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Volume 350:195-197 January 8, 2004 Number 2
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Delayed Onset of Malaria — Implications for Chemoprophylaxis

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by Schwartz, E.
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To the Editor: Schwartz et al. (Oct. 16 issue)1 report that a substantial proportion of cases of malaria in returned travelers are characterized by a late onset. The authors conclude that the usual chemoprophylactic agents do not prevent such cases and suggest switching to agents such as primaquine or atovaquone–chloroguanide for prophylaxis. However, we believe that other considerations — including tolerability and cost for the millions of travelers who remain malaria-free — are just as important.

The U.S. government recorded more than 18 million trips to malaria-prone continents by citizens in 1995.2 Conservatively, assuming that only 20 percent of these . . . [Full Text of this Article]



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