High case-fatality from falciparum malaria in UK travellers returning from The Gambia: A case series

Background: Following two deaths from falciparum malaria in UK travellers returning from The Gambia, we investigated the epidemiology of cases during part of the "winter sun" season in 2005/2006. Method: We obtained data on laboratory-confirmed cases of falciparum malaria (diagnosed 1.11.2005 to 31.1.2006) in travellers returning from The Gambia. Information on prophylaxis and deaths, for all Gambia associated cases from 2000 to 2004, and for cases from all countries between 1.11.2005 and 31.10.2006 (excluding series cases), was used for comparison. We obtained Gambian tourist figures from the World Tourism Organisation. Results: Twenty-six cases of falciparum malaria were identified between 1.11.05 and 31.1.06 (32 during the entire year), of whom three died and seven required intensive care. Twenty cases (80%) were on holiday, and half the year's cases were diagnosed in December. Of the 24/26 where it was determined, half had taken no prophylaxis and half had taken inadequate prophylaxis. The annual risk was 75 per 100,000 charter flight passengers. Conclusions: Compliance with chemoprophylaxis was poor and the case-fatality rate high (11.5% vs. 3.8% in 2000-2004). A clear message emphasising the importance of chemoprophylaxis, bite avoidance and prompt diagnosis was disseminated to clinicians, public and the travel industry.