Economics of Malaria Prevention in US Travelers to West Africa

Background. Pretravel health consultations help international travelers manage travel-related illness risks through education, vaccination, and medication. This study evaluated costs and benefits of that portion of the health consultation associated with malaria prevention provided to US travelers bound for West Africa. Methods. The estimated change in disease risk and associated costs and benefits resulting from traveler adherence to malaria chemoprophylaxis were calculated from 2 perspectives: the healthcare payer's and the traveler's. We used data from the Global TravEpiNet network of US travel clinics that collect de-identified pretravel data for international travelers. Disease risk and chemoprophylaxis effectiveness were estimated from published medical reports. Direct medical costs were obtained from the Nationwide Inpatient Sample and published literature. Results. We analyzed 1029 records from January 2009 to January 2011. Assuming full adherence to chemoprophylaxis regimens, consultations saved healthcare payers a per-traveler average of $14 (9-day trip) to$372 (30-day trip). For travelers, consultations resulted in a range of net cost of $20 (9-day trip) to a net savings of$32 (30-day trip). Differences were mostly driven by risk of malaria in the destination country. Conclusions. Our model suggests that healthcare payers save money for short- and longer-term trips, and that travelers save money for longer trips when travelers adhere to malaria recommendations and prophylactic regimens in West Africa. This is a potential incentive to healthcare payers to offer consistent pretravel preventive care to travelers. This financial benefit complements the medical benefit of reducing the risk of malaria

Early diagnosis of Nocardia asteroides endophthalmitis by retinal biopsy: case report and review.

Hematogenous nocardial endophthalmitis is a rare but devastating infection. Of a total of 10 cases (one described for the first time and nine reported previously in the English-language literature), the lung appeared to be the primary focus of infection in eight (80%). Six (60%) of the cases occurred in individuals receiving corticosteroid therapy; these individuals had undergone renal transplantation (two cases) or cardiac transplantation (one case) and had underlying conditions that included lymphoma (two cases) and chronic active hepatitis (one case). In two immunocompetent individuals, infection followed dissemination from traumatic wounds. Common clinical findings were a rapid decrease in visual acuity and eye pain. All nine of the previously reported cases resulted in total blindness of the involved eye; five patients died not long after diagnosis. In the present report (the first in a cardiac transplant recipient), a favorable outcome with restoration of vision followed early diagnosis through the recently developed technique of fine-needle retinal biopsy