Managing malaria in Australia

World Malaria Day (25 April) aims to bring attention to international efforts to roll back the disease, which is transmitted by the anopheles mosquito. Endemic in 97 countries, malaria’s burden is greatest among some of the poorest and most vulnerable of the world’s population.
 
‘[Rolling back malaria] is a really important goal, because of the huge effect it’s having, particularly on children under five and pregnant women,’ Dr Penny Burns, a GP with a special interest in travel medicine, told newsGP.
 
‘The amount of work that’s been done has been tremendous and malaria has been rolled back in certain regions of the world, while in other areas it hasn’t worked quite as well.
 
‘I think it’s something we all need to contribute to, but it’s huge battle and we’ve got a long way to go yet.’
 
Australia is fortunate to be one of the planet’s few tropical areas to have largely won the battle after the Northern Territory (NT) was declared malaria-free in 1981. Infected anopheles mosquitoes do appear in the NT and Far North Queensland from time to time, but there is a strong infrastructure in place to prevent them from taking root.
 
‘Australian public health units are regularly looking for community outbreaks of malaria,’ Dr Burns said. ‘If there’s a cluster of malarial cases, they are on the case very quickly and they go in and manage the vector, which is the insects.’
 
The strongest risk factor for contracting malaria for most Australians is travel to countries in which the disease is endemic.
 
‘People who live in malarial zone areas pick up a little bit of low-grade immunity if they don’t get the disease as a full-blown case, but as travellers we have no immunity so we’re at higher risk,’ Dr Burns explained.
 
‘So that ease of travel [for Australians] means we need to be really careful. You do see people coming back to Sydney who have been in Papua New Guinea, for example, who have acquired malaria over there.’
 
Dr Burns believes the most important role a GP can play in fighting malaria is in educating patients about how to avoid contracting the disease altogether.
 
‘If you can avoid being bitten by a malarial mosquito, you’re not going to get malaria’ Dr Burns said.
 
‘You need to use [insecticide] impregnated nets if you’re going into areas where there’s mosquitoes; wear light, long, loose-fitting clothing at night; use insecticide with Deet in it.
 
‘And then if people do get a fever when they’re overseas or when they come back, they need to know to present to the doctor.’
 
GPs play a very important role in diagnosing malaria among returning travellers. A diagnosis needs to be achieved as quickly as possible, not just to provide the correct treatment to the patient, but also to prevent further outbreaks.
 
‘If the vector is then found to be in, for example, Far North Queensland, it’s less likely to spread and be transmitted to other people – because we don’t want malaria to actually become resident in the mosquitoes,’ Dr Burns explained.
 
To provide a malaria diagnosis, it is important for GPs to keep the disease in mind when consulting with febrile patients who have recently travelled in tropical and sub-tropical countries. The next step is a blood test designed to detect the disease and identify the disease type (out of five different types of malaria). Other healthcare workers may then need to become involved post-diagnosis.
 
‘If the patient had severe falciparum malaria, for example, it would require hospitalisation and treatment under an infectious diseases physician. The public health unit would also get involved,’ Dr Burns said.

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