• Malaria risk for travellers

• BPSU 21st Annual Report

Malaria risk for travellers

Falciparum malaria has recently been diagnosed in two German tourists who had returned from a holiday in Punta Cana in the Dominican Republic [1]. In accordance with German guidelines neither case had taken malaria chemoprophylaxis, though both had used insect repellents. The United Kingdom (UK) guidelines, developed by the Advisory Committee on Malaria Prevention in UK Travellers (ACMP), do recommend malaria chemoprophylaxis for travellers to the Dominican Republic [2]. The National Travel Health Network and Centre (NaTHNaC) is reiterating current advice about malaria for those travelling to endemic areas over the forthcoming holiday season [3].

Malaria occurs in most tropical and sub-tropical regions of the world, including popular winter sun destinations (such as the Dominican Republic, The Gambia, and Goa, India) as well as other countries in West Africa and the Indian sub-continent, which are regions popular with those visiting friends and relatives. A total of 1758 cases of malaria occurred in the UK in 2006, the majority acquired in West Africa [4]. Clusters of falciparum malaria cases were also reported in those returning from The Gambia during the winter months in 2005 and 2006 [5, 6].

Travellers should ensure that they see their general practitioner or a travel health advice specialist for a full risk assessment ideally at least one month before departure. If, however, a trip has been booked at the last minute, travellers should still ensure they see a travel health practitioner before departure, particularly if they are travelling to a tropical destination. Country specific travel health advice is available for all countries on the NaTHNaC website at <http://www.nathnac.org/ds/map_world.aspx> and the UK malaria guidelines developed by the Advisory Committee on Malaria Prevention in UK Travellers (ACMP), are available at <http://www.hpa.org.uk/infections/topics_az/malaria/guidelines.htm>.

Travellers who fall ill after a visit to a malarious area should seek prompt medical attention and be aware that malaria can present up to a year or more after return. Healthcare professionals should always take a travel history from anyone with a fever or flu-like illness, and be aware that absence of fever in an ill patient does not exclude the diagnosis of malaria. If the travel history includes travel to a malarious area in the past year, a blood film examination should be performed without delay.

Malaria is a notifiable disease, all malaria cases should also be reported to the Health Protection Agency Malaria Reference Laboratory. Reporting forms are available at http://www.malaria-reference.co.uk/.

References
1. ProMED-mail. Malaria – Germany ex-Dominican Republic: Punta Cana. ProMED-mail 2007 [online] [cited 3 December 2007]; 26 Nov: 20071126.3826. Available at <http://www.promedmail.org>.

2. Chiodini P, Hill D, Lalloo D, Lea G, Walker E, Whitty C, Bannister B. Guidelines for malaria prevention in travellers from the United Kingdom . London: Health Protection Agency, January 2007. Available at <http://www.hpa.org.uk/infections/topics_az/malaria/guidelines.htm>.

3. National Travel Health Network and Centre. Clinical update, 3 December 2007: Malaria risk for travellers [online] [cited 3 December 2007]. Available at <http://www.nathnac.org/pro/clinical_updates/malaria_031207htm.htm>.

4. Health Protection Agency. Malaria imported into the United Kingdom in 2006: Implications for those advising travellers. Health Protection Report 2007; 1 (18): news. Available at <http://www.hpa.org.uk/hpr/archives/2007/hpr1807.pdf>

5. Health Protection Agency. Malaria deaths in travellers returning from The Gambia. Commun Dis Rep CDR Wkly [serial online] 2005 [cited 3 December 2007]; 15 (49): news. Available at <http://www.hpa.org.uk/cdr/archives/2005/cdr4905.pdf>.

6. Health Protection Agency. Further cases of falciparum malaria cases in travellers returning from The Gambia - update. Commun Dis Rep CDR Wkly [serial online] 2005 [cited 3 December 2007]; 16 (2): news. Available at <http://www.hpa.org.uk/cdr/archives/2006/cdr0206.pdf>

BPSU 21 st Annual Report

The British Paediatric Surveillance Unit (BPSU) has recently published its 21st annual report [1]. The report mainly focuses on activities undertaken during the year 2006. Reference is also made to studies and activities, which commenced in the year 2007 [1].

Three new BPSU studies began during the reporting period: malaria in childhood, vitamen K deficiency bleeding (VKDB), and maternal alloimmune thrombocytopenia (FMAIT)

Six studies had their period of surveillance extended for a further year in 2006: HIV, congenital rubella, progressive intellectual and neurological deterioration (PIND), medium chain acyl CoA herpes simplex virus and childhood scleroderma. Surveillance of early onset eating disorders (EOED) ended in May 2007, though a one- year follow is currently underway.

The British Paediatric Surveillance Unit (BPSU) was set up in 1986 to facilitate research into rare childhood diseases in the UK and the Republic of Ireland . The Unit is a collaboration between RCPCH and the Health Protection Agency, The University College London – Institute of Child Health (London), Health Protection Scotland (HPS), and The Faculty of Paediatrics of the Royal College of Physicians of Ireland.

References

1. BPSU 21st Annual Report 2006-2007. Londo : British Paediatric Surveillance Unit, Royal College of Paediatrics and Child Health, 2007. Available at <http://bpsu.inopsu.com/publications/annual_reports/BPSU%20Annual%20report%202006-7.pdf>