Malaria prophylaxis policy for travellers from Europe to the Indian Sub Continent

TropNetEurop is an electronic network which links surveillance data on imported infectious diseases throughout Europe. The network is designed to identify emerging trends in regional or global destinations as they affect European travellers. Sentinel surveillance is carried out by participating clinical sites using rapid case reporting. This data can serve as a convenient tool to identify changes relevant to Public Health bodies and focus further investigations.A number of countries in the Indian Subcontinent (ISC) including India, Pakistan, Bangladesh and Sri Lanka continue to report endemic malaria transmission to the World Health Organisation [1]. Malaria prevention in travellers from most European and North American countries to this region has relied on the use of chemoprophylactic drugs. Although Plasmodium vivax malaria has been the most frequent species in surveillance reports, ongoing transmission of Plasmodium falciparum has meant that the recommended drug regimens have included drugs to prevent both falciparum and vivax malaria. The number of imported cases of malaria reported from these countries has been noted to be declining and the continued use of chemoprophylaxis for travellers to these countries has been questioned [2]. Switzerland and Germany have discontinued recommending chemoprophylaxis and introduced standby therapy for travellers to the ISC [3].In Sweden, routine chemoprophylaxis for travellers to India is not recommended [4].Reports to National malaria surveillance bodies of malaria cases contracted in the above four countries between 1999 and 2004 were analysed. The data was provided through TropNetEurop members who have access to national data and who could provide details by year and, where possible, species. The data from the UK was complemented by data from the International Passenger Survey (IPS). The IPS is a year round survey of incoming and outgoing passengers at all major exit ports. Around 0.2% of all travellers are interviewed an