5 January 2007

Cluster of Plasmodium falciparum malaria cases from northern Goa

Over late December 2006 and early January 2007 four cases of Plasmodium falciparum malaria in travellers who visited northern Goa have been reported from three European countries [1,2]. The travellers had visited beach resorts north of Panaji.

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 [3]. This current cluster of cases has coincided with increased rainfall in the affected region.

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. An early review of this advice will be made, based on surveillance for malaria cases.

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. ProMED-mail. Malaria - Denmark, ex India (Goa). ProMED-mail 2006; 1 Jan: 20070101.0001. [Accessed 4 January 2007] http://www.promedmail.org/pls/promed/f?p=2400:1001:

8999966726245447672::NO::F2400_P1001_BACK_PAGE,

F2400_P1001_PUB_MAIL_ID:1010,35684

2. ProMED-mail. Malaria - Germany, Sweden ex India (Goa). ProMED-mail 2006; 2 Jan: 20070102.0014. [Accessed 4 January 2007] http://www.promedmail.org/pls/promed/f?p=2400:1001:

8999966726245447672::NO::F2400_P1001_BACK_PAGE,

F2400_P1001_PUB_MAIL_ID:1010,35699

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.