The knowledge, attitudes and practices of wintersun vacationers to the Gambia toward prevention of malaria: is it really that bad?

BACKGROUND: Each year clusters of imported malaria cases are observed in Dutch wintersun vacationers returning from The Gambia. To gain more insight in the travel health preparation and awareness of these travellers, the knowledge, attitudes and practices (KAP) of this travel group was studied by analysing the data of the Continuous Dutch Schiphol Airport Survey. METHODS: In the years 2002 to 2009 a questionnaire-based survey was conducted at the Dutch Schiphol Airport with the aim to study the KAP, i.e. accuracy of risk perception ("knowledge"), intended risk-avoiding behaviour ("attitude") and use of personal protective measures and malaria chemoprophylaxis ("practice") toward prevention malaria in travellers to The Gambia. Travellers to other high-risk destinations served as controls. RESULTS: The KAP of travellers to The Gambia toward prevention of malaria was significantly better than that observed in other travellers. Trend analyses indicated that attitude improved over time in both groups but knowledge did not change. Only in travellers to high-risk countries other than The Gambia significant increases in protection rates were observed over time. CONCLUSIONS: The KAP of travellers to The Gambia toward prevention of malaria was better than that observed in travellers to destinations other than The Gambia. Trend analyses revealed a significant improvement of intended risk avoiding behaviour but not in protection rates or risk perception.

Travel health preparation and travel-related morbidity of splenectomised individuals.

Asplenic or hyposplenic patients are at an increased risk of encapsulated bacterial and intraerythrocytic parasitic infections, which are endemic at many travel destinations. With proper travel health advice and preparation splenectomised individuals could have comparable travel-related morbidity as healthy control subjects. We conducted a prospective case-control study with 21 travel pairs. Each pair consisted of a splenectomised patient (case) and a healthy, non-splenectomised travel companion (control) in order to match for travel destination, duration and potential exposures to travel-related health risks. All participants filled out a questionnaire detailing travel health preparation including vaccination and malaria prophylaxis as well as travel-related morbidity. Cases and controls were comparable for age and gender. Cases received significantly more information about on demand use of antibiotics in case of fever. Immunisation coverage against encapsulated bacteria and adherence to malaria prophylaxis guidelines was suboptimal. There were no significant differences in the occurrence of travel-related ailments nor differences in severity of ailments. The immunisation coverage against encapsulated bacteria and adherence to malaria prophylaxis guidelines was suboptimal in some splenectomised patients and should be improved. Strict adherence to national travel health advice guidelines and specific guidelines for asplenic patients is advisable. However, with regard to travel-related morbidity there are no significant differences in morbidity between splenectomised patients and healthy controls, at least in the setting of short-term travel.

Trends in the knowledge, attitudes and practices of travel risk groups towards prevention of malaria: results from the Dutch Schiphol Airport Survey 2002 to 2009.

BACKGROUND: Previous studies investigating the travellers' knowledge, attitudes and practices (KAP) profile indicated an important educational need among those travelling to risk destinations. Initiatives to improve such education should target all groups of travellers, including business travellers, those visiting friends and relatives (VFRs), and elderly travellers. METHODS: In the years 2002 to 2009, a questionnaire-based survey was conducted at the Dutch Schiphol Airport with the aim to study trends in KAP of travel risk groups towards prevention of malaria. The risk groups last-minute travellers, solo-travellers, business travellers, VFRs and elderly travellers were specifically studied. RESULTS: A total of 3,045 respondents were included in the survey. Travellers to destinations with a high risk for malaria had significantly more accurate risk perceptions (knowledge) than travellers to low-risk destinations. The relative risk for malaria in travellers to high-risk destinations was probably mitigated by higher protection rates against malaria as compared with travellers to low risk destinations. There were no significant differences in intended risk-taking behaviour. Trend analyses showed a significant change over time in attitude towards more risk-avoiding behaviour and towards higher protection rates against malaria in travellers to high-risk destinations. The KAP profile of last-minute travellers substantially increased their relative risk for malaria, which contrasts to the slight increase in relative risk of solo travellers, business travellers and VFRs for malaria. CONCLUSIONS: The results of this sequential cohort survey in Dutch travellers suggest an annual 1.8% increase in protection rates against malaria coinciding with an annual 2.5% decrease in intended risk-seeking behaviour. This improvement may reflect the continuous efforts of travel health advice providers to create awareness and to propagate safe and healthy travel. The KAP profile of last-minute travellers, in particular, substantially increased their relative risk for malaria, underlining the continuous need for personal protective measures and malaria chemoprophylaxis for this risk group.

Travel-related morbidity in children: a prospective observational study.

OBJECTIVE: Scarce data are available on the occurrence of ailments and diseases in children during travel. We studied the characteristics and frequencies of ailments in children aged 0 to 18 years and their parents during traveling. METHODS: A prospective observational study on ailments reported by children and parents traveling to (sub)tropical countries was conducted. The ailments were semi-quantitatively graded as mild, moderate, or severe; ailments were expressed as ailment rates per personmonth of travel. RESULTS: A total of 152 children and 47 parents kept track of their ailments for a total of 497 and 154 weeks, respectively. The children reported a mean ailment rate of 7.0 (5.6-8.4) ailments per personmonth of travel; 17.4% of the ailments were graded as moderate and 1.4% as severe. The parents reported a mean ailment rate of 4.4 (3.1-5.7); 10.8% of the ailments were graded as moderate and 5.5% as severe. Skin problems like insect bites, sunburn and itch, and abdominal complaints like diarrhea were frequently reported ailments in both children and parents. Children in the age category 12 to 18 years showed a significantly higher ailment rate of 11.2 (6.8-14.1) than their parents. CONCLUSIONS: Skin problems and abdominal problems like diarrhea are frequently reported ailments in children and their parents and show a high tendency to recur during travel. The majority of these ailments are mild but occasionally interfere with planned activities. Children in the age group 12 to 18 years are at a greater risk of developing ailments during a stay in a (sub)tropical country and they should be actively informed about the health risks of traveling to the tropics.

Trends in knowledge, attitudes, and practices of travel risk groups toward prevention of hepatitis A: results from the Dutch Schiphol Airport survey 2002 to 2009.

BACKGROUND: Previous studies investigating the travelers' knowledge, attitudes, and practices (KAP) profile indicated an important educational need among those traveling to risk destinations. Initiatives to improve such education should target all groups of travelers, including business travelers, those visiting friends and relatives (VFR), and older adult travelers. METHODS: In the years 2002 to 2009, a longitudinal questionnaire-based survey was conducted at the Dutch Schiphol Airport with the aim to study trends in KAP of travel risk groups toward prevention of hepatitis A. The risk groups last-minute travelers, solo travelers, business travelers, travelers VFR, and older adult travelers were specifically studied. RESULTS: A total of 3,045 respondents were included in the survey. Travelers to destinations with a high risk for hepatitis A had significantly less accurate risk perceptions (knowledge) than travelers to low-to-intermediate-risk destinations. The relative risk for hepatitis A in travelers to high-risk destinations was probably mitigated by less intended risk-seeking behavior and by higher protection rates against hepatitis A as compared with travelers to low-to-intermediate-risk destinations. Logistic regression analyses showed that an age >60 years was the only significant determinant for improvement of their knowledge. Trend analyses showed a significant change over time in attitude toward more risk-avoiding behavior and toward higher protection rates against hepatitis A in travelers to high-risk destinations. The KAP profile of the risk groups travelers VFR (irrespective of hepatitis A risk of their destination) and solo as well as last-minute travelers to high-risk destinations substantially increased their relative risk for hepatitis A. CONCLUSIONS: The results of this longitudinal survey in Dutch travelers suggest an annual 5% increase in protection rates against hepatitis A coinciding with an annual 1% decrease in intended risk-seeking behavior. This improvement may reflect the continuous efforts of travel health advice providers to create awareness and to propagate safe and healthy travel. The KAP profile of travelers visiting friends and relatives (VFR) and solo as well as last-minute travelers to high-risk destinations substantially increased their relative risk for hepatitis A. These risk groups should be candidates for targeted interventions.

East and west, home is best? A questionnaire-based survey on mortality of Dutch travelers abroad.

A questionnaire-based survey on the mortality of Dutch travelers abroad revealed that travel outside of Europe carried an increased mortality risk predominantly caused by fatal cardiovascular events and traffic accidents rather than fatal infections. Discussion of these items should receive a prominent place in our travel health consultation.

Anti-malaria drug mefloquine induces motor learning deficits in humans.

Mefloquine (a marketed anti-malaria drug) prophylaxis has a high risk of causing adverse events. Interestingly, animal studies have shown that mefloquine imposes a major deficit in motor learning skills by affecting the connexin 36 gap junctions of the inferior olive. We were therefore interested in assessing whether mefloquine might induce similar effects in humans. The main aim of this study was to investigate the effect of mefloquine on olivary-related motor performance and motor learning tasks in humans. We subjected nine participants to voluntary motor timing (dart throwing task), perceptual timing (rhythm perceptual task) and reflex timing tasks (eye-blink task) before and 24 h after the intake of mefloquine. The influence of mefloquine on motor learning was assessed by subjecting participants with and without mefloquine intake (controls: n = 11 vs mefloquine: n = 8) to an eye-blink conditioning task. Voluntary motor performance, perceptual timing, and reflex blinking were not affected by mefloquine use. However, the influence of mefloquine on motor learning was substantial; both learning speed as well as learning capacity was impaired by mefloquine use. Our data suggest that mefloquine disturbs motor learning skills. This adverse effect can have clinical as well as social clinical implications for mefloquine users. Therefore, this side-effect of mefloquine should be further investigated and recognized by clinicians.

Efficacy and safety of exchange transfusion as an adjunct therapy for severe Plasmodium falciparum malaria in nonimmune travelers: a 10-year single-center experience with a standardized treatment protocol.

BACKGROUND: Even in circumstances where optimal antimalarial and supportive treatment is available, severe Plasmodium falciparum malaria is still associated with a significant case fatality. Although exchange transfusion (ET) has been considered as a controversial adjunct therapy, we have not encountered any case fatality since ET was introduced as a standard adjunct therapy for patients with severe malaria. STUDY DESIGN AND METHODS: In this retrospective cohort study of 25 patients with severe malaria, the efficacy and safety of ET as an adjunct to parenteral antimalarial treatment (which was implemented in our hospital starting in 1998) were evaluated and compared with 31 historical control patients who were treated with conventional parenteral antimalarial treatment in the period before ET was added to the standard of care for severe malaria (generally before 1997). RESULTS: The parasite clearance times (PCT)(25%), PCT(50%), PCT(75%) and PCT(90%) were all significantly shorter for patients treated with ET than for patients treated with parenteral quinine only. The shorter PCTs in the ET group were the result of a more rapid parasite clearance in the early phases after initiation of ET. CONCLUSION: No case fatalities were observed in the ET group. The complications that were observed with ET were more likely related either to the multiorgan dysfunction associated with severe malaria or to side effects of parenteral quinine rather than to the ET procedure. ET may be safely executed in a setting with intensive care facilities and availability of safe blood products and should be considered as a beneficial adjunct treatment to parenteral antimalarial therapy.

[Availability of antimalarial agents in Dutch hospitals]. / Beschikbaarheid van malariamiddelen in Nederlandse ziekenhuizen.

OBJECTIVE: To investigate the availability of antimalarial agents for the treatment of falciparum malaria in all Dutch hospital pharmacies, including changes in the situation over a period of two years. DESIGN: Descriptive. METHOD: In the period October 2006 to March 2007 all Dutch hospital pharmacies were questioned about the availability of antimalarial agents, by means of a telephone survey. The survey was repeated at the end of 2008. RESULTS: The percentage of hospitals that had quinine in stock increased from 72 (62 of the 86 hospitals responding) to 80 (73 of 91 hospitals). In 2008 artesunate was in stock in 7 hospitals. At the end of 2008 18 Dutch hospitals had no medication available for the treatment of severe malaria tropica; 6 hospitals had no agents for the treatment of malaria at all. CONCLUSION: The ideal situation, in which every hospital in the Netherlands has a supply of adequate agents for the treatment of severe malaria, has not yet been achieved.

The safety and tolerance of atovaquone/proguanil for the long-term prophylaxis of plasmodium falciparum malaria in non-immune travelers and expatriates [corrected].

BACKGROUND: In Europe, atovaquone/proguanil (A/P) is only licensed for malaria prophylaxis for 28 days of travel. Data on the long-term safety and tolerance in nonimmune travelers are scarce. METHODS: We initiated a prospective observational study on ailments reported by travelers using A/P on a long-term basis. Ailments were recorded on a regular questionnaire. Travelers rated their ailments as (1) mild, not interfering with their daily activities; (2) moderate, causing interference with daily activities; or (3) severe, resulting in a visit to a doctor or clinic. RESULTS: One hundred sixty-nine subjects used A/P for a total of 2.974 weeks. One hundred fifty-three (90.5%) traveled to malaria-endemic regions in Africa. Seventy-five (44%) travelers, who used A/P for 1.140 weeks, reported no ailments. Ninety-four (56%) subjects who used A/P for 1.834 weeks reported a total of 363 ailments. Diarrhea was the most common ailment (13.5%; graded as mild in 7.2%, moderate in 4.7%, severe in 1.7%). Further complaints were headache (7.4%), malaise (6.1%), insomnia (5.2%), abdominal pain (5.0%), nausea (5.0%), and oral ulcers (4.1%). Four (2.4%) subjects discontinued prophylaxis due to complaints. No patient was admitted. Five (3.0%) cases of malaria were reported. CONCLUSIONS: In our observational study encompassing more than 57 person-years of follow-up, A/P was tolerated well when taken longer than the current recommendation of 28 days of travel. Treatment-limiting ailments resulting in discontinuation of chemoprophylaxis were observed in 4 of 169 (2.4%) participants, whereas none of them was admitted. There were five (3.0%) cases of self-reported malaria. These observations suggest that A/P is also a safe and efficacious drug for the long-term chemoprophylaxis of falciparum malaria.

The quality of travel clinics in the Netherlands.

BACKGROUND: In 1996, the Dutch National Coordination Center for Travelers' Health Advice (LCR) was established to improve uniformity in health advice to travelers and in the quality of national vaccination centers. In this study, we evaluate the influence of LCR guidelines on the quality of travel clinics in the Netherlands. METHODS: In 1997 and 2001, questionnaires regarding implementation of LCR quality criteria were sent to the Dutch travel clinics where most travel advice is given. In 2003, the Health Care Inspectorate surveyed all Dutch yellow fever vaccination centers including those surveyed in 1997 and 2001. The data yielded by all three surveys were included in our assessment. RESULTS: The response rate was 78, 84, and 100% in 1997, 2001, and 2003, respectively. Between 1997 and 2001, the number of travel clinics with 5,000 visitors or more increased. The LCR quality criteria are widely implemented: of the criteria surveyed in this study, 11/14 (79%) were implemented in more than 80% of the clinics in 2003. Between 1997 and 2003, vaccine management improved (eg, registration of batch numbers and monitoring of refrigerators); in more clinics, physicians were present in case of emergency and advice given by nurses was more often checked daily, but this is still only in 52% of the travel clinics. Although two thirds of the professionals working in travel medicine are nurses, only 55% of them were adequately trained in this specialty. CONCLUSIONS: Between 1997 and 2003, the LCR quality guidelines are widely implemented, but implementation can still be improved. To further improve the quality of travel clinic staff, the LCR recently started certification of basic and refresher courses for physicians and nurses working in travel medicine and now registers those completing such courses.

MDR1 gene polymorphisms are associated with neuropsychiatric adverse effects of mefloquine.

BACKGROUND: Mefloquine, a drug used for treatment and prophylaxis of malaria, is known for its neuropsychiatric adverse effects. We hypothesized that neuropsychiatric adverse effects of mefloquine are associated with polymorphisms in the MDR1/ABCB1 gene that encodes for the efflux pump P-glycoprotein. METHODS: The association between MDR1 C1236T, G2677T, and C3435T single-nucleotide polymorphisms and the occurrence of neuropsychiatric adverse effects was examined in a prospective cohort study of 89 healthy white travelers taking mefloquine. RESULTS: Of the subjects, 27 (28%) reported neuropsychiatric adverse effects, women significantly more frequently than men. Allele frequencies of the C1236T, G2677T, and C3435T polymorphisms were similar to those found in other white populations, and there was no significant association between any of the individual polymorphisms and neuropsychiatric adverse effects. However, women with the 1236TT, 2677TT, and 3435TT genotypes had a higher risk of neuropsychiatric adverse effects than the reference groups of women with heterozygous and homozygous CC or GG genotypes, with odds ratios of 6.3 (95% confidence interval [CI], 1.1-36.9), 10.5 (95% CI, 1.1-100.6), and 5.4 (95% CI, 1.1-30.0), respectively. The association for women homozygous for the 1236-2677-3435 TTT haplotype was even stronger (P = .004) than the effect of any of the individual polymorphisms. No associations with mefloquine blood levels were observed. CONCLUSION: In this study the MDR1 1236TT, 2677TT, and 3435TT genotypes, along with the 1236-2677-3435 TTT haplotype, were associated with neuropsychiatric adverse effects of mefloquine in women. MDR1 polymorphisms may play an important role in predicting the occurrence of neuropsychiatric adverse effects of mefloquine, particularly in female travelers.

Combined typhoid fever and hepatitis A vaccine: comparison of immunogenicity and safety to concomitant monovalent vaccine over 3 years.

BACKGROUND: The safety and immunogenicity of Viatim, a combined hepatitis A (HA) and typhoid fever (Vi) vaccine, were compared with the monovalent component vaccines up to and 1 month after a booster dose at 3 years. METHODS: Healthy, adult volunteers were randomized to receive Viatim (group A, n = 179) or separate HA and Vi vaccines (group B, n = 181); subgroups were boosted after 3 years with Viatim (groups C and D, n = 56 and 46, respectively). Local and systemic reactions were recorded for 28 days postvaccination. Seroconversion and seroprotection rates and geometric mean antibody concentrations were measured at 14 and 28 days, 1, 2, and 3 years postvaccination, and 28 days after the booster dose. RESULTS: Local and systemic safety profiles were equivalent between the two groups. Immediate local reactions were infrequent (1 in group A and 2 in group B). Local reactions, consisting mostly of mild or moderate pain, were least frequent with monovalent HA. Antibody concentrations to both antigens were similar in groups A and B, in which HA seroprotection rates (> or = 20 mIU/mL) were respectively, 98.7% and 100% at day 28, and 99.1% and 99.0% after 3 years, achieving 100% after the booster. Vi seroprotection rates (> or = 1 microg/mL) of 85.2% and 84.9% after 28 days fell to 32.1% and 35.6% after 3 years, increasing to 67.3% and 69.8% after the booster dose. CONCLUSIONS: The combined HA/Vi vaccine, Viatim, had equivalent tolerability and safety and was as rapidly immunogenic as its component monovalent vaccines when given concurrently. A booster dose after 3 years significantly increased antibody levels with some evidence of relative hyporesponsiveness of the typhoid response.

Evaluation of plasma lactate as a parameter for disease severity on admission in travelers with Plasmodium falciparum malaria.

BACKGROUND: Rapid immunochromatographic dipstick assays are used increasingly in many tropical and Western countries as a tool to diagnose Plasmodium falciparum malaria. However, these tests do not provide any information about the severity of the infection. We evaluated the usefulness of plasma lactate as a parameter for disease severity on admission in imported P. falciparum malaria. METHODS: In a cohort of 61 nonimmune travelers with imported P. falciparum malaria, plasma lactate levels on admission were related to the severity of the infection. Results from 12 of 61 patients fulfilled the criteria of severe malaria. RESULTS: Logistic regression analysis showed that a plasma lactate level above the upper range of normal was associated with an odds ratio of 31 (95% CI 6-164) for severe malaria. As a continuous variable, a 1 mmol/L increase in plasma lactate level was associated with an odds ratio of 12 (95% CI 3-50) for severe malaria. The sensitivity of an increased plasma lactate level on admission for severe malaria was 67% with a specificity of 94%. CONCLUSIONS: A timely determination of plasma lactate on admission may be helpful in the assessment of disease severity in travelers with imported P. falciparum malaria. An increased plasma lactate level should raise suspicion of a severe P. falciparum malaria infection, in particular when concomitant infections are not considered likely.

Knowledge, attitudes and practices in travel-related infectious diseases: the European airport survey.

BACKGROUND: The European Travel Health Advisory Board conducted a cross-sectional pilot survey to evaluate current travel health knowledge, attitudes and practices (KAP) and to determine where travelers going to developing countries obtain travel health information, what information they receive, and what preventive travel health measures they employ. Subsequently, the questionnaire used was improved and a cross-sectional, multicenter study was undertaken in airports in Europe, Asia, South Africa and the United States. This paper describes the methods used everywhere, and results from the European airports. METHOD: Between September 2002 and September 2003, 5,465 passengers residing in Europe and boarding an intercontinental flight to a developing country were surveyed at the departure gates of nine major airports in Europe. Questionnaires were self-administered, and checked for completeness and validated by trained interviewers. RESULTS: Although the majority of travelers (73.3%) had sought general information about their destination prior to departure, only just over half of the responders (52.1%) had sought travel health advice. Tourists and people traveling for religious reasons had sought travel health advice more often, whereas travelers visiting friends and relatives were less likely to do so. Hepatitis A was perceived as the most probable among the infectious diseases investigated, followed by HIV and hepatitis B. In spite of a generally positive attitude towards vaccines, 58.4% and 68.7% of travelers could not report any protection against hepatitis A or hepatitis B, respectively. Only one in three travelers to a destination country with at least some malaria endemicity were carrying antimalarial drugs. Almost one in four travelers visiting a high-risk area had an inaccurate risk perception and even one in two going to a no-risk destination were unnecessarily concerned about malaria. CONCLUSIONS: The large variation in destinations, age of the travelers and reasons for traveling illustrates that traveling to a developing country has become common practice. The results of this large-scale airport survey clearly demonstrate an important educational need among those traveling to risk destinations. Initiatives to improve such education should target all groups of travelers, including business travelers, those visiting friends and relatives, and the elderly. Additionally, travel health advice providers should continue their efforts to make travelers comply with the recommended travel health advice. Our common objective is to help travelers stay healthy while abroad, and consequently to also reduce the potential importation of infectious diseases and the consequent public health and other implications.

Post-marketing surveillance: adverse events during long-term use of atovaquone/proguanil for travelers to malaria-endemic countries.

BACKGROUND: Atovaquone/proguanil in Europe is only licensed for 4 weeks of travel. Data on its long-term tolerability in nonimmune travelers are scarce. METHODS: We prospectively studied adverse reactions reported by long-term travelers using atovaquone/proguanil among a population intolerant to mefloquine. The average length of atovaquone/proguanil use was 9 weeks (4.5 to 34 weeks). Adverse events were recorded on a regular questionnaire. Travelers rated complaints as: (1) mild, not interfering with their daily activities; (2) moderate, causing interference, such as canceling a trip or being confined to the hotel; or (3) severe, causing a visit to a doctor or clinic. Hospital admission was classified as category 3 and specified. We then compared our data with those on adverse reactions from 2 large multicenter studies of atovaquone/proguanil in nonimmune travelers. RESULTS: One hundred and fifty-four subjects used atovaquone/proguanil for a total of 1538 weeks. Diarrhea was the most common ailment (18%). Further complaints were abdominal pain (mild 4%, moderate 5%, severe 2%), headache (mild 4%, moderate 4%, severe 1%), dizziness (mild 3%, moderate 1%, severe 1%), and insomnia (mild 6%, moderate 0%, severe 0%). Two subjects of 154 (1%) discontinued prophylaxis, both due to diarrhea. Nobody was admitted to hospital. No case of malaria was reported. Comparison with data from previous, larger atovaquone/proguanil studies shows that the adverse events reported by the long-term atovaquone/proguanil users are no different in type and frequency of occurrence to those travel-related health problems normally encountered in the Tropics. CONCLUSIONS: Atovaquone/proguanil was well tolerated by these long-term travelers. Long-term users of atovaquone/ proguanil antimalarial prophylaxis suffer no more ailments than normally occur to travelers in tropical regions.

Serodiagnosis of imported schistosomiasis by a combination of a commercial indirect hemagglutination test with Schistosoma mansoni adult worm antigens and an enzyme-linked immunosorbent assay with S. mansoni egg antigens.

A commercial indirect hemagglutination (IHA) test using erythrocytes coated with Schistosoma mansoni adult worm antigens (WA) and an enzyme-linked immunosorbent assay (ELISA) with S. mansoni egg antigens (SEA) were assessed for their use in serodiagnosis of imported schistosomiasis (hereafter these tests are designated WA/IHA and SEA/ELISA, respectively). The sensitivity of the tests was evaluated with sera from 75 patients with proven S. mansoni infection, 25 with proven S. haematobium infection, and 10 with clinical Katayama fever. The specificity was assessed with sera from 283 patients with various parasitic, bacterial, viral, and fungal infections and sera containing autoimmune antibodies. Sensitivities of the WA/IHA with a cutoff titer of 1:160 (WA/IHA(160)) in detecting S. mansoni, S. haematobium, S. mansoni and S. haematobium combined, and clinical Katayama fever were 88.0, 80.0, 86.0, and 70.0%, respectively, with a specificity of 98.9%. The WA/IHA with a cutoff of 1:80 (WA/IHA(80)) showed sensitivities of 94.7, 92.0, 94.0, and 90.0%, respectively, with a specificity of 94.7%. The comparable values of SEA/ELISA were 93.3, 92.0, 93.0, and 50.0%, respectively, with a specificity of 98.2%. Combined use of ELISA and WA/IHA(80) gave sensitivities of 100% for S. mansoni, S. haematobium, and S. mansoni and S. haematobium combined and 90% for Katayama fever. The specificity of this combination in detecting schistosomiasis was 92.9%. Combination of SEA/ELISA with WA/IHA(160) gave sensitivities of 98.7, 96.0, 98.0, and 80% with a specificity of 97.2%. Our findings suggest that WA/IHA and SEA/ELISA are each sensitive and specific serological tests that are easy to use for the diagnosis of imported schistosomiasis. The combined use of these two tests enabled the serological diagnosis of schistosomiasis to be achieved with very high degrees of both sensitivity and specificity.