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The ongoing global pandemic of SARS-CoV-2 (Covid-19) poses unique diagnostic and clinical management challenges in regions where seasonal epidemic-prone diseases are endemic. Diseases such as dengue, malaria, seasonal influenza, leptospirosis, chikungunya, scrub typhus and bacterial infections often
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present with febrile syndromes that mimic or co-exist with SARS-CoV-2 infection, complicating diagnosis and treatment. This document provides guidelines for preventing, diagnosing and managing such co-infections. A high level of suspicion is essential during the monsoon and post-monsoon seasons, taking into account region-specific disease prevalence. While the WHO's case definition for SARS-CoV-2 is broad and sensitive, the need for parallel testing for co-infections, in accordance with the protocols of the MoHFW, ICMR, NVBDCP and NCDC, is necessitated by overlapping clinical features. Ensuring the availability of reliable rapid diagnostic kits and applying integrated clinical and laboratory approaches are crucial to improving patient outcomes in the context of concurrent infections.
Accessed on 26/08/2025.
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Malaria and HIV, two of the world’s most deadly diseases, are widespread, but their distribution overlaps greatly in sub-Saharan Africa. Consequently, malaria and HIV coinfection (MHC) is common in the region. In this paper, pertinent publications on the prevalence, impact, and treatment strategie
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s of MHC obtained by searching major electronic databases (PubMed, PubMed Central, Google Scholar, ScienceDirect, and Scopus) were reviewed, and it was found that the prevalence of MHC in SSA was 0.7%–47.5% overall. Prevalence was 0.7%–47.5% in nonpregnant adults, 1.2%–27.8% in children, and 0.94%–37% in pregnant women. MHC was associated with an increased frequency of clinical parasitemia and severe malaria, increased parasite and viral load, and impaired immunity to malaria in nonpregnant adults, children, and pregnant women, increased in placental malaria and related outcomes in pregnant women, and impaired antimalarial drug efficacy in nonpregnant adults and pregnant women. Although a few cases of adverse events have been reported in coinfected patients receiving antimalarial and antiretroviral drugs concurrently, available data are very limited and have not prompted major revision in treatment guidelines for both diseases. Artemisinin-based combination therapy and cotrimoxazole are currently the recommended drugs for treatment and prevention of malaria in HIV-infected children and adults. However, concurrent administration of cotrimoxazole and sulfadoxine–pyrimethamine in HIV-infected pregnant women is not recommended, because of high risk of sulfonamide toxicity. Further research is needed to enhance our understanding of the impact of malaria on HIV, drug–drug interactions in patients receiving antimalarials and antiretroviral drugs concomitantly, and the development of newer, safer, and more cost-effective drugs and vaccines to prevent malaria in HIV-infected pregnant women.
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Malaria is a significant risk for travelers to endemic regions. This patient information highlights essential prevention through mosquito protection and, when indicated, chemoprophylaxis with Atovaquone/Proguanil, Doxycycline, or Mefloquine. Emergency self-treatment options may be carried in specifi
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c settings. Travelers are advised to follow medication schedules carefully, use consistent bite protection, and seek immediate medical care if fever occurs during or after travel. Early recognition and treatment are crucial to prevent severe or life-threatening complications.
Accessed on 26/08/2025.
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The Centrum für Reisemedizin (CRM) is a comprehensive source of information, guidelines and resources on travel medicine for healthcare professionals and travellers. Its website offers up-to-date recommendations on disease prevention, vaccinations, malaria prophylaxis and health risks in different
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regions around the world. As part of the Thieme Group, the CRM promotes evidence-based medical counselling, training and educational materials for patients, with the aim of improving travel health outcomes and ensuring safe international mobility.
Accessed on 26/08/2025.
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The website "Bereit zu Reisen" provides comprehensive guidance on malaria prophylaxis for travelers to endemic regions. It emphasizes preventive strategies, including mosquito bite avoidance through protective clothing, insect repellents, and sleeping under treated nets. In addition, the site detail
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s chemoprophylaxis options, explaining recommended medications, dosing schedules, and duration of use before, during, and after travel. Emergency self-treatment procedures are also outlined for situations where immediate medical care is unavailable. Overall, the resource serves as a practical reference for travelers, combining evidence-based recommendations on exposure prevention, medication use, and prompt response to potential malaria symptoms to ensure safe and healthy travel.
Accessed on 26/08/2025.
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In 2019, 1.5 billion international tourist trips were counted worldwide. Germany, with 70.8 million vacations lasting ≥ 5 days, was one of the populations most willing to travel. These days, even elderly and multimorbid persons regularly travel long-distance, which can be associated with significa
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nt health risks. By advising travelers and implementing preventive measures, the risk of illness can be reduced significantly.
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This document, issued by the United Nations Medical Directors in July 2021, outlines vaccination and malaria prophylaxis recommendations for UN personnel travelling on official business and UN healthcare workers. The guidance aims to minimise the risk of vaccine-preventable diseases and malaria by f
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ocusing on three key areas:(1) routine vaccines, such as those for influenza, measles, polio, hepatitis B, varicella and SARS-CoV-2 (the virus that causes the disease known as 'Covid-19'), which are recommended for all staff regardless of their destination;
(2) destination-based measures, including mandatory vaccines (e.g. yellow fever, meningitis and polio), recommended vaccines depending on regional risks (e.g. cholera, typhoid, hepatitis A and rabies) and WHO-advised malaria prevention through mosquito protection and chemoprophylaxis. The third area covers vaccines for healthcare workers with direct patient or laboratory exposure, including hepatitis B, influenza, diphtheria, pertussis and others. The recommendations emphasise the importance of pre-travel medical consultations, adherence to host country requirements, and individualised risk assessments.
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Depending on the health profile of the traveller, the type of travel to be undertaken, and the place of transit and destination, travellers may face various health risks during travel. The International travel and health collection is an update of International travel and health (2012) and serves as
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an entry point for other World Health Organization (WHO) publications that provide further information. Its primary target audience is travel health practitioners and travel health professionals, who provide health advice to travellers on appropriate precautions to be taken to minimize any travel-related health risks in unfamiliar environments, before, during and after travel. The guidance may also be of interest to health authorities who intend to support travel health professionals in their jurisdiction or develop
health advice for their population. It may also be of interest to travellers who wish to obtain such information for themselves as well as those working in the travel industry, such as agents and organizers, airlines and shipping companies.
Module 3 outlines the clinical features, geographical distribution and chemoprophylaxis against malaria, as well as personal protection measures against mosquitoes that travellers should take during their journey and at destinations, and treatment for those who are infected.
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Published by the World Health Organization, International Travel and Health 2012 provides comprehensive guidance on the health risks associated with international travel, as well as practical measures to prevent or reduce adverse health outcomes. Although the book is primarily intended for medical a
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nd public health professionals who advise travellers, it is also useful for travel agents, transport providers and informed travellers. It covers a variety of topics, such as preventing infectious diseases, environmental hazards, accident risks, vaccination requirements, malaria prophylaxis and travel medical kits. Particular attention is given to travellers visiting friends and relatives, those travelling at short notice, and those journeying to remote or high-risk destinations. Recommendations are based on individual health status, destination, travel duration and behaviour. The publication emphasises the shared responsibility of travellers, healthcare providers and the travel industry in promoting safe travel and minimising preventable illnesses. Online updates provide real-time information on outbreaks, vaccine guidance and disease distribution.
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This website provides comprehensive guidance on vaccinations, malaria prevention and general health measures for travellers to tropical and developing regions. It emphasises two main vaccination criteria: the administrative requirements of the destination country and the actual health risks to the t
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raveller. Malaria prevention measures include chemoprophylaxis (e.g. atovaquone-proguanil, doxycycline or mefloquine) and vector control methods such as insecticide-treated nets, insect repellents and environmental protection measures. Additional travel health risks covered include bites from other arthropods, envenomations, dog and mammal bites, food and water hygiene, traveller's diarrhoea, and considerations for pregnant women, infants, the elderly, and people with chronic conditions. It strongly recommends carrying a travel medical kit and having a pre-travel consultation. Overall, the document aims to minimise illness and ensure safe travel.
Accessed on 27/08/2025.
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This ECDC overview summarises the number of travel-associated malaria cases reported in the EU/EEA in 2023. The cases are based on confirmed reports through the EpiPulse platform and only include infections acquired outside mainland Europe. The data show the number of cases and the infection rate pe
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r 100,000 travellers by country of infection. The aim is to inform public health authorities and travellers about malaria risk. Analyses are limited to locations with repeated cases or sufficient case numbers. Infection rates were calculated using IATA air travel data. The findings reflect reported cases only and do not imply ongoing transmission.
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Combination therapy is a cornerstone of modern malaria treatment, particularly in the context of widespread multidrug resistance. Using two or more antimalarial drugs with different mechanisms simultaneously enhances efficacy, shortens treatment duration, improves compliance and delays the developme
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nt of resistance. Artemisinin-based combination therapies (ACTs), such as artemether–lumefantrine, artesunate–amodiaquine and artesunate–sulfadoxine/pyrimethamine, are highly effective in rapidly clearing parasites and reducing gametocyte carriage. They are also generally well tolerated. Non-artemisinin combinations, quinine-based regimens and novel combinations (e.g. piperaquine–dihydroartemisinin) offer alternative therapeutic options, although clinical experience with these remains limited. Although ACTs are the preferred first-line treatment, factors such as cost, local drug resistance patterns, safety during pregnancy and paediatric use must inform implementation and policy decisions.
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To mark the International Day of the African Child, Medicines for Malaria Venture (MMV) celebrated the inclusion of three of its antimalarial medicines on the WHO Model List of Essential Medicines (EML) and the EML for Children (EMLc). These are two artemisinin-based combination therapies (ACTs) for
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adults, children and infants, and a rectal artesunate formulation for the pre-referral treatment of severe malaria in young children. The approved therapies — pyronaridine–artesunate, dihydroartemisinin–piperaquine and rectal artesunate — offer child-friendly formulations and are the first-line treatment for uncomplicated malaria caused by Plasmodium falciparum and P. vivax. Inclusion in the EMLc facilitates national adoption, improves access to high-quality treatments and addresses the disproportionate malaria burden among children under five. This supports global efforts to reduce malaria mortality and advance elimination.
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The annual bulletin of the Mekong Malaria Elimination (MME) programme is a yearly report that reviews ongoing efforts to combat multidrug resistance and eliminate malaria in the 6 countries of the Greater Mekong subregion (GMS): Cambodia, China (Yunnan province), Lao People's Democratic Republic, My
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anmar, Thailand and Viet Nam.
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The Mekong Malaria Elimination (MME) programme is an initiative aimed at supporting Greater Mekong Subregion (GMS) countries – Cambodia, Lao People's Democratic Republic, Myanmar, Thailand, Viet Nam, and Yunnan (China) – in achieving the goal of malaria elimination by 2030. Data for this epidemi
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ological summary were compiled from country reports. Between July and September 2024, 48 115 malaria cases were reported. During that period, GMS countries recorded 44% fewer cases, with P. falciparum + mixed and P. vivax cases declining by 81% and 36%, respectively. Meanwhile, testing declined by 25% when compared to the same period in 2023.
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Antimicrobial resistance (AMR) and malaria remain significant public health challenges in the WHO Eastern Mediterranean Region (EMR). In 2021, the region reported 1.7 million sepsis-related deaths, with 373,000 associated with bacterial AMR. High antibiotic consumption, particularly in high-income c
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ountries, combined with rising usage in middle-income countries, has accelerated the emergence of drug-resistant infections. Malaria management is further complicated by biological threats, including vector insecticide resistance, PFHRP2/3 gene deletions, and antimalarial drug resistance, alongside insufficient trained personnel and limited molecular surveillance capacity. Effective strategies to address these challenges include strengthening regional and cross-border surveillance networks, designating WHO collaborating centers for molecular monitoring, enforcing national treatment policies, and raising public and healthcare provider awareness about rational antimalarial and antibiotic use. These measures, coupled with sustainable funding and enhanced therapeutic efficacy studies, are essential to reduce the development and spread of drug-resistant malaria and improve overall health outcomes in the EMR.
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Malaria remains a significant public health concern in the SADC region, accounting for 20% of childhood deaths, as well as prompting numerous outpatient visits and hospitalisations. Around three-quarters of the population, including 35 million children under the age of five and 8.5 million pregnant
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women, are at risk. Transmission patterns vary from high and stable in the north to malaria-free in the south, with low, unstable and seasonal zones in between. Although interventions such as indoor residual spraying (IRS), insecticide-treated nets (ITNs/LLINs), intermittent preventive treatment in pregnancy (IPTp), rapid diagnostic tests (RDTs), and artemisinin-based combination therapies (ACTs) have reduced the malaria burden, challenges persist in terms of funding, human resources, surveillance, and cross-border coordination. Achieving malaria elimination in the SADC region requires harmonised regional standards, strengthened surveillance, and improved access to quality treatment and policy prioritisation.
Accessed on 27/08/2025.
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The 2024 World Malaria Report shows that the malaria burden remains overwhelmingly concentrated in Africa. The continent accounted for 94% of global cases and 95% of malaria-related deaths in 2023. Although the number of malaria cases increased globally from 204 million in 2000 to 246 million in 202
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3, the number of deaths declined from 805,000 to 569,000. Children under five are still the most affected group, accounting for 76% of malaria deaths in Africa. A few countries, particularly Nigeria and the Democratic Republic of the Congo, carry the highest burden. Since 2000, Africa has significantly reduced malaria incidence and mortality, averting over 1.7 billion cases and 12 million deaths. Nevertheless, malaria continues to pose a significant health challenge, necessitating ongoing action and investment.
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In 2022, a total of 6,131 confirmed malaria cases were reported across the EU/EEA. Of these, 5,375 had a known importation status and nearly all (99.8%) were travel-related. Only 13 infections were acquired within Europe, with seven occurring in France, three in Germany, two in Spain and one in Irel
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and. A distinct seasonal peak was observed from July to September, reflecting travel to malaria-endemic regions. Notification rates were higher among men than women, with a male-to-female ratio of 2:1. France reported the highest number of cases, followed by Germany, Spain, Italy and Belgium. After dropping sharply in 2020 due to travel restrictions imposed during the pandemic, overall notification rates increased again in 2021 and 2022, reaching 0.8 cases per 100,000 people. These findings emphasise that malaria in Europe is predominantly an imported disease closely linked to international travel, with sporadic local transmission being rare.
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The Best Buys for Disease Elimination is a practical, evidence-based guide to the most effective actions for countries to implement in order to eliminate communicable diseases. The guide highlights the efficient use of resources and prioritizing populations in vulnerable situations.
“The Region
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of the Americas is advancing steadily towards the elimination of communicable diseases,” said Dr. Jarbas Barbosa, PAHO Director. “To achieve this, it is necessary to increase and sustain high vaccination coverage, engage communities to expand access to diagnosis and treatment, strengthen surveillance, and bring integrated services to marginalized communities, incarcerated populations, and those living in informal settlements,” he added.
For each disease and condition included in the Elimination Initiative, the Best Buys are presented as one-page documents with clear, accessible information. Each Best Buy summarizes expected impact goals, disease elimination targets, key operational indicators, and priority interventions that have proven to be cost-effective in different contexts.
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