TRAVAX update on Malaria advice in India

Friday 3rd October 2014

TRAVAX, part of Health Protection Scotland, is our source of information and advice on malaria prophylaxis. Their guidance is used to create our own malaria prophylaxis resource.

Following ongoing discussion amongst the relevant authorities, TRAVAX has issued updated guidance, including their rationale, for malaria prophylaxis in India.

Numark members are asked to annotate their copy of the 2014 Malaria prophylaxis guide accordingly. The updated advice will be incorporated into the next edition.

There is no clear agreement on the risk of malaria for travellers going to India and recommendations differ among authorities who produce malaria advice, including World Health Organisation (WHO), Centers for Disease Control and Prevention (CDC), the Advisory Committee on Malaria Prevention in UK Travellers (ACMP) and the Scottish Malaria Advisory Group (SMAG).

The last systematic review of the malaria advice and malaria map of India, for TRAVAX and fitfortravel was conducted by SMAG in 2012 and the methods used were published on TRAVAX.

In 2013 and 2014 SMAG has undertaken a number of reviews, looking at the incidence of side effects of antimalarials and their efficacy and the use of emergency standby treatments.

New malaria advice for India;

Taking these reviews into account and the previous methodology for India advice 2012, SMAG has therefore agreed on the following approach to 2014 India recommendations:

  • High risk with chloroquine resistance is found in north-eastern states including Assam and Orissa.
  • Low risk (with additional advice) in the Andaman and Nicobar Islands, Andhra Pradesh, Chhattisgarh, Goa, Gujarat, Madhya Pradesh, Maharashtra and West Bengal, bite avoidance is the mainstay of prevention. Antimalarial chemoprophylaxis may be considered for certain higher risk groups of traveller, including:
    1. those with extended travel into rural areas.
    2. those visiting friends and relatives.
    3. those without a spleen.
    4. those who are immunosuppressed or immunocompromised.
    5. travellers with significant co-morbidity.
  • Low to no risk in parts of the states of Himachel Pradesh, Jammu and Kashmir and Sikkim, and also in the cities of Bangalore, Kolkata, Mumbai, Nagpur, Nasik and Pune.+

Chemoprophylaxis

  • High risk areas

Atovaquone/proguanil OR doxycycline OR mefloquine is advised throughout the year. If these drugs are unsuitable (e.g. in some young children and in early pregnancy) chloroquine PLUS proguanil may be used, it is very important to emphasise the importance of urgent medical attention for any feverish illness.

  • Low risk areas with additional advice

For those travellers with additional risk (as above) atovaquone/proguanil OR doxycycline OR mefloquine is advised throughout the year. If these drugs are unsuitable (e.g. in some young children and in early pregnancy) chloroquine PLUS proguanil may be used, it is very important to emphasise the importance of urgent medical attention for any feverish illness.

  • Low to no risk areas

Antimalarials are not usually advised, but, as in all areas of India, bite avoidance should be practiced.