Malaria

Malaria continues to be a significant hazard for aircrew and travellers from the United Kingdom visiting tropical countries. Currently approximately 1600 cases of Malaria in the UK are reported each year. The majority of these cases involve travellers to West Africa. Malaria is in essence a preventable disease. Unfortunately, each year there are several deaths associated with Malaria and a number of patients develop ongoing serious health problems (Malaria of the brain, enlargement of the spleen etc.) It goes without saying that anyone with acute Malaria will be unfit to exercise the privileges of their medical certificate, but there are also potential issues for fitness to fly related to chemoprophylaxis.

The 3 cornerstones (ABC) for the management of the risk of malaria infections are:

Awareness

Recognition that Malaria is a serious and preventable disease. Increased awareness raises compliance with preventative measures and ensures that those who develop symptoms of the disease seek early treatment:

• a high temperature (fever) of 38°C (100.4F) or above
• sweats and chills
• generally feeling unwell
• muscle pains
• headaches
• cough
• diarrhoea

This includes that travellers, who recently (up to 3 months ago) visited areas affected by Malaria, make health care staff aware of this risk.

Bite prevention

Prevention is better than cure.

• The use of repellents – DEET based repellents are the most effective
• Use of insecticide to kill any mosquitoes present in accommodation
• Use of mosquito nets – impregnation with repellents increases their effectiveness by 50%
• Wearing of appropriate (long-sleeved) clothing and the impregnation of clothes with repellents
• Use of room protection (air conditioning and ceiling fans)

Chemoprophylaxis

Medication which prevents exposure to Malaria from becoming an infection. Malaria prophylaxis should normally be started before travelling to affected areas, taken throughout the stay in the area and, depending on the specific medication being taken, for up to 4 weeks after leaving countries where Malaria is present.

Most medication used for prophylaxis is safe to take from an aero-medical perspective (currently only Mefloquine is not acceptable for aeromedical certification) but individual tolerance to, and absence of, side-effects incompatible with aviation duties has to be established.

Advice on the appropriate prophylactic medication regimes for individuals needs to be sought from appropriate sources (GP/Travel Clinic/Occupational Health Department) which will take into account the traveller’s individual health needs and the area of intended travel.

Guidance for Health Care Professionals (HCP) is available from the GOV.UK Website.

As fake medication is in circulation both on the internet and abroad the advice to travellers is to obtain medication from a reputable outlet in the UK before commencing travel.

The following do not work for the prevention of Malaria: homeopathic remedies/herbal remedies/electronic buzzers/vitamin B supplements/garlic/Marmite/bath oils.

Standby Treatment

The issue of standby treatment is generally only considered for those travelling to remote areas where access to medical services is not possible within 24 hours of the development of symptoms of Malaria. This would normally not be applicable to aircrew.

Where the issue of standby treatment is deemed necessary relevant advice should be sought from appropriate Health Care Providers (HCPs). Guidance can be found on the HPA Website.

Summary

• Malaria remains a serious risk to international travellers
• All aircrew should take sensible precautions – ABC above
• Up to date advice on preventative medication should be sought from HCPs who have expertise in infectious diseases and knowledge of the aviation environment
• Aircrew developing symptoms of malaria during their stay in Malaria-affected areas or upon their return should seek urgent medical advice and inform their HCP of their visit to such an area