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J Travel Med. 2016 Jul 4;23(5). doi: 10.1093/jtm/taw043. Print 2016 May.

A comparison of compliance rates with anti-vectorial protective measures during travel to regions with dengue or chikungunya activity, and regions endemic for Plasmodium falciparum malaria.

Author information

Department of Preventive Medicine and Biostatistics, Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
Division of Infectious Diseases, Naval Medical Center Portsmouth, Portsmouth, VA, USA.
Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA.
San Antonio Uniformed Services Health Education, Fort Sam Houston, TX, USA.
Walter Reed National Military Medical Center, Bethesda, MD, USA.
Madigan Army Medical Center, Tacoma, WA, USA.
Landstuhl Regional Medical Center, Landstuhl, Germany.
Naval Medical Center of San Diego, San Diego, CA, USA.
Enteric Diseases Department, Naval Medical Research Center, Silver Spring, MD, USA.
DoD HIV/AIDS Prevention Program, Naval Health Research Center, San Diego, CA, USA.



There is limited information on compliance rates with anti-vectorial protective measures (AVPMs) during travel to countries with risk of dengue and chikungunya. We evaluated differences in mosquito exposures, and factors associated with AVPM compliance in travellers going to countries where the principal mosquito-borne infectious disease threat is falciparum malaria and those where risk of dengue or chikungunya predominates.


Department of Defence beneficiaries with planned travel to regions where the predominant mosquito-borne infection is falciparum malaria, and those with predominantly dengue or chikungunya risk, were included. Regions were divided into three groups: 'high-risk falciparum malaria', 'low-risk falciparum malaria' and 'chikungunya/dengue risk'. Demographics, trip characteristics, arthropod exposure and AVPM compliance were captured using pre- and post-travel surveys. Skin repellent compliance was defined as self-reported use, categorized as 'often/every day'. A logistic regression model was used to estimate factors associated with AVPM compliance.


183 (9%), 185 (9%) and 149 (7%) travelled to high and low falciparum malaria risk regions, and chikungunya/dengue risk regions, respectively. Overall, 53% (95% CI: 48-57%) and 16% (95% CI: 12-19%) were compliant with repellent use on skin and clothing, respectively. Daytime bites were reported more frequently in chikungunya/dengue risk regions than high malaria risk regions (37% vs. 10%), while night time bites were frequently in high malaria risk regions (53% vs 20%; P < 0.001). Compliance with skin repellents was associated with female gender [RR: 1.54 (95% CI: 1.05-2.28)], observing mosquitoes during travel [RR: 2.77 (95% CI: 1.76-4.36)] and travel during the rainy season [RR: 2.45 (95% CI: 1.66-3.71)]).


Poor AVPM compliance was observed in the overall cohort. Compliance with skin repellent use was associated with female gender, observing mosquitoes and travelling during the rainy season, and was not associated with the risk of malaria or chikungunya/dengue at the travel destination.


Anti-vectorial protective measures; chikungunya; compliance; dengue; malaria

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