Lesson of the week: Malaria at Christmas: risks of prophylaxis versus risks of malaria

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Abstract
Health professionals need to educate travellers about the dangers of malaria and the importance of prophylaxis There was a large increase in the number of cases of falciparum malaria imported into the United Kingdom and reported to the malaria reference laboratory in the first quarter of 1998.1 The two factors cited to explain this increase were unusually heavy rains in east Africa and a reduction in the use of the most effective antimalaria drug, mefloquine.1 At the same time there was an increase in the number of cases of severe malaria in the United Kingdom.1 During December 1997 and January 1998 this hospital treated five patients for severe malaria and gave advice on a further 20 patients with malaria who had been admitted to intensive care units throughout England. Of the 25 patients, 13 were male (median adult age 50; range 23 to 85) and two were children. Twenty two of those treated were of European origin. Altogether 20 patients had travelled to east Africa (16 to Kenya and at least six of these to Mombasa); five had travelled to west Africa. Median parasitaemia was 16% (range 1.1% to 60%). Ten patients (40%) had taken no prophylaxis; one of these was a Kenyan man of Asian origin who was on holiday in the United Kingdom. Prophylactic drugs had been prescribed for 15 patients: 11 had been prescribed proguanil and chloroquine, two had been prescribed mefloquine, and two had been prescribed other drugs. Nine of the 15 had not taken the drugs as prescribed. Thus 19 of the 25 (76%) had taken either inadequate doses or no prophylactic drugs. The cost to the NHS for intensive care for these patients exceeded £160 000 ($256 000). We report on …