Malaria death risk for elderly

Older people are at an increased risk of death from malaria, researchers warned yesterday.

Dr Anna Checkley of the London School of Hygiene and Tropical Medicine, UK, and her team say that malaria causes avoidable deaths every year in people who travel to countries where it is endemic.

The team set out to see which travellers are at greatest risk of dying from malaria, in order to improve health messages. They analysed 20 years of UK national figures covering 25,054 patients, of whom 184 died.

Results appear in the British Medical Journal. "Mortality increased steadily with age, with a case fatality of 4.6 per cent in people aged above 65 years," they report.

This equates to a nearly eleven-fold increase in risk compared with 18 to 35 year olds. Tourists are more than nine times more likely to die from malaria than those of African heritage visiting friends or family. The risk is particularly high for tourists returning from holidays in the Gambia, West Africa.

People of African heritage have a lower risk of dying from the disease, possibly due to early exposure to malaria, or to greater awareness of the symptoms and a tendency to seek medical help earlier.

"Most travellers acquiring malaria are of African heritage visiting friends and relatives," write the authors.

"In contrast the risks of dying from malaria once acquired are highest in the elderly, tourists, and those presenting in areas in which malaria is seldom seen. Doctors often do not think of these as high risk groups for malaria; for this reason they are important groups to target in pre-travel advice."

Risk factors for mortality from imported falciparum malaria in the UK over 20 years: an observational study. Checkley, A. M. et al. The British Medical Journal March 28 2012 doi: 10.1136/bmj.e2116