12 January 2007

Cluster of Plasmodium falciparum malaria cases from northern Goa - update

Since late December 2006, eight cases of Plasmodium falciparum malaria associated with travel to Goa in India have been reported in European travellers [1]. Four of the travellers, previously reported, stayed in beach resorts in Goa for two to three weeks. The remaining travellers visited other areas of India in addition to Goa.

Another case of P. falciparum malaria was diagnosed on 29 December 2006, in a traveller from the United Kingdom [2]. The patient had travelled with four others to a beach resort north of Goa’s capital Panaji. The patient has since made a full recovery.  

In recent years, numbers of malaria cases reported from India have been low and decreasing, so that most advisors, including the Health Protection Agency, Advisory Committee for Malaria Prevention (ACMP), have ceased recommending chemoprophylaxis for visitors to low-risk regions [1, 3].

Advice for travellers

The ACMP advises that health professionals who are advising travellers:

• highlight the risk of malaria
• instruct on the use of mosquito bite avoidance measures
• recommend malaria prevention tablets to those travellers who will be visiting Goa, particularly areas north of Panaji, and who will be remote from medical care.

The advice to take malaria prevention tablets for certain travellers to Goa is a change in the current ACMP advice for India [3]. This advice remains in effect until further notice as the situation is clarified. Continued review of this advice will be made based on surveillance for malaria cases. Complete recommendations for other areas of India should be consulted [3].

The recommended chemoprophylaxis is chloroquine plus proguanil. Alternatives are mefloquine, atovaquone plus 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 and for those with a fever on return from the tropics the illness should be considered to be malaria until proven otherwise.

References

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

2. Health Protection Agency. Cluster of malaria cases from northern Goa. Health Protection Report [serial online] 2007 [accessed 12 January 2007]; 1;2 Available at  http://www.hpa.org.uk/hpr/news/#malaria

3. Chiodini P, Hill D, Lalloo D, Lea G, Walker E, Whitty C and 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/publications/2006/malaria/default.htm