Are Travellers Hearing Malaria Health Advice?

Peter Russell

December 12, 2018

The number of cases of malaria brought into the UK fell around the turn of the century, but researchers have investigated why there are still around 1700 cases of imported malaria each year.

A study in the journal Clinical Infectious Diseases found that further reductions in cases might be possible if more emphasis was placed on targeting health advice about pre-travel prophylaxis at people going to malarious countries for work or tourism.

Malaria Cases Have Plateaued

The research team, led by Cambridge University Hospital Foundation Trust, noted that between 1996 and 2003 the UK had experienced a 31.2% reduction in imported cases of malaria. However, that decline was not sustained and figures plateaued in the following years.

The researchers wanted to know whether the epidemiology had changed and whether current health advice messages remained appropriate.

They reviewed 225 paper records of confirmed malaria, including demographic data, of patients seen in Addenbrooke's hospital between 2002 and 2016. These were analysed and assessed in the context of national figures from Public Health England (PHE).

Most of the infections were due to Plasmodium falciparum, which accounted for 66.7% of cases over the 15 year period. P.vivax accounted for 15.1% of cases, P.malariae 4%, P.ovale 6.7%, while in 7.5% of cases patient records were incomplete.

Further analysis revealed that there were more cases of malaria amongst males than females, apart from in the 10 to 14 years age group.

Family Visits, Work, and Tourism

Most of the malaria cases seen at Addenbrooke's were imported from African countries, particularly Ghana and Nigeria, and other countries in West Africa. This trend was reflected in national data.

Data was available in 169 cases for why infected individuals had been to or travelled from a country with malaria. The main reasons given were:

  • Visiting family in their country of origin (27.8%)

  • Going on holiday (22.5%)

  • Work, including volunteering, and military attachments (20.1%)

  • Being a foreign student studying in the UK (13%)

Anti-malarial Drugs

The researchers also analysed the proportion of individuals who had taken and adhered to chemoprophylaxis. This data, available for 193 of the patients, showed that "a staggering" 60% took no prophylaxis at all.

Of the 40% that took prophylaxis, 32.5% did not know what they had taken, while the remainder took a variety of drugs but none consistently, and none when they returned to the UK.

The most common identified prophylactic drug used was doxycycline, which is the cheapest of the anti-malaria drugs recommended.

The study found that individuals who had been visiting their families were least likely to have used chemoprophylaxis, possibly because they were travelling to a familiar environment and may have underestimated the loss of semi-immunity.

However, some travellers said they felt that even if they were to get ill they would be able to deal with an infection when they returned home. This suggested that health messages on the importance of malarial chemoprophylaxis have lost much of their impact.

The authors noted that some malaria chemoprophylaxis were now available over the counter in the UK. While this was a "promising endeavour" to improve access without the need to see a doctor, "The issue that remains is bringing services like this to the attention of travellers and not only emphasising the importance of taking chemoprophylaxis but adhering to chemoprophylaxis regimen".

Clinical Infectious Diseases, ciy1037, https://doi.org/10.1093/cid/ciy1037 Published: 07 December 2018. Abstract.

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