Travellers returning to Sweden with falciparum malaria: Pre-travel advice, behaviour, chemoprophylaxis and diagnostic delay

Transmission Risk from Imported Plasmodium vivax Malaria in the China-Myanmar Border Region

Malaria importation and local vector susceptibility to imported Plasmodium vivax infection are a continuing risk along the China–Myanmar border. Malaria transmission has been prevented in 3 border villages in Tengchong County, Yunnan Province, China, by use of active fever surveillance, integrated vector control measures, and intensified surveillance and response.

Beginning Again

Settling in a new country exposes immigrants to various health risk factors, and the existing literature alludes to immigrant women being more vulnerable than men. This article highlights some of the difficulties faced by West African women while settling into life in Australia. A qualitative design was used to explore the experiences of West African immigrant women living in Sydney, Australia. Data were collected using audiotaped face-to-face interviews, and narratives were transcribed verbatim and thematically analyzed. Twenty-one West African women participated in this study. The findings revealed the many challenges that participants faced after immigrating to their new country, and these are presented under the following themes: beginning again and experiencing loneliness and isolation. Participants encountered difficulties in developing social networks and obtaining employment, and as a result, they felt lonely and isolated. Therefore, nurses and health care professionals need to incorporate screening for precursors of emotional and social well-being issues when caring for this population.

High case-fatality from falciparum malaria in UK travellers returning from The Gambia: a case series

BACKGROUND

Following two deaths from falciparum malaria in UK travellers returning from The Gambia, we investigated the epidemiology of cases during part of the "winter sun" season in 2005/2006.

METHOD

We obtained data on laboratory-confirmed cases of falciparum malaria (diagnosed 1.11.2005 to 31.1.2006) in travellers returning from The Gambia. Information on prophylaxis and deaths, for all Gambia associated cases from 2000 to 2004, and for cases from all countries between 1.11.2005 and 31.10.2006 (excluding series cases), was used for comparison. We obtained Gambian tourist figures from the World Tourism Organisation.

RESULTS

Twenty-six cases of falciparum malaria were identified between 1.11.05 and 31.1.06 (32 during the entire year), of whom three died and seven required intensive care. Twenty cases (80%) were on holiday, and half the year's cases were diagnosed in December. Of the 24/26 where it was determined, half had taken no prophylaxis and half had taken inadequate prophylaxis. The annual risk was 75 per 100,000 charter flight passengers.

CONCLUSIONS

Compliance with chemoprophylaxis was poor and the case-fatality rate high (11.5% vs. 3.8% in 2000-2004). A clear message emphasising the importance of chemoprophylaxis, bite avoidance and prompt diagnosis was disseminated to clinicians, public and the travel industry.

Problem pathogens: prevention of malaria in travellers

Human infection with Plasmodium spp leading to clinical episodes of malaria probably began very early in the history of humankind and has persistently inflicted disease among human populations. Malaria is currently considered the world's most important parasitic infection. The global impact of malaria is incalculable and appears to be worsening over the past decades. Although most of this burden of disease is carried by developing tropical countries, cases of imported malaria acquired by international travel are increasingly reported. These numbers are growing because of increased travel to malaria-endemic areas and also due to increased risk of transmission in these areas. Indeed, travel has contributed to the global spread of malaria during the history of humankind. Travellers visiting malaria risk areas should use both personal protective measures and chemoprophylaxis. Non-adherence to chemoprophylactic regimens is frequently secondary to drug side-effects. Therefore, a careful risk-benefit analysis on the use of antimalarial prophylaxis should be carried out in every individual travelling to malaria risk areas. Standby malaria self-treatment represents an alternative in some travellers. However, carefully selected and geographically specific antimalarial drug regimens should be recommended to non-immune people travelling to high-risk areas.