Which patients need specific guidance? Part 2, chemoprophylaxis

To prevent mosquito bites and thus reduce risk of malaria, dengue fever, and yellow fever in endemic areas, advise patients to apply an insect repellent containing deet (N,N-diethyl-3-methylbenzamide) to exposed skin and thin clothing, to sleep in well-screened or air-conditioned areas (or to sleep under a mosquito net pretreated with permethrin), and to wear long sleeves and trousers tucked into socks. Patients traveling to areas where chloroquine-sensitive malaria is endemic may take chloroquine as chemoprophylaxis. Those planning travel to areas with chloroquine-resistant malaria - except western Cambodia and the Thai-Myanmar and Thai-Cambodia border areas - may use mefloquine, doxycycline, or atovaquone/proguanil. Travelers to western Cambodia and the border areas mentioned above, where mefloquine- and chloroquine-resistant strains of malaria are present, can take doxycycline or atovaquone/proguanil. Chemoprophylaxis should be started 1 to 2 weeks before travel and continued for 4 weeks after return (7 days for atovaquone/proguanil). Key preventive measures for long-term travelers include vaccination against hepatitis A and B and malaria chemoprophylaxis.