UK travellers returning home

Malaria and Fever: Returning UK Travellers

How common is malaria in travellers coming back to the UK? Did you know malaria is the commonest specific diagnosis made in travellers who have returned back to the UK from abroad? It affects up to 75% of hospital admissions with fever in returning travellers in the developed world, and in the UK there were 1,618 cases diagnosed in 2016 alone… This trend doesn’t show signs of falling either, with no significant changes in the number of cases diagnosed in the last 10 years. The average is just over 1,500 cases diagnosed year on year from 2007 to 2016. Nearly 1 in 5 travellers returning from sub-Saharan Africa returning with a fever are diagnosed with malaria. Fever is so important as a discriminator for diagnosing malaria, with 97% of those being diagnosed presenting with a history of fever.

Fever in the traveller

There are many other causes of fever in the traveller, but if you’ve been travelling in an area known to have malaria and you have a fever once you return home, you could be at risk and you need to get this checked out by a health professional, even if you’ve been taking anti-malarial medication. There is a chance that it might not have been effective, for example if the malarial parasite has developed resistance to the treatment.

Types of Malaria

There are different type of malaria, but the commonest type of malaria that returning travellers to the UK present with is Plasmodium Falciparum, with more than 90% of the cases that have been diagnosed in the UK coming from sub-Saharan Africa, and more than 7 in 10 of those coming from West Africa, where there are especially high levels of malaria.

When symptoms start

Most people with fever caused by malaria will develop symptoms within one month of travel, especially if caused by Plasmodium Falciparum, however, many cases are diagnosed after one year. Nearly 20% of Plamodium Vivax (another type of malaria) infections are diagnosed after one year since returning from the endemic infected region.

There are many different types of symptoms of malaria, but 97% of all patients diagnosed present with fever. Other symptoms include jaundice (yellowing of the skin), abdominal pain, headache, nausea, vomiting and diarrhoea.

Who’s at Risk?

You do not have to have been in a malaria-endemic region to catch malaria, however the chances of catching malaria are much significantly higher if you are. Malaria is a life threatening condition if it isn’t treated, and if you have an underlying medical condition such as diabetes or lung disease then the severity of the disease can be much worse. Children can have particularly severe symptoms of malaria and are even more at risk.

If travellers are visiting friends and relatives, they are 4 times a likely to develop a malaria infection compared to tourists, which is likely to be due to the type of travelling that they are doing. For example, having longer trips and spending more time in rural regions.

Prevention

The best form of prevention for malaria is bite prevention, but you cannot guarantee that you will not be bitten. Medication to prevent malaria, along with bite protection gives you the best chance at staying safe against malaria.

Further Information

For further information including medication to prevent malaria visit The Doctor  Service

References

  1. Imported Malaria in the UK: Statistics
  2. Falciparum malaria as a cause of fever in adult travellers returning to the United Kingdom: observational study of risk by geographical area, Fhogartaigh C et al, QJM, 2008
  3. Fever in the returning traveller, Fink D et al, BMJ 2018
  4. Imported Malaria, Willcox M et al, BMJ 2013
  5. https://travelhealthpro.org.uk/
  6. https://www.nhs.uk
  7. https://www.fitfortravel.nhs.uk
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