1 June 2007

Malaria in São Paulo, Brazil

The Advisory Committee on Malaria Prevention (ACMP) has received information that 67 cases of Plasmodium vivax malaria have been reported in the city of São Paulo, Brazil during the previous six months [1]. This is a higher number of cases than is usually seen; approximately 15 to 30 cases of malaria are reported in residents of the area annually [2]. The recent increase in cases is thought to be partly due to the occupation of forested areas in the south of the city by local residents that may have increased their contact with mosquitoes. There may also be improved malaria surveillance. 

In addition, a case of P. vivax malaria has been reported to the Malaria Reference Laboratory (MRL) in a traveller from the United Kingdom who visited Cachoeiras do Macacu, approximately 100km northeast of Rio de Janeiro [1]. 

Advice for travellers

P. vivax malaria is widely distributed in tropical South America, although distribution is patchy and usually sparse [3]. The risk of malaria in travellers visiting areas outside of the Amazon Basin, including the coastal states of São Paolo and Rio de Janeiro, is still considered to be very low. Therefore the ACMP does not recommend malaria prevention tablets outside of the Amazon Basin in Brazil as the risk of adverse events is thought to be higher than the risk of malaria.

All travellers to Brazil should be advised to take insect bite avoidance measures. The current recommendations for malaria prevention can be found in the Guidelines for Malaria Prevention in Travellers from the United Kingdom.

The ACMP will monitor the situation in Brazil. Any change in recommendations will be posted as a Clinical Update on the NaTHNaC and HPA websites.

References

1. Health Protection Agency. Malaria cases in Sao Paulo area of Brazil, South America. Health Protection Report [serial online] 2007; 1: 22. Available at  http://www.hpa.org.uk/hpr/archives/2007/hpr2207.pdf

2. Superintendencia de Controle de Endemias. (website in Portuguese) [accessed 31 May 2007] Available at http://www.sucen.sp.gov.br/base_dados/tab_mal/texto_tab_mal

_ca_aut7.htm#sr1

3. Cerutti C Jr, Boulos M, Coutinho AF et al. Epidemiologic aspects of the malaria transmission cycle in an area of very low incidence in Brazil. Malar J. 2007; 6: 33. Available at http://www.malariajournal.com/content/pdf/1475-2875-6-33.pdf