G UIDELINES FOR M ALARIA P REVENTION IN T RAVELLERS FROM THE U NITED K INGDOM 10
1. General Issues G UIDANCE G UIDELINES FROM THE FOR HPA M ALARIA ADVISORY P REVENTION C OMMITTEE IN ON MT ALARIA RAVELLERS P REVENTION FROM THE IN U NITED UK TRAVELLERS K INGDOM extend to risks <strong>from</strong> <strong>in</strong>fectious agents • establish procedures to use if an aris<strong>in</strong>g <strong>from</strong> work activities, ie risks to employee is presented with serious non-employees. The ACMP prophylaxis The MHSWR guidel<strong>in</strong>es provide aare <strong>in</strong>tended and imm<strong>in</strong>ent <strong>for</strong> UK-based danger, visitors and to broad <strong>malaria</strong> framework endemic <strong>for</strong> areas controll<strong>in</strong>g and may health not be •appropriate co-operate and <strong>for</strong> use co-ord<strong>in</strong>ate by those health and resid<strong>in</strong>g safety <strong>in</strong> at endemic work. COSHH areas. provides a and safety if <strong>the</strong>re is more than one framework Whilst <strong>the</strong>se aimed guidel<strong>in</strong>es at controll<strong>in</strong>g deal <strong>the</strong> with risks <strong>malaria</strong>, employer <strong>malaria</strong> <strong>in</strong> <strong>prevention</strong> a workplace. is only one <strong>from</strong> aspect hazardous of pre-travel substances advice. <strong>in</strong>clud<strong>in</strong>g An overall risk assessment-based package of <strong>in</strong>fectious travel health agents. advice should be provided. Control of Substances Hazardous In <strong>the</strong>se guidel<strong>in</strong>es, which have been specifically to Health developed Regulations <strong>for</strong> <strong>travellers</strong> 2002 <strong>from</strong> <strong>the</strong> Duties UK, <strong>the</strong>re under are a Section small number 3 of <strong>the</strong> of <strong>in</strong>stances HSWA where (as amended) <strong>the</strong> advice given differs <strong>from</strong> that <strong>in</strong> guidel<strong>in</strong>es <strong>from</strong> o<strong>the</strong>r countries or <strong>the</strong> World Health Organisation. This is because 6. <strong>travellers</strong> If people <strong>from</strong> work<strong>in</strong>g <strong>the</strong> UK under do not <strong>the</strong> usually control visit all possible 8. Under localities COSHH <strong>the</strong> of <strong>malaria</strong>-endemic manager is required and countries direction and of may o<strong>the</strong>rs not visit are treated <strong>the</strong> same as localities to as <strong>travellers</strong> <strong>from</strong> o<strong>the</strong>r countries. Many <strong>travellers</strong> <strong>from</strong> <strong>the</strong> UK who enter <strong>malaria</strong>-endemic countries are visit<strong>in</strong>g friends self-employed and relatives <strong>in</strong> <strong>for</strong> localities tax and <strong>from</strong> national which people tend • assess to migrate <strong>the</strong> risks to of <strong>the</strong> exposure UK. They todo not <strong>in</strong>surance <strong>the</strong>re<strong>for</strong>e suffer purposes, exactly <strong>the</strong>y <strong>the</strong> are same never<strong>the</strong>less patterns of <strong>malaria</strong> hazardous exposure substances as permanent <strong>in</strong> <strong>the</strong>ir residents treated or visitors as <strong>from</strong> employees o<strong>the</strong>r cultures. <strong>for</strong> health and workplace, safety 1.1 How purposes. to give It may, <strong>the</strong> advice <strong>the</strong>re<strong>for</strong>e, be • 1.2 prevent Medical exposure history or of substitute <strong>the</strong> traveller with a necessary to take appropriate action to less hazardous substance or protect Emphasise <strong>the</strong>m. to <strong>the</strong> If any traveller doubt <strong>the</strong> exists ABCD about of It is process/method essential that a full if possible, cl<strong>in</strong>ical history is <strong>malaria</strong> <strong>prevention</strong>: obta<strong>in</strong>ed, to <strong>in</strong>clude current medication, who Awareness is responsible of risk <strong>for</strong> <strong>the</strong> health and significant • control exposure health problems if <strong>prevention</strong> and any or safety Bite of <strong>prevention</strong> a worker, this could be clarified known substitution drug allergies. are not reasonably and Chemoprophylaxis <strong>in</strong>cluded <strong>in</strong> <strong>the</strong> terms of a contract. practicable, prompt Diagnosis and treatment Safe and effective <strong>malaria</strong> <strong>prevention</strong> However, a legal duty under Section 3 of • ma<strong>in</strong>ta<strong>in</strong>, exam<strong>in</strong>e and test <strong>the</strong> control requires a sound knowledge of <strong>the</strong> HSWA • Emphasise cannot that be passed whilst no on regimen by means is of medical measures, history eg of automatic <strong>the</strong> traveller. dos<strong>in</strong>g When <strong>the</strong>ir a contract 100% effective, and <strong>the</strong>re <strong>the</strong> will comb<strong>in</strong>ation still be duties of patients systems, seek pre-travel advice <strong>in</strong> primary towards preventive o<strong>the</strong>rs measures under Section advised 3 will of HSWA. give care, • provide this <strong>in</strong><strong>for</strong>mation <strong>in</strong><strong>for</strong>mation, will <strong>in</strong>struction be available and significant protection aga<strong>in</strong>st <strong>malaria</strong>. <strong>from</strong> <strong>the</strong>ir own practice records but <strong>in</strong> <strong>the</strong> If such workers are employed on <strong>the</strong> tra<strong>in</strong><strong>in</strong>g <strong>for</strong> <strong>the</strong>ir employees, and • Make use of visual aids, especially case of specialist travel cl<strong>in</strong>ics <strong>malaria</strong> basis <strong>malaria</strong> that <strong>the</strong>y distribution are responsible maps and <strong>for</strong> <strong>the</strong>ir <strong>prevention</strong> • provide health advice surveillance may be sought of at <strong>the</strong> own show health examples and safety, of <strong>the</strong> legal preventive advice first employees attendance. if appropriate. The General Medical should measures be sought advised, be<strong>for</strong>e such do<strong>in</strong>g as aids to Council (2001) bite <strong>prevention</strong>. 9. More <strong>in</strong><strong>for</strong>mation on COSHH <strong>in</strong> general • Discuss <strong>the</strong> choices of Management chemoprophylaxis of Health regimens and and Safety <strong>the</strong>ir at can be found <strong>in</strong> <strong>the</strong> COSHH Approved Work <strong>in</strong>dividual Regulations advantages 1999and Code of Practice (ACoP)4 and on disadvantages, <strong>in</strong>clud<strong>in</strong>g cost. Legionella <strong>in</strong> Legionnaires’ disease: The 7. • Under Provide <strong>the</strong>se <strong>the</strong> traveller Regulations with <strong>the</strong> written manager control of legionella bacteria <strong>in</strong> water of a <strong>in</strong><strong>for</strong>mation spa pool is on required <strong>malaria</strong> toand its systems ACoP5 (L8). <strong>prevention</strong>. The Department of Health • assess <strong>the</strong> risks <strong>in</strong> <strong>the</strong>ir workplace, has an <strong>in</strong><strong>for</strong>mation leaflet available <strong>in</strong> • use 11 different competent languages help to (see apply chapter health 9). and safety legislation, 1 states “If you provide treatment or advice <strong>for</strong> a patient, but are not <strong>the</strong> patient's general practitioner, you should tell <strong>the</strong> general practitioner <strong>the</strong> results of <strong>the</strong> <strong>in</strong>vestigations, <strong>the</strong> treatment provided and any o<strong>the</strong>r <strong>in</strong><strong>for</strong>mation necessary <strong>for</strong> <strong>the</strong> cont<strong>in</strong>u<strong>in</strong>g care of <strong>the</strong> patient, unless <strong>the</strong> patient objects.” ACMP suggests that a hand-held record of <strong>the</strong> <strong>malaria</strong> <strong>prevention</strong> measures advised is given to <strong>the</strong> traveller so that <strong>the</strong>y may pass it on to <strong>the</strong>ir GP. 11