title: Increasing Plasmodium falciparum malaria in southwest London: a 25 year observational study.
abstract: OBJECTIVE
  To identify changes in the presenting number and species of imported malaria in children in southwest London.
  
  
  METHODS
  A prospective single observer study over 25 years (1975-99) of all cases of paediatric malaria seen at St George's Hospital.
  
  
  RESULTS
  A confirmed diagnosis was made in 249 children (56% boys; 44% girls; median age 8.0 years). Of these, 53% were UK residents and 44% were children travelling to the UK. A significant increase was noted in the number of cases over the 25 years (1975-79: mean 4.8 cases/year; 1990-99: mean 13.7 cases/year). Over the 25 years Plasmodium falciparum was seen in 77%, P vivax in 14%, P ovale in 6%, and P malariae in 3% of cases. P falciparum had increased in frequency (1975-79: P falciparum 50%, P vivax 50%; 1990-99: P falciparum 82%, P vivax 6%), associated with an increase in the proportion of children acquiring their infection in sub-Saharan Africa. Median time between arrival in the UK to the onset of fever was: P falciparum, 5 days; P ovale, 25 days; P malariae, 37 days; and P vivax, 62 days. Median time interval between the onset of fever to commencement of treatment was 4 days. This had not improved over the 25 year period. Only 41% of UK resident children presenting to hospital had taken prophylaxis and the overall number of symptomatic children taking no prophylaxis was increasing.
  
  
  CONCLUSIONS
  Imported childhood P falciparum malaria is increasing in southwest London associated with increasing travel from sub-Saharan Africa. Over the 25 year period there has been no improvement in chemoprophylaxis rates or time to diagnosis.
authors.affiliation: Department of Haematology, St George's Hospital, Blackshaw Road, London SW17 OQT, UK.
authors.forename: J P
authors.initials: JP
authors.lastname: Williams
authors.forename: M
authors.initials: M
authors.lastname: Chitre
authors.forename: M
authors.initials: M
authors.lastname: Sharland
mesh_terms: D000293:Adolescent; D017954:Africa South of the Sahara; D002648:Child; D002675:Child, Preschool; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008131:London / Q000453:epidemiology; D016778:Malaria, Falciparum / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D008297:Male; D011446:Prospective Studies; D012621:Seasons; D013997:Time Factors; D014195:Travel