant in making a decision about prophylaxis in circumstances that one could call “minimal risk.”

The risk is not zero, but it is so low that some people will elect not to take prophylaxis (and some people will elect to take prophylaxis).

In most of Africa, the risk of malaria is so significant that this type of discussion is not appropriate. However, in many parts of India, Central and South America, and SE Asia, it is appropriate.

There may be no “right” answer in these situations.

India is a complex risk situation, with the overall number of cases in returning travelers to US on the increase, mainly in the VFR population. However, it is difficult to find case reports of malaria that occurred in non-VFR travelers who only visited an urban area.

Warmly, DavidDavid R Shlim MD President, ISTM Jackson Hole, Wyoming

5/11/2014

13

5/11/2014

14

2013 2014

UK malariaguidelines 2014

Short description of the changes since 2013

http://www.nathnac.org/travel/news/malaria_acmp_290714.htm

5/11/2014

15

Antimalarials inpregnancy

breastfeeding

Antimalarials & Pregnancy & Breastfeeding 2014

UK France

5/11/2014

16

2014 Antimalarials & Pregnancy & Breastfeeding

Medasso / ITG Gezondheidsadviezen voor reizigers Uitgave 2014-2015Medasso / IMT Conseils de santé pour voyageurs Edition 2012-2013

2014 Antimalarials & Pregnancy & Breastfeeding


5/11/2014

17

2014 Antimalarials & Breastfeeding


Mefloquine precautions

5/11/2014

18

2014


Roche - Lariam ®Obligatory patient alert card to share with the clients

5/11/2014

19

5/11/2014

20

Stop atovaquone-proguanil earlier after return ?

Only Exceptionally this might be an option, if the patient remains

“under supervision” for at least 4 weeks

• In Israel atovaquone/proguanil may be stopped the day after return from sub-Saharan malaria-endemic region

• BUT .. read carefully the JTM article & the thoughtful editorial

5/11/2014

21


• BUT .... read carefully the JTM article & the thoughtful JTM editorial


• IT IS MUCH TO EARLY TO CHANGE THE GUIDELINE

• Exceptional situations…people who forgot to continue for 7 days…what ‘s the minimum ? ,,,

5/11/2014

22

Lariam & obesity

Medasso-Headlines Gezondheidsadviezen voor reizigers Uitgave 2014-2015Medasso-Headlines Conseils de santé pour voyageurs Edition 2012-2013

2014

5/11/2014

23

Riamet & Eurartesim

2014


5/11/2014

24

EC & BIOCIDES

2014


5/11/2014

25

5/11/2014

26

Some permethrine solutions available in Belgium

(not exhaustive)• Pistal ® = permethrine 0,2 % spray

(pharmacist)• BioKill® = permethrine 2,2% 500 cc

(chemist’s shop, brico shop)Not yet available anymore ? Back in the near future ? :• Mouskito® Textile Spray Qualiphar (permethrine 6%, 100 ml,

pharmacist)• Insectal Nycomed® (permethrine 0,25%, 150 ml, pharmacist)• BugProof Nomad Medical® Tropicare (permethrine 0,5%, 100

ml outdoor-sport)

5/11/2014

27

End Malaria

2013

5/11/2014

28

Documents

BELGIAN CONSENSUS MEETING on TRAVEL MEDICINE June 20, … · Vaccinations, on 26-06-2014 • Responsable final redaction : A. Van Gompel. 5/11/2014 2 PART 1 • 1.a - Vaccination