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Background. Malaria chemoprophylaxis is a mainstay of malaria prevention in travelers. Adequate pretravel advice forms the basis for efficient malaria prophylaxis. This study assessed the determinants for seeking pretravel advice and evaluated the quality of advice from each source and its influence on the patterns and outcome of malaria prophylaxis intake. Methods. In March and April 2004, a self-administered questionnaire was distributed by cabin crews to passengers flying back to Germany from three popular tourist destinations: Kenya, Senegal, and Thailand. To evaluate the quality of advice and actual intake, figures were assessed against the official recommendations of the German Society of Travel Medicine and International Health (DTG). Results. A total of 1,001 passengers were included in the study (Kenya, 492; Senegal, 131; and Thailand, 378), of which 81% had sought any kind of pretravel health advice. Travelers’ age and time of pretravel consultation were associated with the source of information consulted. Seventy-five percent of travelers from Senegal and Kenya received DTG compliant advice compared to only 17% of travelers from areas with low malaria risk in Thailand. Travelers returning from Kenya and Senegal had used correct chemoprophylaxis in only 65 and 47% of trips, respectively. In multivariate analysis, the factors determining correct intake among Senegal and Kenya travelers were receiving pretravel advice (from nonmedical professionals: OR 4.4, 95% CI 1.9–10.0 and from medical professionals: OR 15.4, 95% CI 7.3–32.4), a correct risk perception (OR 2.9, 95% CI 1.9–4.5), 2 to 3 weeks of travel abroad (vs a duration >3 wk: OR 2.2, 95% CI 1.3–3.8), and travel to Kenya (OR 1.9, 95% CI 1.1–3.1). Conclusions. Malaria prevention among a large proportion of German travelers to tropical destinations is inadequate. Public health efforts should be made to raise awareness among travelers, travel agencies, and medical institutions in Germany. [ABSTRACT FROM AUTHOR]

Chikungunya virus (CHIKV) has been previously reported in many African and Asian areas, but it recently reemerged strongly in countries bordering the Indian Ocean as well as caused an outbreak in northern Italy. In Germany, where potential CHIKV vectors are not yet established, CHIKV infection is mandatorily notifiable. Cases reported from 2006 through 2009 were analyzed for travel characteristics and demographic factors. 152 cases of symptomatic CHIKV infection were notified. Both sexes were affected, with a median age of 46 years. Over the years, countries of infection largely followed the outbreaks reported from various travel destinations. India and the Maldives were the countries of infection most frequently named. In Sri Lanka, India, and Thailand, which are also frequently named countries of infection for dengue virus, the median age of CHIKV-affected patients was higher than that of dengue fever patients. Taking traveler numbers into consideration, risk of CHIKV infection was higher in the Seychelles and Mauritius than in Thailand and India. Even though substantial underdiagnosis is suspected, this assessment of CHIKV importation to Germany offers valuable information about the details of travel-associated cases. Between 17 and 53 notified cases per year signify that CHIKV would be occasionally available for local transmission in Germany once a vector becomes present. Although CHIKV most often causes a comparatively mild disease, the high median age of notified cases and the higher age than dengue patients support more severe disease courses in older adults. Travelers to all CHIKV endemic areas should protect against mosquito bites. In Germany, CHIKV surveillance will be continued to monitor ongoing importation of the virus and to detect early potential autochthonous cases.