A study by the Health Protection Agency’s Malaria Reference Laboratory (HPA) and published in today’s BMJ.com shows that despite highly effective measures available to prevent malaria, the burden of disease among UK travellers has steadily increased over the last 20 years.
There were 39,300 cases of malaria in the UK between 1987 and 2006. Of these 20,488 were in UK travellers (visitors from the UK to malarious countries) and the remainder were among visitors to the UK.
The majority of the malaria cases in UK travellers (65 per cent) were in people visiting friends or family in Africa or South Asia .
Worryingly, only 42 per cent of UK travellers reported taking any appropriate medication to prevent malaria. People visiting friends and family in their country of origin were less likely to report using preventative measures than other travellers although they were more likely to acquire malaria compared to other groups.
This study, examining 20 years of records, is supported by the latest information on UK malaria cases for 2007. Published by the Agency in April this year, figures showed that there were 1,548 cases of malaria reported among UK travellers last year. Where the reason for travel was recorded, 72% of cases among UK travellers were in those visiting friends and relatives abroad. Figures also show that 83% of malaria patients had not taken any protective drugs against malaria.
Professor Peter Chiodini, who heads up the Agency’s Malaria Reference Laboratory, said: “It is vital that anyone travelling to an area where malaria is a risk seeks medical advice before their trip. This is particularly true for people travelling to visit friends and relatives who have been shown to take less precautions to protect themselves than other people who are on holiday.
“There is a prevailing myth that travellers who were born in a malaria-endemic country such as Africa have some ‘natural’ immunity to malaria and this is simply not the case. Like all other people who go to Africa and Asia they need to make sure they take their anti-malaria drugs and follow the guidelines that are there to protect everyone.
“Without taking the appropriate protective drugs and using other preventative measures to prevent mosquito bites, UK travellers are exposing themselves to a killer disease that is almost completely preventable.
“Talk to your GP surgery or travel health clinic about appropriate measures for your own trip. Despite it being almost completely preventable, many people in the UK are being caught out by malaria. Please don’t be one of them.”
There are several different types of malaria and the study showed that there has been a steady rise in the proportion of cases due to Plasmodium falciparum (Pf) which is the cause of most deaths from malaria. This type of malaria was most commonly seen in people who had been to West Africa, particularly Nigeria and Ghana. The majority of other cases of malaria were Plasmodium vivax and these are mainly seen in people who have been to South Asia.
Global impact of malaria
Malaria has a massive impact on human health; it is the world’s second biggest killer after tuberculosis. Around 300 million clinical cases occur each year resulting in between 1.5 – 2.7 million deaths annually, the majority in sub-saharan Africa. It is estimated that 3,000 children under the age of five years fall victim to malaria each day. Around 40% of the world’s population is at risk. The societies and economic development of some of the world’s poorest nations are severely affected by malaria.
Symptoms
It is important for travellers to be aware of the symptoms of malaria, which can be very similar to those of flu. The symptoms of malaria include a flu-like illness, fever, shaking, headache, muscle aches and tiredness. Nausea, vomiting and diarrhoea may also occur.
If travellers develop these symptoms whilst abroad or up to one year after returning, they should seek prompt medical advice and tell their doctor they have been in an area where malaria is a hazard.
Seeking advice
Members of the public should seek advice about their specific travel health needs from their GP surgery or local travel clinic.
An information sheet on insect bite avoidance and updates on other travel health issues are available on the National Travel Health Network and Centre (NaTHNaC) website at http://www.nathnac.org/travel/factsheets/iba.htm and http://www.nathnac.org/travel/news/index.htm which deals with queries about patients with complex medical needs or travel itineraries.
Specialist advice
The risks posed by malaria in some countries change over time. Health professionals who require assistance and more specialist advice when advising travellers should contact the HPA Malaria Reference Laboratory (0207 636 3924) or NaTHNaC (0845 602 6712).
Travel guidelines
The Health Protection Agency’s Advisory Committee on Malaria Prevention for UK Travellers (ACMP) has produced guidelines for healthcare workers who advise travellers or prospective travellers who wish to read about the options themselves. Guidelines are available here.
Malaria Reference Laboratory
The Malaria Reference Laboratory provides an integrated service for public health in relation to malaria. It combines reference and diagnostic parasitology of malaria with surveillance of all imported malaria reported in the UK, analysing the results and using these, together with wide consultation to develop national policy on prevention of imported malaria, which it then disseminates widely.
The HPA is holding a conference on 24 October 2008 which is looking at the ways to tackle malaria in Africa. The conference ‘Working together to tackle malaria in the African and Asian communities’ will be held in London. For more information please see http://www.hpa-events.org.uk/MalariaConference.