Trends in imported childhood malaria in the uk: 1999-2003

Shamez Ladhani ^1*, Rashna J Aibara ², Marie Blaze ³, Valerie Smith ³ and Delane Shingadia ¹

¹ Academic Centre for Child Health, Royal London Hospital, Whitechapel, London, United Kingdom
² Department of Paediatrics, Central Middlesex Hospital, London, United Kingdom
³ Malaria Reference Laboratory, Health Protection Agency, London School of Hygiene &Tropical Medicine, United Kingdom

^* To whom correspondence should be addressed. E-mail: drshamez{at}aol.com.

Accepted 19 June 2006

Abstract

Objective: To describe the epidemiology of imported malaria in children in the UK.

Methods:Surveillance data on imported malaria collected through an enhanced surveillance network set up by the Malaria Reference Laboratory was analysed for cases diagnosed between January 1999 and December 2003.

Results: Over the 5 year study period, 9238 cases were reported to the Malaria Reference Laboratory and children accounted for 1456 (14.8%) cases. The number of imported paediatric malaria cases fell from 326 in 1999 and 241 in 2003. Malaria infection occurred in children of all ages and the number of cases increased gradually with age. Visiting family and relatives was the most common reason for travel (59.5%), with only 7.2% travelling to a malaria endemic area on holiday. Most infections (88.4%) were acquired in Africa, mainly Nigeria (49.7%). P. falciparum was responsible for 81.7% of all cases, followed by P. vivax (11.1%). The number of both P. falciparum and P. vivax cases fell gradually from 262 and 45 cases in 1999 to 196 and 20 cases in 2003, respectively. Antimalarial prophylaxis was taken by 39.0% of 500 children with malaria who had travelled to an endemic country. The proportion of children with malaria who had taken antimalarial prophylaxis decreased steadily from 53% in 1999 to 29% in 2003. Two children (0.14%) died compared to 62 adults (0.76%) over the 5 year study period (p=0.007).

Conclusions: Although the incidence of malaria has started to fall, a significant number of children are still diagnosed with malaria in the UK. In addition, the proportion of children with malaria who had taken antimalarial prophylaxis is falling. While it is reassuring to note the low mortality, there is an urgent need to improve preventive measures among families travelling to high-risk countries.

Keywords: epidemiology, imported malaria, outcome, paediatric, prophylaxis

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