Preventing malaria in travellers

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David G Lalloo, reader in tropical medicine1,
David R Hill, director 23

¹Liverpool School of Tropical Medicine, Liverpool L3 5QA
²National Travel Health Network and Centre, London WC1E 6AU
³London School of Hygiene and Tropical Medicine, London WC1E 7HT

Correspondence to: D G Lalloo dlalloo{at}liverpool.ac.uk

Summary points

Malaria can be prevented by avoiding bites and using appropriate chemoprophylaxis
An individual harm-benefit assessment should be made for each traveller
The possibility of malaria should be kept in mind for any traveller returning from an endemic area

Protecting travellers against malaria is increasingly important as the number travelling overseas continues to rise, with a disproportionate increase in visits to tropical areas where malaria transmission may occur. Each year about 1700 cases of malaria occur in the United Kingdom, 1300 in the United States, and 3000 in France.1 2 3 In the UK, about 75% of these cases are caused by Plasmodium falciparum, which produces the most severe form of malaria; five to 16 deaths occur annually and are nearly always in cases of falciparum malaria.1

Most infections occur in travellers resident in the UK, rather than in visitors to the UK. Malaria is a major risk for travellers if they do not take chemoprophylaxis or if they take incorrect prophylaxis.4 5 This review explores how to protect travellers from malaria. Most of the evidence base for malaria prophylaxis comes from small randomised controlled trials or observational studies.

Approach to preventing malaria

A useful approach is the “ABCD” of malaria prevention: Awareness of risk, Bite avoidance, Compliance with chemoprophylaxis, and the prompt Diagnosis of malaria (box 1)

Box 1 Harm-benefit assessment based on the “ABCD” approach to malaria prevention*

Assessment and awareness of malaria risk

Detailed geographical location of trip (name of country alone not adequate); time of year may also be relevant. See www.nathnac.org or www.cdc.gov/malaria/travel/index.htm
Duration of time in the area
Activities to be undertaken (relates to likelihood of exposure to infected mosquitoes—urban environment is generally less risky than rural environment)