Imported malaria in children: a review of clinical studies

Imported malaria is a preventable disease, yet it is responsible for several thousand cases and a substantial number of deaths every year. There has been a pronounced rise in the incidence of imported malaria in most developed countries over the past three decades and, more concerning, Plasmodium falciparum, which is responsible for almost all cases of severe malaria, is now the most prevalent species. Children account for around 15-20% of all imported malaria cases and must be considered separately from adults because they have different risk factors for developing malaria and a higher risk of developing severe disease since they are more likely to be non-immune to malaria. We did a thorough review of the literature since 1980 to identify and critically assess clinical case series on children with imported malaria with respect to travel destination, reason for travel, the use of antimalarial prophylaxis, clinical presentation, delay in diagnosis, laboratory features, complications, management, and outcome. Children living in non-endemic countries and travelling during school holidays to visit family and relatives in their parents' country of origin currently account for the largest proportion of cases in many European countries. This group of travellers deserves special attention because they often do not take antimalarial prophylaxis or other preventive measures. There is a need for standardised recommendations on management and prevention of imported malaria in children, which should be supported by large multicentre clinical trials. A prospective national surveillance study on imported malaria in children was launched in the UK and Ireland through the British Paediatric Surveillance Unit in 2006, which may provide answers to some of the questions raised in this Review.