Effectiveness of personal protection measures against mosquito bites for malaria prophylaxis in travelers

Background: To determine the effectiveness of personal protection measures (PPM) against mosquito bites in travelers as tools of malaria prevention. Methods: Two step questionnaire survey conducted in European tourists who visited East Africa: cross-sectional evaluation during the return flight with follow-up 12 weeks after return home. Among 100,336 tourists participating in a malaria survey, 89,617 had answered all questions relating to PPM and to malaria occurrence. The main outcome measure was the occurrence of malaria. Results: Only 2% of tourists visiting East Africa regularly take all four of the most important PPM. Regular use of PPM resulted in a small, but significant reduction of malaria incidence when travelers were interviewed 12 weeks after returning home. Air-conditioned rooms and clothing which covered arms and legs were effective, whereas repellants, insecticides, coils, etc. showed no significant effect. Conclusions: In general, advice relating to all possible PPM in travelers should be concentrated on those who are at greatest risk of bites, and thus of malaria. For those at low and intermediate risk, preference should be given to convenient measures with proven effectiveness, such as using air-conditioned rooms and appropriate clothing.