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"PART I - SPECIAL REPORTS
MALARIA
During 1970, 101 cases of malaria were reported for inclusion in the Communicable Disease
Report from England, Wales, Scotland and Northern Ireland, including five deaths. It is the
lethality of the disease rather than the likelihood of its spread which constitutes the danger, and
is desirable that all physicians in this Country should be aware of the problem.Up to date in 1971
four deaths have occurred. It may be noted that in addition to intravenous therapy with antimalarial
drugs in patients with cerebral malaria, a lifesaving measure is the use of dexa methasone
(Woodruff, A.W. and Dickinson, C.J., 1968). No indigenous infection was reported in 1970.
An analysis of the cases indicates the main type of circumstances in which patients contract
malaria. Proper appreciation of the situation by the general practitioner and medical officer of
health will enable adequate measures of prophylaxis to be recommended and early diagnosis and
treatment of the disease to be effected.
Detailed information was obtained in 68 of the 101 cases of malaria reported. Table 1 summarises
the type of travellers who developed malaria on return to this country. As might be expected,
the majority of cases occurred in long term (i.e. a year or more) residents abroad, and if service
personnel are included, 57 per cent of the total come into this category. Only seven cases were
in immigrants. About 10 per cent of the infections were probably relapses.
It is worth noting that nine people apparently contracted the disease by being bitten by
mosquitoes at an intermediate halt, and probably in such circumstances, the traveller thought it
was unnecessary to take a prophylactic drug. Equally he might well deny having been ina malarious
area when asked by his physician the question "where have you been?". Another type of case
which may fail to be recognised is the school child who returnsfrom a short visit to parents in the
tropics and exhibits fever during an epidemic of influenza at school.
Table 2 gives the interval between return from abroad to the time of development of symptoms.
About 10 per cent of cases show delayed incubation periods of six months or more. Fortunately
this type of case excludes the malignant P. falciparum and, even if misdiagnosed at first, is unlikely
to have severe consequences, for the other infections are almost never fatal.
Table 3 shows the species of parasite concerned, and the probable place were the disease
was contracted. The two most dangerous areas are seen to be West Africa and the Far East (particularly
Malaysia).