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PHE issues updated malaria prevention guidelines

Public Health England (PHE) has issued updated guidelines on malaria prevention for UK travellers.

Of note, the PHE Advisory Committee on Malaria Prevention (ACMP) has added South Africa to the list of countries with temporary recommendations. The ACMP recommends that practitioners engage as much as possible with those planning to visit Africa to emphasise that the malaria situation there remains serious and requires rigorous application of preventive measures.

The ACMP also reviewed malaria risk for travellers to Southeast Asia, South America, parts of the Caribbean and south Asia. This has resulted in substantial changes to advice where the malaria risk has been judged to now be below the threshold to advise chemoprophylaxis.

In 2016, there were 1618 cases of malaria recorded in the United Kingdom. Plasmodium falciparum, the most dangerous causative agent, accounted for more than 80% of cases, followed by Plasmodium vivax (10.3%) and Plasmodium ovale 5.4%, both of which are associated with the relapsing disease.

Chloroquine-resistant falciparum malaria is now effectively universal, the PHE says, and the parasite has also developed resistance to a variety of other agents. In areas of chloroquine-resistant P falciparum, the PHE recommends mefloquine 250 mg once-daily, doxycycline 100 mg once-daily, or the new combination treatment atovaquone-proguanil 250/100 mg once-daily. For areas where there is little chloroquine resistance, the recommendation is chloroquine 155 mg and proguanil 100 mg, twice-daily.

The ACMP recommends that causal prophylaxis is continued for 7 days after leaving a malarious area and suppressive prophylactic drugs should be continued for four weeks.

Healthcare professionals working in England, Wales or Northern Ireland are advised that the updated ACMP guidelines are now the preferred source of guidance for malaria prevention.


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