Malaria prevention guidelines for travellers from the UK

Due to reported increases in malaria cases in Khartoum and the impact of current civil unrest on health services there, antimalarial chemoprophylaxis is now advised for all travellers to Sudan, including Khartoum; atovaquone-proguanil or doxycycline or mefloquine is recommended. This change will remain in place for 6 months, then be reviewed. Anyone returning from Sudan should be vigilant for the signs of malaria and seek immediate medical attention if they have a fever or flu-like illness.

First identification of Plasmodium falciparum artemisinin resistance in the UK (ex Uganda)

Malaria is a potentially life-threatening infection caused by protozoan parasites of the genus Plasmodium. There were 1,375 and 1,475 infections caused by Plasmodium falciparum in the UK in 2018 and 2019, respectively. Numbers of imported cases fell during the coronavirus (COVID-19) pandemic, but have increased since and provisional data from the Malaria Reference Laboratory indicate that the total for 2022 may exceed the 2019 figure.

Clinicians are reminded to be vigilant and consider malaria in travellers unwell after returning from a malaria risk country, especially with a fever or flu-like symptoms.

The recommended treatment for uncomplicated falciparum malaria in UK patients is artemisinin-based combination therapy (ACT); Artemether-lumefantrine (Riamet®) is the first line therapy of choice.

Since 2007, evidence has emerged of artemisinin-resistant P. falciparum characterised by the pfk13 gene marker, initially in South East Asia and then in Africa in 2020.

In September 2022 the first case of artemisinin-resistant P. falciparum carrying the variant pfk13_675V was detected in the UK in a UK resident following travel to Uganda.

Uganda is an important destination for UK travellers, and the Malaria Reference Laboratory continues to monitor closely for further evidence of ACT treatment failure in the UK.

Cases of suspected antimalarial treatment failure should be discussed urgently with the local infection service and expert advice on treatment is also available from the Hospital for Tropical Diseases and the Liverpool School of Tropical Medicine.

All malaria-positives, from all geographical areas, should be confirmed in the Malaria Reference Laboratory. Please send an aliquot of the EDTA blood plus 2 thin and 2 thick blood films. Details are obtainable at www.malaria-reference.co.uk or please telephone 020 7927 2427 for further advice on sending samples.

Due to the widespread flooding in Pakistan, antimalarial chemoprophylaxis is currently advised for travellers to flood-affected areas; atovaquone-proguanil or doxycycline ormefloquine is recommended.

Southern and central Pakistan have been most affected, particularly Balochistan and Sindh provinces.

Further information on affected areas is available in the Pakistan 2022 Floods Response Plan: 1 September 2022 to 28 February 2023.