According to a study published on bmj.com, researchers from the London School of Hygiene and Tropical Medicine and the University of Oxford have found that individuals aged 65+ are approximately 10 times more likely to die from malaria after visiting a malaria-infected country than tourists aged between 18 to 35 years old. In addition, they found that the mortality rate is particularly high among tourists after visiting the Gambia, West Africa in the winter.
In order to examine fatal and non-fatal cases of malaria, the researchers conducted a study based on 20 years of UK data involving more than 25,000 patients.
The team discovered that tourists who contract malaria after visiting an infected country are more than 9 times more likely to die from the disease compared with individuals of African heritage traveling to meet friends or family.
Although most cases of travelers’ malaria do affect individuals of African heritage in the UK, their mortality risk from the disease is fairly low. According to the researchers they may be because they are exposed to malaria earlier, or have greater knowledge of the symptoms and usually seek medical attention sooner.
The researchers found that 4.6% (25/548) of people aged 65+ die from malaria compared with 0% in children under the age of 5. Overall, 81 out of 2,740 tourists with malaria died, a case mortality rate of 3.0%, compared with 26 out of 8,077 individuals visiting family and friends (0.32%). In addition, the mortality rate for people born in infected countries was 0.4% (36/8,937) compared with 2.4%.
Furthermore, case mortality was higher among individuals visiting the Gambia (3.9% [28/726]) than any other country in west Africa (0.4% [58/13,448]). However, when the researchers only examined tourists they found that this difference increased significantly, with a case mortality rate from the Gambia of 6.0% (20/333) compared with 1.4% (8/565) for those visiting other west African countries.
It is estimated that each year there are 250 million cases of malaria and more than 800,000 malaria-related deaths. The UK has one of the highest rates of imported malaria in the world, and half of the cases come from migrants traveling from infected countries. In addition, each year more people are traveling to infected countries. According to the researchers, low awareness of the dangers of the disease as well as low drug prophylaxis rates could be factors contributing to malaria deaths among tourists. Furthermore, over one fourth of malaria deaths occurred in December. The researchers state that this may be because travelers mistake malaria symptoms for common winter viruses, or may not be diagnosed quick enough over the holiday period.
The team found that lower death rates are associated with how often malaria is observed in an NHS region. This finding indicated that familiarity with treating malaria may result in better outcomes. Although the prognosis for malaria should be good if treated early, delay in seeking medical attention may be a significant factor to malaria mortality.
The researchers conclude that tourists (especially over 65+ years of age) who contract malaria are significantly more likely to die from the disease than people of African heritage, although those of African heritage who are visiting family and friends are considerably more likely to contract the disease as a result of low prophylaxis uptake.
The team highlight that it is vital that doctors provide pre-travel advice encouraging individuals to contact them immediately if they return from their holiday with a fever as well as the need for taking anti-malaria drugs. In addition, doctors should highlight the prevalence of malaria, the needs for early diagnoses, and mortality and they should also target individuals of African heritage.
Written by Grace Rattue