THE USE OF MALARIA DIAGNOSTIC TEST KITS BY TRAVELERS

Malaria prophylaxis measures of travelers include, in addition to chemoprophylaxis, stand-by treatment (self treatment) which is indicated in areas of low transmission, for short-term travelers and for those with brief, repeated exposure to malaria. The indication of stand-by treatment has now been expanded in some areas, partly due to an increasing concern about the possible adverse effects of malaria chemoprophylaxis. However, the inappropriate use of stand-by treatment in non-malaria cases may expose persons to a significant drug risk, thus developing simple and reliable self diagnostic tests especially for Plasmodium falciparum malaria has been expected. Recently marketed kits for detecting P. falciparum histidine-rich protein 2 (HRP-2) or pLDH could be good candidates for malaria self diagnosis by travelers. Especially a card-type kit detecting HRP-2 is characterized by its simplicity and reliability, often showing a sensitivity of>95% or even sometimes 100%. Although the sensitivity of those tests could not always be 100%, they could be very useful when performed properly, especially in cases travelers develop malaria-like symptoms in areas remote from reliable medical facilities. However, reports of self diagnosis with those kits performed by travelers showed discouraging results. Recent studies highlighted errors of performing these tests correctly and of interpreting previously reacted strips or cards. Travelers should not become a victim of potentially useful malaria diagnostic tests due to their incorrect use. Nonetheless, we still believe that the use of those kits by travelers should not be abandoned, rather they must have potential for application to travelers' malaria. This goal could be accomplished by improving the contents of the kits' instructions and also by giving full oral explanation to travelers at travel clinics.