9 March 2007

Cluster of malaria cases from northern Goa - update

Since December 2006, a cluster of cases of Plasmodium falciparum malaria has been detected in travellers who had visited northern Goa [1-3]. Since NaTHNaC’s 12 January 2007 Clinical Update [2], a further four cases of P. falciparum in travellers from the United Kingdom have been confirmed by the Malaria Reference Laboratory (MRL) between 4 January and 15 February 2007 [4]. These cases occurred in three female and one male traveller who visited Goa separately, and who had stayed in a variety of accommodation. None of the travellers had taken malaria prevention tablets.

In recent years, the number of P. falciparum malaria cases reported from India has been low. In 2006 eleven cases of falciparum malaria were reported, and in 2005 nine cases were reported. Many advisors, including the Health Protection Agency Advisory Committee for Malaria Prevention (ACMP), had ceased recommending chemoprophylaxis for visitors to low-risk regions including Goa [5].

Advice for travellers

Based on the additional cases of falciparum malaria reported from Goa, the ACMP now advises that health professionals who are advising travellers:

• highlight the risk of malaria
• instruct on the use of mosquito bite avoidance measures
• consider recommending malaria prevention tablets for travellers visiting Goa

This advice for travellers to Goa to consider taking malaria prevention tablets is a change to current ACMP guidelines for India [5] and remains in effect until further notice. Continued review of this advice will be made based on surveillance for malaria cases. Complete recommendations for other areas of India should be consulted [5].

The recommended malaria prevention tablets for Goa are chloroquine plus proguanil. Alternatives are mefloquine, atovaquone/proguanil (Malarone®) or doxycycline.

Travellers should seek medical attention promptly if they become unwell and inform their doctor that they have been in a malarious area. Healthcare workers should consider malaria in every ill patient who has recently returned from the tropics.

References

1. Health Protection Agency. Cluster of malaria cases from northern Goa. Health Protection Report [serial online] 2007; 1: 2. [accessed 9 March 2007] Available at http://www.hpa.org.uk/hpr/archives/2007/news2007/

news0207.htm#malaria

2. NaTHNaC. Cluster of malaria cases from northern Goa - update. 12 January 2007. [Accessed 9 March 2007] Available at http://www.NaTHNaC.org/pro/clinical_updates/

malaria_Goa120107.htm

3. Jelinek T, Behrens R, Bisoff Z et al. Recent cases of faliciparum malaria imported to Europe from Goa, India, December 2006-January 2007. Eurosurveillance [serial online] 2007 [accessed 9 March 2007]; 12(10): E070111.1. Available at http://www.eurosurveillance.org/ew/2007/070111.asp#1

4. Health Protection Agency. Cluster of malaria cases from northern Goa - update. Health Protection Report [serial online] 2007 [accessed 9 March 2007]; 1; 10. Available at http://www.hpa.org.uk/hpr/news/default.htm#malaria

5. Chiodini p, Hill D, Lalloo D. Lea G, Waler E, Whitty C and Bannister B. Guidelines for malaria prevention inb travellers from the United Kingdom. London, Health Protection Agency, January 2007. Available at http://www.hpa.org.uk/publications/2006/malaria/default.htm.