{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,25]],"date-time":"2025-12-25T19:48:59Z","timestamp":1766692139758,"version":"3.48.0"},"reference-count":26,"publisher":"BMJ","issue":"6959","license":[{"start":{"date-parts":[[1994,10,8]],"date-time":"1994-10-08T00:00:00Z","timestamp":781574400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.bmj.com\/company\/legal-information\/terms-conditions\/legal-information\/tdm-licencepolicy"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["BMJ"],"accepted":{"date-parts":[[1994,7,18]]},"published-print":{"date-parts":[[1994,10,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    <jats:bold>Objectives:<\/jats:bold>\n                    To estimate the costs and benefits of prophylaxis against travel acquired malaria, typhoid20fever, and hepatitis A in United Kingdom residents during 1991.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Design:<\/jats:bold>\n                    Retrospective analysis of national epidemiological and economic data.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Main outcome measures:<\/jats:bold>\n                    Incidence of travel associated infections in susceptible United Kingdom residents per visit; costs of prophylaxis provision from historical data; benefits to the health sector, community, and individuals in terms of avoided morbidity and mortality based on hospital and community costs of disease.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Results:<\/jats:bold>\n                    The high incidence of imported malaria (0.70%) and the low costs of providing chemoprophylaxis resulted in a cost-benefit ratio of 0.19 for chloroquine and proguanil and 0.57 for a regimen containing mefloquine. Hepatitis A infection occurred in 0.05% of visits and the cost of prophylaxis invariably exceeded the benefits for immunoglobulin (cost-benefit ratio 5.8) and inactivated hepatitis A vaccine (cost- benefit ratio 15.8). Similarly, low incidence of typhoid (0.02%) and its high cost gave whole cell killed, polysaccharide Vi, and oral Ty 21a typhoid vaccines cost-benefit ratios of 18.1, 18.0, and 22.0 respectively.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Conclusions:<\/jats:bold>\n                    Fewer than one third of travellers receive vaccines but the total cost of providing typhoid and hepatitis A prophylaxis of pounds sterling25.8m is significantly higher than the treatment costs to the NHS (pounds sterling 1.03m) of cases avoided by prophylaxis. Neither hepatitis A prophylaxis nor typhoid prophylaxis is cost effective, but costs of treating malaria20greatly exceed costs of chemoprophylaxis, which is therefore highly cost effective.\n                  <\/jats:p>","DOI":"10.1136\/bmj.309.6959.918","type":"journal-article","created":{"date-parts":[[2011,10,27]],"date-time":"2011-10-27T19:30:49Z","timestamp":1319743849000},"page":"918-922","source":"Crossref","is-referenced-by-count":89,"title":["Is travel prophylaxis worth while? Economic appraisal of prophylactic measures against malaria, hepatitis A, and typhoid in travellers"],"prefix":"10.1136","volume":"309","author":[{"given":"R H","family":"Behrens","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J A","family":"Roberts","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[1994,10,8]]},"reference":[{"key":"2025122311525386000_309.6959.918.1","unstructured":"Central Statistical Office. Business monitor; overseas travel and tourism. London: Government Statistical Service, 1991. (MA6.)"},{"key":"2025122311525386000_309.6959.918.2","unstructured":"World Health Organisation. International travel and health. Vaccination requirements and health advice. Geneva: World Health Organisation, 1994;41-53."},{"key":"2025122311525386000_309.6959.918.3","unstructured":"Office of Population Censuses and Surveys. Communicable diseases statistics 1991. London: OPCS, 1991. (MB2 No 18.)"},{"key":"2025122311525386000_309.6959.918.4","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1016\/0163-4453(93)96241-H","article-title":"Under-reporting of malaria, a notifiable disease, in Britain.","volume":"26","author":"Davidson","year":"1993","journal-title":"J Infect"},{"key":"2025122311525386000_309.6959.918.5","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.303.6808.991-c"},{"key":"2025122311525386000_309.6959.918.6","doi-asserted-by":"publisher","DOI":"10.1016\/0163-4453(90)90600-D"},{"key":"2025122311525386000_309.6959.918.7","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1136\/bmj.300.6723.499","article-title":"Risk of malaria in British residents returning from malarious areas.","volume":"300","author":"Phillips-Howard","year":"1990","journal-title":"BMJ"},{"key":"2025122311525386000_309.6959.918.8","unstructured":"Chemist and druggist price list. Chemist and Druggist 1991;32:No 10."},{"key":"2025122311525386000_309.6959.918.9","doi-asserted-by":"publisher","DOI":"10.1016\/0035-9203(93)90003-9"},{"key":"2025122311525386000_309.6959.918.10","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1991.03460060088030"},{"key":"2025122311525386000_309.6959.918.11","unstructured":"Department of Health. Immunisation against infectious diseases. London: HMSO, 1992."},{"key":"2025122311525386000_309.6959.918.12","doi-asserted-by":"publisher","DOI":"10.1016\/0140-6736(93)90814-W"},{"key":"2025122311525386000_309.6959.918.13","unstructured":"Doctors and Dentists Review Body. General medical practitioners workload survey 1989-1990. London: DDRB, 1990."},{"key":"2025122311525386000_309.6959.918.14","unstructured":"Paris JAG Bakhshi SS . Hepatitis A and travel abroad: a study of notifications in Birmingham. Commun Dis Rep CDR Rev 1992;2:R43."},{"key":"2025122311525386000_309.6959.918.15","unstructured":"Department of Employment. Employment Gazette. 1993 June:s50-4."},{"key":"2025122311525386000_309.6959.918.16","first-page":"20","article-title":"Your money or your life.","volume":"138","author":"Marin","year":"1983","journal-title":"Three Banks Review"},{"key":"2025122311525386000_309.6959.918.17","doi-asserted-by":"publisher","DOI":"10.1016\/S0033-3506(05)80441-X"},{"key":"2025122311525386000_309.6959.918.18","doi-asserted-by":"publisher","DOI":"10.1016\/0163-4453(90)90853-Z"},{"key":"2025122311525386000_309.6959.918.19","unstructured":"Bradley DJ Warhurst DC . Malaria imported into the United Kingdom during 1991. Commun Dis Rep CDR Rev 1993;3:R25."},{"key":"2025122311525386000_309.6959.918.20","unstructured":"McCormick A . The notification of infectious diseases in England and Wales. Commun Dis Rep CDR Rev 1993;3:R19."},{"key":"2025122311525386000_309.6959.918.21","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1136\/jramc-140-02-04","article-title":"Prevalence of immunity to hepatitis A in recruits to the British army and Royal Air Force.","volume":"140","author":"Cumberland","year":"1994","journal-title":"J R Army Med Corps"},{"key":"2025122311525386000_309.6959.918.22","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/156.1.84"},{"key":"2025122311525386000_309.6959.918.23","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1093\/infdis\/156.1.84","article-title":"Health problems after travel to developing countries.","volume":"156","author":"Steffen","year":"1987","journal-title":"J Infect Dis"},{"key":"2025122311525386000_309.6959.918.24","doi-asserted-by":"publisher","DOI":"10.1016\/0035-9203(91)90005-J"},{"key":"2025122311525386000_309.6959.918.25","doi-asserted-by":"publisher","DOI":"10.1016\/0035-9203(90)90123-V"},{"key":"2025122311525386000_309.6959.918.26","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1016\/0035-9203(90)90123-V","article-title":"Protecting the health of the international traveller.","volume":"84","author":"Behrens","year":"1990","journal-title":"Trans R Soc Trop Med Hyg"}],"container-title":["BMJ"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/data.bmj.org\/tdm\/10.1136\/bmj.309.6959.918","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmj.309.6959.918","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T19:53:02Z","timestamp":1766519582000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.bmj.com\/lookup\/doi\/10.1136\/bmj.309.6959.918"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1994,10,8]]},"references-count":26,"journal-issue":{"issue":"6959","published-online":{"date-parts":[[1994,10,8]]},"published-print":{"date-parts":[[1994,10,8]]}},"alternative-id":["10.1136\/bmj.309.6959.918"],"URL":"https:\/\/doi.org\/10.1136\/bmj.309.6959.918","relation":{},"ISSN":["0959-8138","1468-5833"],"issn-type":[{"type":"print","value":"0959-8138"},{"type":"electronic","value":"1468-5833"}],"subject":[],"published":{"date-parts":[[1994,10,8]]}}}