Knowledge and Attitudes Regarding the Vaccination of Brazilian Immigrants in Portugal: Risks When Returning to Their Country of Origin?

Vaccination is one of the main advancements in public health in the prophylaxis of infectious diseases. We intend to describe the general knowledge about vaccines/vaccination among Brazilian immigrants in Portugal, characterize their attitudes toward vaccination, and describe their knowledge of the yellow fever (YF) vaccine. A cross-sectional study was conducted using a self-completion questionnaire (face-to-face or remote). A total of 542 people participated in the study; the mean age was 36.81 years; 40.1% were male; 44.8% had their 12th year of schooling; and 27.0% had resided for ≥10 years in Portugal. Regarding general knowledge about vaccination, 53.8% answered at least 6/8 questions correctly. A total of 37.1% tended to have a favorable attitude toward vaccination. Concerning traveling, 76.7% attributed the risk of disease at the destination as the main reason for accepting vaccines. A total of 89.3% knew that there was a risk of YF in Brazil. A total of 40% answered correctly only one question about the YF vaccine; 21.6% did not answer any questions correctly. Thus, most of the Brazilian immigrants in this study have high general knowledge about vaccines/vaccination, few have a favorable attitude, and their knowledge about the YF vaccine is scarce. This could limit vaccination adherence when visiting Brazil, making health education actions necessary to increase knowledge and prevent YF risks.

Moringa as a household water purification method - community perception and pilot study in Guinea-Bissau.

BACKGROUND: Public perceptions of water-related issues are still under-researched topics. The current paper intends to explore a local community's perceptions regarding household water purification (HWP) strategies, namely before and after trying a new method: moringa seeds powder (moringa-teabag). METHODS: In September 2020, six focus group discussions (N = 65) assessing perceptions about the usefulness of Moringa oleifera Lam (Moringaceae) as a HWP method (before moringa-based HWP trials), and questionnaires (N = 104) evaluating successes and identifying difficulties (after one week of moringa-based HWP trials). Participants were all women aged over 18 years, living in Ondame, Biombo region, Guinea-Bissau. Data were analyzed using qualitative and quantitative approaches. RESULTS: The focus group discussions revealed that people are aware of the fact that water can transmit diseases. Although certain persons showed concern about shallow well water safety, people generally underestimate the risk, as they trust tubewell water. Not everyone had an understanding of what water contamination is, or the concept of medical importance. Some respondents declared they use traditional methods such as boiling and bleach to treat water before drinking. However, those who reported no kind of treatment indicated reasons such as lack of time, cost, and bleach's taste and smell. In the questionnaire, more than half of the participants (68%) reported treating water before consumption. Nevertheless, these results are not consistent with our field notes. Participants demonstrated a strong belief in the capacity of moringa-teabags to purify water and even consider them better or much better (81%) than other methods. Participants asked for more information on moringa-teabag for household water purification. CONCLUSION: More information on water treatment and water safety would help to raise public awareness about waterborne diseases. These findings could be used to promote greater adherence to moringa-based HWP as an alternative to household water treatment.

Clinical and Microbiological Profile of Diabetic Foot Ulcers Infected With Staphylococcus aureus in a Regional General Hospital in Bahia, Brazil.

It is necessary to know the resistance profile of Staphylococcus aureus to better control diabetic foot ulcer infections, to establish rational antibiotic therapy, and to avoid the development of resistant strains. This cross-sectional study evaluated the clinical parameters, virulence, and antimicrobial resistance profiles of S aureus in patients with diabetic foot disease admitted to a public hospital. S aureus strains were identified in patients with diabetes with amputation indication. Infected tissue samples were collected, microbes were isolated and identified. The microbial resistance profile was determined. Samples were also analyzed for biofilm formation and other virulence markers. The 34 individuals examined were mostly men, black, aged 60 years on average, and generally had a low income and education level. Most individuals had type 2 diabetes, and the mean time since diagnosis was 13.9 years. On an SF-36 (the Medical Outcomes Study 36-item short-form health survey) quality-of-life questionnaire, 75% of individuals obtained a score equal to 0 for physical impairment. S aureus specimens from 17 patients were isolated, corresponding to 50% of samples. Five isolates were classified as methicillin-resistant S aureus (MRSA). Molecular typing revealed that 20% of MRSA strains were SCCmec type V and 80% were type I. All isolates were sensitive to doxycycline; 61.5% were resistant to erythromycin, 38.5% to cefoxitin, 30.7% to clindamycin and ciprofloxacin, 23% to meropenem, 15.3% to gentamicin, 38.5% to oxacillin, and 7.7% (one strain) to vancomycin. Regarding biofilm production, 53% of samples were able to produce biofilms, and 84.6% had icaA and/or icaD genes. Additionally, the following enterotoxin genes were identified in the isolates: seb, sec, seg, and sei (5.9%, 5.9%, 11.8%, and 23.9%, respectively) and agr types 1 (5.9%) and 2 (11.8%). Genotypic evaluation made it possible to understand the pathogenicity of S aureus strains isolated from the diabetic foot; laboratory tests can assist in the monitoring of patients with systemic involvement.

If I told you that there is no need for yellow fever vaccine booster would you still come to the travel clinic?: a cross-sectional study.

BACKGROUND: Yellow Fever (YF) immunization required a single dose vaccine with boosters every 10 years. After International Health Regulation (IHR) amendment annex 7 (July 2016), it was accepted that a single dose confers lifelong immunity. Since pre-travel advice is as important as vaccination when traveling, it is essential to clarify why travelers come to a travel health consultation, with the possibility of IHR amendment having a negative impact on travelers' health. This study aims to describe travelers' reasons to come to a pre-travel consultation in Lisbon and if they would return if they wouldn't need the YF vaccine booster. METHODS: An observational cross-sectional study was conducted during 5 months in the waiting room of Instituto de Higiene e Medicina Tropical travel clinic in Lisbon, Portugal. Travelers were asked about sociodemographic characteristics, destination country, travel duration and reasons to travel in an anonymous self-administered questionnaire. RESULTS: A total of 1043 travelers agreed to participate in the study. Although 61.0% (627/1028) did not come to the clinic to get the YF vaccine, from those who did, 36.7% (133/362) would not come and 12.9% (47/362) didn't knew if they would come if the vaccine would not be necessary. CONCLUSION: The IHR amendment may have a negative impact on travel clinic attendance and on travelers´ health.

Health Problems During and After Travel: A Prospective Observational Study in a Travel Clinic in Portugal.

INTRODUCTION: In order to improve the health of travellers during travel it is important to better understand the health problems faced by travellers in different destinations. The main objective of this study was to characterise the perceived health problems of travellers during and up to six months after travel on a pre-travel clinic in Lisbon, Portugal. MATERIAL AND METHODS: This is a prospective observational study. Participants were recruited among those travellers attending a pretravel clinic between May 2016 and April 2017, meeting the inclusion criteria (age over 18 years old and predicted time of stay from five to 90 days). Structured questionnaires were applied by telephone interviews, three and six months after arrival. Associations and their magnitude were sought between travel and traveller's characteristics with total and specific health problems, using multiple logistic regression models. RESULTS: Out of 364 participants who completed the study, 60% were under 37 years of age, and 87.9% presented a higher educationaldegree. Africa and Asia were travel destinations for 89.1% of travellers. Three months after travel, 39.3% confirmed some travel-acquired health problem, namely diarrhoea (26.6%) and unmeasured fever (12.4%). A malaria case was diagnosed, occurring 3.5 months after return. From a total of 189 travellers to countries with high risk of malaria and chemoprophylaxis recommendation, 65.6% adhered completely and 6.9% of those presenting fever during travel sought healthcare. DISCUSSION: The proportion of travellers that became ill was lower compared to other published studies. Failure to follow a randomsampling method and the characteristics of the travel consultation with a particular profile of travellers in terms of level of education and ability to pay, challenges the external validity of the study. CONCLUSION: Health problems during or after travel occurred in 39.3% of travellers with diarrhoeal disease being the most common (26.6%). From our findings, the need for taking chemoprophylaxis for malaria or seeking health care in the presence of fever is not translated into appropriate action. The reasons are unclear and should be the subject of further research. Furthermore, research is needed with inclusion of other centres practicing travel medicine in Portugal, both in the pre-travel setting and others, in order to better understand the health risks associated with Portuguese traveller's characteristics and destinations.

Introdução: De forma a melhorar a saúde dos viajantes é necessário compreender os principais problemas de saúde enfrentados em diferentes destinos. O principal objetivo deste estudo foi caracterizar os problemas de saúde relatados por pessoas que recorreram a uma consulta do viajante em Lisboa durante e até seis meses após a viagem. Material e Métodos: Este é um estudo observacional e prospetivo. Os participantes foram recrutados entre os viajantes que compareceram na consulta entre maio de 2016 e abril de 2017, de acordo com os critérios de inclusão (idade igual ou superior a 18 anos e o tempo previsto de permanência em viagem de cinco a 90 dias). Os questionários estruturados foram aplicados por entrevistas telefónicas, três e seis meses após a chegada. Usando vários modelos de regressão logística, foram procuradas associações entre as características das viagens e dos viajantes com os problemas de saúde totais e específicos, e determinada a sua relevância. Resultados: Dos 364 participantes que completaram o estudo, 60% tinham menos de 37 anos de idade e 87,9% tinham um curso superior. As regiões de África e da Ásia foram os destinos de viagem para 89,1% dos viajantes. Três meses após a viagem, 39,3% dos viajantes relataram algum problema de saúde nomeadamente diarreia (26,6%) e febre (12,4%). Foi diagnosticado um caso de malária 3,5 meses após o regresso. Num total de 189 viajantes para regiões com indicação para quimioprofilaxia de malária, 65,6% tiveram uma adesão completa e 6,9% procuraram cuidados de saúde, no caso de febre durante a viagem. Discussão: A proporção de viajantes que adoeceu foi menor do que noutros estudos publicados. O não cumprimento de um método de amostragem aleatória e as características desta consulta de viajante, que apresenta um perfil específico de viajantes em termos de nível de escolaridade e capacidade de pagamento, colocam em causa a validade externa do estudo. Conclusão: Os problemas de saúde, durante ou após a viagem, ocorreram em 39,3% dos viajantes, sendo que a diarreia é o problema mais frequente (26,6%). A não adesão a recomendações carece de melhor caracterização. É necessário realizar este tipo de estudo em viajantes que não vão a consultas de aconselhamento antes da viagem e noutros centros de medicina do viajante, de forma a melhor caracterizar os riscos de doença associados a diferentes características e destinos dos viajantes portugueses.

What happens when we modify mosquitoes for disease prevention? A systematic review.

The release of modified mosquitoes to suppress/replace vectors constitutes a promising tool for vector control and disease prevention. Evidence regarding these innovative modification techniques is scarce and disperse. This work conducted a systematic review, gathering and analysing research articles from PubMed and Biblioteca Virtual em Saúde databases whose results report efficacy and non-target effects of using modified insects for disease prevention, until 2016. More than 1500 publications were screened and 349 were analysed. Only 12/3.4% articles reported field-based evidence and 41/11.7% covered modification strategies' post-release efficacy. Variability in the effective results (90/25.7%) questioned its reproducibility in different settings. We also found publications reporting reversal outcomes 38/10.9%, (e.g. post-release increase of vector population). Ecological effects were also reported, such as horizontal transfer events (54/15.5%), and worsening pathogenesis induced by natural wolbachia (10/2.9%). Present work revealed promising outcomes of modifying strategies. However, it also revealed a need for field-based evidence mainly regarding epidemiologic and long-term impact. It pointed out some eventual irreversible and important effects that must not be ignored when considering open-field releases, and that may constitute constraints to generate the missing field evidence. Present work constitutes a baseline of knowledge, offering also a methodological approach that may facilitate future updates.

Molecular epidemiology and host genetics of norovirus and rotavirus infections in Portuguese elderly living in aged care homes.

Norovirus (NoV) and rotavirus group A (RVA) are major agents of acute gastroenteritis worldwide. This study aimed to investigate their epidemiological profile in Portuguese elderly living in long-term care facilities and to assess the host genetic factors mediating infection susceptibility. From November 2013 to June 2015, 636 faecal specimens from 169 elderly, mainly asymptomatic, living in nursing homes in Greater Lisbon and Faro district, Portugal, were collected. NoV and RVA were detected by real-time polymerase chain reaction and NoV genotyped by phylogenetic analysis. NoV detection rate was 7.1% (12 of 169). Three GI.3 and one GII.6 strains were genotyped. RVA detection rate was 3.6% (6 of 169), exclusively in asymptomatic individuals. Host genetic factors associated with infection susceptibility were described on 250 samples by saliva-based enzyme-linked immunosorbent assays. The Lewis-negative phenotype was 8.8% (22 of 250) and the rate of nonsecretors was 16.8% (42 of 250). Association to NoV and RVA infection was performed in the subgroup of individuals (n = 147) who delivered both faecal and saliva samples. The majority of NoV- and RVA-positive individuals (90.9% and 83.3%, respectively) were secretor-positive, with Lewis B phenotype. In a subset of individuals, FUT2 and FUT3 genes were genotyped to assess mutations and validate the secretor and Lewis phenotypes. All sequenced nonsecretors were homozygous for FUT2 nonsense mutation G428A. In this study, low detection rates of NoV and RVA infections were found during two winter seasons. However, even in the absence of any outbreak, the importance of finding these infections in a nonepidemic situation in long-term care facilities may have important implications for infection control.

Sanitation workers from Portugal: Is there evidence of Leptospira spp?

Leptospires are spirochetes of Leptospira genus. Infection in humans occurs by penetration into the mucous membranes, or into the skin (small wounds or abrasions). Humans are infected when they contact with urine of rodents, the main reservoirs. We aimed to evaluate the presence of anti-Leptospira spp antibodies and leptospiral DNA in sanitation workers (occupational group with increased risk) from Lisbon and Tagus Valley Region (Portugal). Blood samples were collected from 347 sanitation workers, being applied a questionnaire to analyze exposure to rodents and preventive measures. The samples were screened by MACROLepto-test, for the presence of antibodies against pathogenic leptospires. "Positive" and "Non conclusive" samples were then tested with Microscopic Agglutination Test (MAT). Two nested-PCR protocols (primers LeptoA-LeptoB and lipL32) were applied for Leptospira spp DNA detection. It was not observed anti-Leptospira spp antibodies in the worker's samples. However, it was detected non-pathogenic leptospires in a serum sample. Furthermore, 77% had previously seen rodents in the workplace and 94% always used Personal Protective Equipment (PPE). Despite the regular presence of rodents in their workplace, the use of PPE and hygiene measures seemed to be able to prevent the workers contact with this infectious agent.

Post-exposure serological responses to malaria parasites in potential blood donors.

BACKGROUND: Cases of transfusion-transmitted malaria have been described around the world and highlighted in some studies. Semi-immune individuals are more likely to transmit malaria as they may be asymptomatic. Some countries allow blood donations only based on epidemiological criteria while others reinforce their criteria with serological tests. However, little is known about the longevity of anti-Plasmodium spp. antibodies and its meaning in blood donation. Therefore, this study aims to assess the longevity of different subclasses of anti-Plasmodium spp. antibodies in individuals with previous stays in endemic areas, as well as to assess how those antibodies are related to personal features and travel characteristics. Based on those results, the suitability of the Portuguese blood donors screening method was addressed, i.e. the method to search for an eventual risk of transfusion-transmitted malaria among the population studied. RESULTS: Statistical associations were found between the presence of total anti-Plasmodium spp. antibodies and some travel characteristics, namely to be born in endemic area versus non endemic and previous episodes of malaria. The intersection between seropositive results and the last year of stay in endemic areas showed a longer longevity of anti-Plasmodium spp. antibodies than previously reported. Those results represented a considerable portion of the individuals having returned from their last stay in endemic areas more than 10 years before enrolment in this study. Considering the study population as potential blood donors, serological results also indicated that if epidemiological criteria alone were applied to screen blood donors, an important percentage of seropositive individuals would be approved for blood donation. Because the nature and meaning of those antibodies in the blood donation context is still not understood, those approved individuals could represent a risk for blood transfusion safety. CONCLUSIONS: The place of birth and past episodes of malaria seem to be related to the serological outcome. Epidemiological criteria to screen potential blood donors are insufficient to guarantee the safety of the blood, if applied alone.

Impact of a dengue outbreak experience in the preventive perceptions of the community from a temperate region: Madeira Island, Portugal.

The ability to effectively modify behaviours is increasingly relevant to attain and maintain a good health status. Current behaviour-change models and theories present two main approaches for (healthier) decision-making: one analytical/logical, and one experiential/emotional/intuitive. Therefore, to achieve an integral and dynamic understanding of the public perceptions both approaches should be considered: community surveys should measure cognitive understanding of health-risk contexts, and also explore how past experiences affect this understanding. In 2011, community perceptions regarding domestic source reduction were assessed in Madeira Island͘. After Madeira's first dengue outbreak (2012) a unique opportunity to compare perceptions before and after the outbreak-experience occurred. This was the aim of this study, which constituted the first report on the effect of an outbreak experience on community perceptions regarding a specific vector-borne disease. A cross-sectional survey was performed within female residents at the most aegypti-infested areas. Perceptions regarding domestic source reduction were assessed according to the Essential Perception (EP)-analysis tool. A matching process paired individuals from studies performed before and after the outbreak, ensuring homogeneity in six determinant variables. After the outbreak, there were more female residents who assimilated the concepts considered to be essential to understand the proposed behaviour. Nevertheless, no significant difference was observed in the number of female residents who achieved the defined 'minimal understanding''. Moreover, most of the population (95.5%) still believed at least in one of the identified myths. After the outbreak some myths disappeared and others appeared. The present study quantified and explored how the experience of an outbreak influenced the perception regarding a dengue-preventive behaviour. The outbreak experience surprisingly led to the appearance of new myths within the population, apart from the expected increase of relevant concepts' assimilation. Monitoring public perceptions is therefore crucial to make preventing dengue campaigns updated and worthy.

Polymorphisms in Plasmodium falciparum K13-propeller in Angola and Mozambique after the introduction of the ACTs.

We report the presence of SNPs in Plasmodium falciparum K13-propeller gene in two African countries, Angola and Mozambique, where malaria is a serious public health problem. Samples were collected before and after ACT introduction as first-line treatment. In each country 50 samples collected before and 50 after ACT introduction were analysed. A total of three different mutations (R471R and R575R in Angola and V494I in Mozambique) were identified in five samples, all collected after the introduction of ACT. The R471R mutation detected in Angola has already been reported in Africa (DR-Congo and Gabon). However, the mutations R575R (Angola) and V494I (Mozambique), have never been reported. V494I is adjacent to the known K13 resistance-associated mutation Y493H, although functional analysis did not predict a deleterious effect on protein function.

Angola's 2013 dengue outbreak: clinical, laboratory and molecular analyses of cases from four Portuguese institutions.

INTRODUCTION: Dengue virus (DENV) is the arbovirus with the widest impact on human health. In Africa in general, and in Angola in particular, the epidemiology and public health impact of DENV is far from clear. However, rapid population growth, unplanned urbanization, increased international travel, and the presence of virus major vector (Aedes aegypti) in the country suggest that DENV transmission may occur. METHODOLOGY: In parallel to the occurrence of a dengue outbreak affecting the capital of Angola, between March and July 2013 four Portuguese institutions diagnosed dengue infection in 146 individuals returning to Portugal. Clinical presentation, laboratory findings, and molecular analyses of partial viral genomic segments were performed. RESULTS: The mean age of the individuals included in this study was 42 years old, the majority being men of Portuguese nationality, reporting various lengths of stay in Angola. Fever was the most reported clinical sign, being frequently associated (61.0%) with myalgia and headache. Hematological values, including hematocrit, white-blood cell and platelets counts, correlated with the absence of severe or complicated cases, or coagulation disorders. No deaths were observed. Viral NS1 was detected in 56.2% of the samples, and all NS1 negative cases had anti-dengue IgM antibodies. RT-PCR indicated the presence of DENV1, which was confirmed by phylogenetic analysis of 25 partial NS5 viral sequences. CONCLUSION: The DENV cases analyzed conformed to classical and uncomplicated dengue, caused by the suggested exclusive circulation of a genetically homogeneous DENV1 of genotype III, apparently with a single origin.

Strengthening the perception-assessment tools for dengue prevention: a cross-sectional survey in a temperate region (Madeira, Portugal).

BACKGROUND: Community participation is mandatory in the prevention of Dengue outbreaks. Taking public views into account is crucial to guide more effective planning and quicker community participation in preventing campaigns. This study aims to assess community perceptions of Madeira population in order to explore their involvement in the A. aegypti's control and reinforce health-educational planning. Due to the lack of accurate methodologies for measuring perception, a new tool to assess the community's perceptions was built. METHODS: A cross-sectional survey was performed in the Island's aegypti-infested area, exploring residents' perceptions regarding most critical community behaviour: aegypti-source reduction and their domestic aegypti-breeding sites. A novel tool defining five essential topics which underlie the source reduction's awareness and accession was built, herein called Essential-Perception (EP) analysis. RESULTS: Of 1276 individuals, 1182 completed the questionnaire (92 · 6%). EP-Score analysis revealed that community's perceptions were scarce, inconsistent and possibly incorrect. Most of the population (99 · 6%) did not completely understood the five essential topics explored. An average of 54 · 2% of residents only partially understood each essential topic, revealing inconsistencies in their understanding. Each resident apparently believed in an average of four false assumptions/myths. Significant association (p<0.001) was found between both the EP-Score level and the domestic presence of breeding sites, supporting the validity of this EP-analysis. Aedes aegypti's breeding sites, consisting of décor/leisure containers, presented an atypical pattern of infestation comparing with dengue prone regions. CONCLUSIONS: The studied population was not prepared for being fully engaged in dengue prevention. Evidences suggest that EP-methodology was efficient and accurate in assessing the community perception and its compliance to practices. Moreover, it suggested a list of myths that could persist in the community. This is the first study reporting an aegypti-entomological pattern and community's perception in a developed dengue-prone region. Tailored messages considering findings of this study are recommended to be used in future campaigns in order to more effectively impact the community perception and behaviour.

Sexually transmitted infections in an African migrant population in Portugal: a base-line study.

BACKGROUND: For geographical and recent historic reasons, Portugal is a gateway and home for immigration from sub-Saharan countries. Misconceptions related to these populations often lead to consider them as high-frequency clusters for dissemination of sexually transmitted infections (STIs). Epidemiological evidence-based data is needed to elucidate these issues and baseline prevalence studies are the starting point for this. METHODOLOGY: A prospective study was conducted in 220 African migrants (171 men and 49 women), recently arrived in Portugal, at the time of their first consultation. The presence of STIs was evaluated using a clinical syndromic approach and biological confirmation for gonorrhoea, Chlamydia trachomatis genital infection, syphilis, Hepatitis B and Human Immunodeficiency Virus (HIV) infection. RESULTS: Global prevalence of the targeted infections were 1.8% for gonorrhoea, 0 % for Chlamydia infection, 4.1% for Syphilis, 5.9% for HBsAg presence and 7.3% for HIV infection. Globally, 16.4% of the studied persons had at least one sexually transmitted infection. CONCLUSIONS: We concluded that prevalence rates encountered in this population is similar to that of non-migrant Portuguese populations with a high risk for sexually transmitted diseases. Therefore migration from sub-Saharan Africa doesn't seem to constitute a particularly critical isolated factor for public health risk of STIs in the community.

Pharmacists and travel advice for tropics in Lisbon (Portugal).

BACKGROUND: In Portugal, little is known about the quality of advice given to international travelers by pharmacists. The aim of this study was to determine pharmacists' training, experience, and interest in travel medicine and to assess the technical quality of the information given. METHODS: We sent a postal questionnaire to all pharmacies in the Lisbon area. The technical director or another graduate pharmacist was asked to complete the questionnaire. RESULTS: A total of 251 pharmacists participated in the study. Most of them (93.2%) did not have any training in travel medicine, and most of them expressed a wish to be informed and/or updated on this subject. The number of advised travelers was low. The use of repellent, protective clothes, and mosquito bed nets was the most frequent advice on protection against mosquito bites. From a subgroup of 170 pharmacists, 43.5% indicated mefloquine and 44.1% indicated chloroquine as malaria chemoprophylaxis to African countries. A significant association existed between the variables "to indicate mefloquine" and "seeks to be informed/updated on travel medicine." Those who indicated chloroquine tended to like travel medicine less. Concerning diarrhea prevention and treatment, the consumption of bottled and/or treated water and the administration of antibiotics during the episode were the most reported advice. Concerning vaccination against yellow fever, only 8 of 91 pharmacists correctly indicated all Portuguese-speaking countries with and without the risk of this disease. CONCLUSIONS: Studied pharmacists need training in travel medicine. Travel advice was incomplete and/or incorrect and must be improved.

Quality assessment in a travel clinic: a study of travelers' knowledge about malaria.

BACKGROUND: Quality in health care delivery is considered essential and should be expected for all who deliver health care. We were not able to identify in Portugal any previous studies that assessed the quality of travel medicine consultations. The aims of this study was to assess the impact of travel health advice on travelers' knowledge and the quality of the outcome of the travel consultations at the Institute of Hygiene and Tropical Medicine, Portugal. METHOD: We selected the quasi-experimental model "separate-sample pretest-posttest design." Two random samples were obtained (control and experimental groups). An anonymous self-administered questionnaire was applied during the second half of 2002, until we had received about 200 questionnaires for each group. The questions assessed travelers' knowledge of malaria, its transmission, prevention, and clinical features. RESULTS: There was a significant improvement of travelers' knowledge in the postconsultation group, with 98.5% of individuals understanding that malaria is transmitted by mosquito bite (p= 0.005), 91.5% that malaria may be prevented by appropriate prophylactic medication (p= 0.007), and 93% knowing that malaria is prevented by avoiding mosquito bites (p= 0.003). However, almost half of the postconsultation group did not realize that there was no vaccine available for preventing malaria (p < 0.001) or that avoiding unsafe food and drink did not prevent malaria (p= 0.006). About 53% gave correct answers about malaria incubation periods (p < 0.001), and 91.1% were able to identify the initial symptoms of malaria (p < 0.001). CONCLUSIONS: Travel medicine consultations increase the knowledge base of travelers but do not achieve 100% correct answers. Our results suggest that during a travel health consultation, critical information is assimilated about the prevention of malaria, but myths and misunderstandings that are held by travelers are not completely dispelled.