Recent cases of falciparum malaria imported to Europe from Goa, India, December 2006-January 2007

An increase in numbers of malaria cases has recently been reported in travellers returning from India, in particular from the state of Goa, on the west coast. These cases have been reported to the European Network on Imported Infectious Disease Surveillance (TropNetEurop, http://www.tropnet.net). In the past two years, there have been no reports of malaria in European travellers to Goa. However, since late November 2006, the malaria surveillance map of the network has shownan unusually intensive signal from India, indicating an increase in the number of malaria reports from that region, including Goa. By 10 January, eight patients had been reported: two in Germany, four in Denmark, and two in Sweden. With the exception of two Danish cases, all patients travelled independently of one another. The two German patients, one of the Swedish patients and one of the Danish patients stayed in Goa for 2-3 weeks and had not visited other regions within India. No changes in the general recommendations for travellers have been made in Germany. In addition, the recent cluster of malaria cases imported from Goa has also prompted the Advisory Committee for Malaria Prevention in United Kingdom Travellers (ACMP) to issue temporary change to its recommendations. The ACMP advises that travel advisors should highlight the risk of malaria, instruct on the use of mosquito bite avoidance measures [6], and recommend malaria chemoprophylaxis to those travellers who will be visiting Goa, particularly areas north of Panaji, and who will be remote from medical care. This advice remains in effect until further notice as the situation is clarified. The recommended chemoprophylaxis is chloroquine plus proguanil. Alternatives are mefloquine, atovaquone plus proguanil, or doxycycline.