UKHSA publishes 2022 and 2023 UK malaria cases in returned travellers

Malaria risk reminder for travellers and health professionals as UK Health Security Agency confirm 2022 and 2023 imported UK malaria cases in England, Wales and Northern Ireland

Ahead of World Malaria Day on 25 April 2024, the United Kingdom Health Security Agency (UKHSA) have published details of malaria cases imported into England, Wales and Northern Ireland (EWNI) in 2022 and 2023 [1]. A total of 2,004 malaria cases were reported in the UK in 2023. This is an increase in case numbers compared to 2022, when a total of 1,369 imported malaria cases were reported in EWNI. Malaria case numbers for 2022 and 2023 have now returned to pre-pandemic levels.

Malaria is a serious, potentially fatal, parasitic infection spread by the bite of an infected mosquito and is a risk in many tropical and subtropical areas worldwide. Malaria in the UK is a travel-associated infection, as malaria no longer occurs in the UK [2]. Most UK malaria cases report travel to Africa, with the majority travelling to West Africa and every year malaria deaths are reported in UK travellers who visited risk countries [3].

All malaria deaths are preventable and imported malaria cases are strongly associated with failure to adhere to recognised preventive measures.

Advice for travellers

Before you travel

Simple steps like using insect repellent, covering exposed skin, sleeping under treated bed nets and taking malaria prevention tablets can lower your risk of malaria. Even if you have visited or lived in a country before, you will not have the same protection against infections as local people and are still at risk. Get pre-travel advice as soon as possible, ideally four to six weeks before you travel, although last-minute advice is still important if time is short before you go [1].

Individual country malaria risk and prevention advice can be found on our Country Information pages.

While you are away

When visiting malaria risk areas, make sure you follow ALL these important steps for malaria prevention [4]:

• Awareness of malaria risk at your destination
• Bite prevention - avoiding mosquito bites helps reduce your risk
• Chemoprophylaxis - take the right malaria prevention tablets* recommended for your destinations
• Diagnosis - if you have any malaria symptoms you must get urgent medical help without delay

*If taken as prescribed, modern prevention methods are highly effective (more than 90% protective) and can greatly reduce your risk of dying.

More advice for travellers about mosquito bite avoidance is available.

When you return

Suspected malaria is a medical emergency - some types of malaria can make you very ill and can be life-threatening.

If you or any of your family has a fever or flu-like illness after being in a malaria risk country, you must seek immediate medical attention.

Tell your doctor or nurse that you have travelled to a country with a risk of malaria and ask for a same day result malaria test. Remember you could still have malaria even up to a year after a trip to a malaria-risk region [4].

Advice for health professionals

Some types of malaria can rapidly progress to severe and life-threatening illness if not quickly treated [1, 4, 5]. Malaria must be suspected in anyone with a fever or history of fever who has returned from or previously visited a malaria risk country, regardless of whether they have taken antimalarials.

The shortest incubation period for malaria is six days. Most patients infected with the Plasmodium falciparum parasite have symptoms in the first few months after exposure and almost all within six months. Malaria infections caused by other types of the parasite may more commonly present later than six months after exposure and symptoms can be delayed for years [5].

If a traveller has symptoms and visited a malaria endemic area in the previous year, they must have an urgent blood test for malaria with a same day result. Information for health professionals about blood tests and how to request them in the UK is available from the UKHSA Malaria prevention guidelines for travellers from the UK (page 52) [4].

Health professionals can obtain expert advice on malaria treatment from:

• Hospital for Tropical Diseases
• Liverpool School of Tropical Medicine
• Local infectious diseases unit [4]

All malaria-positive blood tests should be confirmed by the Malaria Reference Laboratory.