JOURNAL OF THE LOUISIANA STATE MEDICAL SOCIETY
The most significant controversies in malaria chemophylaxis today include the safety of mefloquine, the duration of atovaquone-proguanil post-travel, and primaquine for primary prophylaxis. Although contraindicated in travelers with depression or neuropsychiatric disorders, mefloquine is cost- effective for long-term travelers and safe during pregnancy. Only larger studies can confirman abridged post-travel schedule for atovaquone-proguanil shortened from one week to one day. Primaquine should be reserved for anti-relapse prevention and relapse curative treatment following screening for G6PD and CYP2D6 deficiencies. The complex life cycle of the Plasmodium species in two hosts complicates antigenic targeting for the most effective malaria vaccines. Thevaluablefieldexperiencesgainedwith thefirst anti- sporozoite vaccine, SPf66, has led to the development of new similar vaccine candidates targeting sporozoites, intrahepatic stages, and gametocytes. Most malaria vaccinologists now agree that any effective malaria vaccine will have to target several developmental stages in malaria’s life cycle and require significant immune boosting with adjuvants and periodic booster injections.
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James H. Diaz, MD, MPH & TM, DrPH, is Professor and Head of Environmental and Occupational Health Sciences, School of Public Health, Professor of Anesthesiology, School of Medicine, Louisiana State University Health Sciences Center (LSUHSC) in New Orleans, Louisiana.
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