Fever pitch: Why malaria still demands our respect

By Dr Eddy Bajrovic*

There’s good news for Aussies planning to visit a malaria-infected country: The odds of avoiding the mosquito-borne disease have improved dramatically.

Over the last 15 years, the number of global cases of malaria has fallen by 37%, while the number of deaths has plummeted by a staggering 60%, according to a landmark World Health Organisation (WHO) report, ‘Achieving the malaria MDG target’**.

The vast majority of malaria cases and deaths occur in children in sub-Saharan Africa, which is where global malaria control and eradication measures have been concentrated.

But, international travellers have benefitted too: 15 years ago, around 1000 Australian travellers returned from an overseas trip with malaria. This year there have been just 153 cases.

The worldwide drop in malaria infections since the year 2000 means that the MDG (Millennium Development Goal) goals aimed at halting and reversing the incidence of malaria – especially in the more heavily infected regions – are being met.

In financial terms, the cost of beating malaria has been – and will continue to be – high. To ensure success, annual funding for malaria will need to triple – from US$ 2.7 billion today to US$ 8.7 billion by 2030.

Countries on track to eliminate malaria

Highlights of the WHO report included:

- Of the 106 countries and territories reporting malaria transmission in 2000, 102 are on track to see infection rates fall further by the end of this year.

- Thirteen of countries reported no new malaria cases in 2014, while 6 reported fewer than 10 new cases, putting them on well on track to eliminate the disease.

- Countries in the Caucasus and Central and Eastern Asia reported the most rapid decreases.

- Fifteen countries, mainly in sub-Saharan Africa, accounted for 80% of malaria cases and 78% of deaths globally in 2015. A popular destination with Australian travellers, India is third among 15 countries with the highest number of malaria cases and deaths. 

“A great public health success…”

To put the figures into human terms: the 60% drop in the global malaria death rate since 2000 has resulted in 6.2 million lives being saved – the vast majority of them children, the WHO said in a news release accompanying the new report.

Dr Margaret Chan, the WHO’s Director-General, described the advances in global malaria control as “one of the great public health success stories of the past 15 years”.

However, while cases and deaths have declined, nearly half of the world's population – 3.2 billion people – remain at risk. Last year, there were 214 million new cases and 438,000 deaths.

Clearly, the fight to contain and eliminate malaria has a long way to go.

Expert malaria advice essential

While the gains are wonderful news for those living with malaria, international travellers shouldn’t become complacent.

In any malaria-infected country, the battle to control the disease can ebb and flow from one year to the next.

In any given year, climatic conditions may (or may not) favour mosquito breeding, while funds allocated to control outbreaks can be suddenly diverted if other health priorities emerge.

Travellers aren’t likely to be aware of these factors so, more than ever, Australians visiting malaria-infected counties need expert advice from doctors experienced in travel medicine about their particular risk of infection.

Vexed question of malaria meds – or not

The reason malaria must continue to get our respect is because it remains the most common potentially life-threatening post-travel infection. 

But, whether or not a traveller visiting a malaria-infected areas should take one of the drugs designed to prevent infection rarely comes down to a simple ‘yes’ or ‘no’. 

The decision often hinges on a host of issues. Among them, the season of travel, the areas to be visited, the type of accommodation, and the length of any possible exposure.

The possibility of unacceptable side effects from one drug or other may also influence the decision.

Post-travel fever may not be trivial

Regardless of your destination and whether or not you take anti-malaria medication during your trip, it’s just as important to prevent insect bites while away and monitor your health when you return home.

Most of us slip straight back into work mode within a day or two.

And, as holiday memories fade, it can be tempting to dismiss a temperature as trivial: a nuisance that a few Panadol will fix in a day or two.

And, it might be: For 1-in-10 people with a post-travel fever, the cause will be the flu, or a respiratory or urinary tract infection – something you might just as easily have picked up at home.

However, the cerebral strain of malaria, P. falciparum also begins with a fever. Unlike the more common infections, that slight fever can become rapidly fatal without urgent expert treatment.

Take the cautious approach to treatment

If you develop a fever within days or even weeks of travel, see your GP or travel doctor urgently. And, it’s vital that you provide a complete rundown of your travel itinerary.

Once routine infections have been considered and discounted, any of the tropical or infectious diseases known to occur in the country you visited need to be considered as the cause of your illness.

Tropical infections are usually linked to particular activities: a bite from a mozzie or other insects, parasites encountered in fresh-water lakes and streams, or one of the pathogens typically found in contaminated food or water.

Because many travel illnesses have nonspecific signs and symptoms, a unique exposure may provide the only clue to correctly identifying the illness.

What’s critical is limiting the time lost before beginning targeted treatment – particularly when it comes to malaria.

It’s far better to get tested for the more serious diseases sooner rather than later.

* Dr Bajrovic is the Medical Director of Travelvax Australia.

** Download and read ‘Achieving the malaria MDG target’ as a PDF.

Read more about malaria, the danger times for transmission, and tips for avoiding bites from the mosquitoes that carry it. You can also call Travelvax Australia’s travel health advisory service (1300 360 164) to learn more any of the mosquito-borne diseases at your destination, as well as arrange a consultation to receive any recommended or required vaccinations and personalised illness prevention advice.