LAUSR

Malaria prevention guidelines are published each year from Public Health England (PHE). These are written by a panel of experts the Advisory Committee for Malaria Prevention (ACMP) and form the basis of advice UK healthcare professionals provide to their travellers. Such practice has been ongoing for a number of years, but 2017 sees a significant change in the advice provided for over 30 countries where the recommendation for prevention has gone from a choice of chemoprophylaxis in 2016 to one of bite avoidance instead. To achieve this, a full review of laboratory and epidemiological data from UK travellers, the World Health Organization and information from in-country experts was undertaken by ACMP. As a result, some countries in Central and South America, Southeast Asia and Pakistan have had their recommendations substantially revised with an emphasis of bite avoidance and awareness of risk rather than routine recommendation of chemoprophylaxis. Where such changes have been made, additional information is provided to advise that in exceptional circumstances following a stringent travel risk assessment, for groups at increased risk of severe or complex malaria, such as the elderly, immunosuppressed, those with complex co-morbidities and pregnant women, then a clinical decision could be made to advise chemoprophylaxis. In these circumstances, the appropriate drugs are named and expert advice can also be sought from dedicated National telephone helplines/fax services available in the UK. Another dynamic change in this year's UK guidelines is the making available of atovaquone/proguanil malaria chemoprophylaxis in pharmacies without the need for a prescription. This is expected to widely increase access to chemoprophylaxis for those who travel to risk areas. The recommendations provided are published also on the National Travel Health Network and Centre (NaTHNaC) website called TravelHealthPro, commissioned by PHE (https://travelhealthpro.org. uk/about). NaTHNaC have produced new maps to support the ACMP recommendations. These new maps are expertly developed and a new colour coding has been used to reflect the different levels of risk from “No” to “High risk”. Where appropriate, seasonal risk is displayed within the maps and where chemoprophylaxis is advised, this information is also included. All the maps are provided in the malaria guideline document as well. Guidelines for malaria prevention in travellers from the UK: 2017 is an extremely comprehensive publication detailing all aspects of malaria prevention advice pre travel and can be found at https://www.gov.uk/ government/publications/malaria-prevention-guidelines-for-travellersfrom-the-uk. Details of the malaria map development can be found at https:// travelhealthpro.org.uk/news/263/presenting-nathnac-malaria-maps2017. To see specific country guidance on TravelHealthPro go to https:// travelhealthpro.org.uk/countries. Below are some illustrations of the new malaria maps reproduced by kind permission of NaTHNaC, a service commissioned by Public Health England. Their dynamic, informative and beautifully illustrated website is used by travel health professionals and travellers alike and helps to keep us updated and informed on all aspects of pre travel care, standards and resources. See https://travelhealthpro.org.uk/