Business travellers need to be aware of malaria risk: International SOS

Source: International SOS. Fogging of an area likely to harbour malaria-infected mosquitoes.

To mark World Malaria Day 2023 (April 25), International SOS has encouraged organisations to support the global effort to invest, innovate and implement to deliver zero malaria.

Malaria continues to occur in more than 80 countries*, causing over 240 million infections each year, and numbers are growing, says International SOS. The World Health Organization estimates there were 2 million more cases of malaria globally in 2021 compared to 2020, while International SOS’ data shows the trend continued in 2022, with the number of requests for assistance related to malaria 10% higher than in 2021.

With the ongoing recovery of international business travel, there is a greater need to ensure protection against malaria for people who may have been exposed, International SOS points out. Business travellers should be aware of malaria as a potential diagnosis - the early symptoms include fever, a headache, and chills.

Global travel also has the potential to reintroduce or increase transmission of malaria in tropical and temperate countries that have currently eliminated or controlled transmission.

Dr Irene Lai, Medical Director at International SOS, commented: “Every organisation should review the malaria risk to their workforce and implement measures to protect them. For those that send employees to malarial areas, this includes education and awareness, pre-travel medical review and preventive supplies, and access to rapid diagnosis and treatment. For those operating in locations where malaria circulates, this should include surrounding communities through an integrated malaria control programme.”

Dr Dave Knight, a medical doctor and Malaria Specialist at International SOS, added: “Malaria cases and deaths have actually risen during the pandemic, and globally we seem to have lost some traction in controlling malaria. For the private sector, malaria remains a key health risk when operating in the tropics, especially in Africa and parts of Asia and South America. It is predicted with climate change that this risk could grow.

"Furthermore, there are no ground-shifting technology solutions imminent over the next few years that will allow significant mitigation of this risk in a company workforce. We still rely on the age-old interventions. On a positive note, the new RTS,S vaccine is being rolled out in high transmission areas in Africa in infants and young children. It is not suitable for adults yet provides moderate but important protection to very young children over the first few years of life. The private sector should support this initiative in communities within which they operate where appropriate.”

International SOS advises that business travellers to do a pre-travel risk assessment of their destination, and understand the symptoms and signs of malaria as well. If travelling to a malaria-prone area, they should mitigate the risk with suitable accommodation, and know when and how to take their emergency standby medication:

1. Review the malaria-risk to their workforce and if operating in malaria-prone areas, implement an integrated malaria control programme

2. Educate employees on the risk of malaria and the importance of personal protection measures against mosquito bites using the ABCDE approach.

- Awareness: be Aware of the risk and the symptoms.

- Bite prevention: avoid being bitten by mosquitoes.

- Chemoprophylaxis: if prescribed for, use chemoprophylaxis (antimalarial medication) to prevent infection.

- Diagnosis: immediately seek diagnosis and treatment if a fever develops one week or more after being in a malarial area

- Emergency: carry an emergency standby treatment (EST) kit if available and recommended

3. Provide preventive supplies such as insect repellent and anti-malarial drugs

4. Offer employees travelling to malarial areas access to pre-travel medical reviews and destination travel risk-assessments

5. Ensure travelling employees choose accommodations with a bed net, air-conditioning and screening on doors and windows

International SOS also provides consulting services for every part of a company’s malaria risk mitigation programme, including experienced entomology consulting, assessment and design vector control programmes, e-learning to educate employees, medical consulting to ensure proper diagnostic and treatment pathways and data management, as well as ensuring a programme is well managed.

Explore

Watch the associated short video at https://vimeo.com/798944207.

*2020 OECD figures state that malaria-endemic countries in Asia Pacific include Papua New Guinea, Solomon Islands, Pakistan, India, Nepal, the Philippines, Indonesia, Myanmar, the Lao PDR, Cambodia, Thailand, DPR Korea, China, Vietnam, Bangladesh, the Republic of Korea and Malaysia.

Malaria may soon be detected with a simple breath test

Source: CSIRO. Tests such
as this one, which captures
exhaled breath for chemical
analysis, may soon be used to
detect malaria.

Australian scientists at CSIRO, QIMR Berghofer Medical Research Institute and the Australian National University have made a significant discovery that could lead to a simple and quick "breath test" for malaria. Current malaria diagnosis techniques focus on using microscopes to look for parasites in blood, using a method discovered in 1880. 

The researchers looked at the breath of volunteers who had been given a controlled malaria infection as part of existing studies to develop new treatments, and found that the levels of some normally almost undetectable chemicals increased markedly in the breath of the volunteers during the malaria infection.

"What is exciting is that the increase in these chemicals were present at very early stages of infection, when many other methods would have been unable to detect the parasite in the body of people infected with malaria," Dr Stephen Trowell, Research Group Leader at CSIRO said.

"In addition to its potentially better sensitivity, human breath offers an attractive alternative to blood tests for diagnosing malaria."

The study, published in the Journal of Infectious Diseases, was conducted in two independent studies where experimental drug treatments were being tested in volunteers who had been given a very small dose of infection.

Using a sophisticated analytical instrument, the researchers identified four sulphur-containing compounds whose levels varied across the time course of the malaria infection.

"The sulphur-containing chemicals had not previously been associated with any disease and their concentrations changed in a consistent pattern over the course of the malaria infection," Professor James McCarthy, Senior Scientist in Clinical Tropical Medicine at QIMR Berghofer said. "Their levels were correlated with the severity of the infection and effectively disappeared after they were cured."

"Now we are collaborating with researchers in regions where malaria is endemic, to test whether the same chemicals can be found in the breath of patients," Dr Trowell said.

"We are also working with colleagues to develop very specific, sensitive and cheap 'biosensors' that could be used in the clinic and the field to test breath for malaria."
In 2013, according to the WHO, there were almost 200 million cases and over half a million deaths due to this disease.

More effective asthma treatment with an anti-malarial drug

Asthma may soon be controlled more effectively thanks to a pharmacological discovery by researchers from the National University of Singapore (NUS).

The team, led by Associate Professor Fred Wong from the Department of Pharmacology at the NUS Yong Loo Lin School of Medicine, together with Dr Eugene Ho, a recent PhD graduate from the Saw Swee Hock School of Public Health at NUS, have discovered that artesunate, a herbal-based anti-malarial drug, can be used to control asthma with better results than other drugs currently available.

The team revealed that artesunate can produce effects similar to those by dexamethasone, the most potent steroid remedy currently available, but with fewer side effects. As long term usage of steroids have many potential negative side effects, artesunate may be a safer alternative for asthmathic patients. The discovery was published in the journal Metabolomics on 16 July 2014. Artesunate had not been linked with asthma prior to this research.

Moving forward, the team led by Assoc Prof Wong will further explore the therapeutic and pharmacological effects of artesunate for asthma, as well as for other medical conditions. They also intend to work with industry partners to test the effects of artesunate on asthmatic patients.

Dr Ho is also furthering his research as a Research Fellow at the Saw Swee Hock School of Public Health at NUS, where he hopes to discover more beneficial effects of artesunate and accelerate the adoption of this drug for clinical tests.

Artesunate is made from artemisinin (青蒿素) which is from the plant Artemisia annua, or sweet wormwood. On August 12, Sanofi and Path announced that it is now shipping synthetic artemisinin-derived drugs for malaria at a large scale, paving the way for a form of artesunate that may be available in bigger quantities and more cheaply than previously possible.