Infections diagnosed in children and young people screened for malaria in UK emergency departments: a retrospective multi-centre study

ABSTRACT

Background

Data on imported infections in children and young people (CYP) are sparse.

Aims

To describe imported infections in CYP arriving from malaria-endemic areas and presenting to UK emergency departments (ED) who were screened for malaria.

Methods

This is a retrospective, multi-centre, observational study nested in a diagnostic accuracy study for malaria rapid diagnostic tests. Any CYP < 16 years presenting to a participating ED with a history of fever and travel to a malaria-endemic area between 1 January 2016 and 31 December 2017 and who had a malaria screen as a part of standard care were included. Geographical risk was calculated for the most common tropical infections.

Results

Of the 1414 CYP screened for malaria, 44.0% (n = 622) arrived from South Asia and 33.3% (n = 471) from sub-Saharan Africa. Half (50.0%) had infections common in both tropical and non-tropical settings such as viral upper respiratory tract infection (URTI); 21.0% of infections were coded as tropical if gastro-enteritis is included, with a total of 4.2% (60) cases of malaria. CYP diagnosed with malaria were 7.44 times more likely to have arrived from sub-Saharan Africa than from South Asia (OR 7.44, 3.78–16.41).

Conclusion

A fifth of CYP presenting to participating UK EDs with fever and a history of travel to a malaria-endemic area and who were screened for malaria had a tropical infection if diarrhoea is included. A third of CYP had no diagnosis. CYP arriving from sub-Saharan Africa had the greatest risk of malaria.

Abbreviations: CYP: children and young people; ED: emergency department; PERUKI: Paediatric Emergency Research in the UK and Ireland; RDT: rapid diagnostic test; VFR: visiting friends and relatives.

KEYWORDS:

• Children
• imported infection
• malaria
• tropical medicine
• emergency medicine

Acknowledgments

This multi-centre study would not have been possible without the work of the following teams: Sheffield Children’s Hospital: Glenda Amenos Barraza, Shammi Ramlakhan, Fiona Shackley, Mark Simmerson, Emma Wynne; John Radcliffe Hospital, Oxford: Emily Tough, Sally Beer, Charlotte Brown, Jiske Steensma; Bristol Royal Hospital for Children: Sarah Blakey; Royal Hospital for Children, Glasgow: Eleanor Shone, Steve Foster; Watford General Hospital: Michelle Jacobs, Mohamed Rineesh; Royal Berkshire Hospital: Katie Palmer, Manish Thakker; University Hospital of Wales, Cardiff: Jennifer Muller, Jeff Morgan; Chelsea and Westminster Hospital, London: Sophie McEvoy; Royal Hospital for Children and Young People, Edinburgh: Jen Browning; Addenbrookes Hospital, Cambridge: Kashif Malik, Jude Okoye; Royal Free Hospital, London: Shye-Wei Wong, Cynthia Diaba, Sudeepta Hemraj; North Middlesex Hospital, London: Poonam Patel, George Lawson, Katie Knight, Deborah McCartney; Northwick Park Hospital, London: Paul Tanto, Lauren Fraser, Sarah Al-Rawi, Kazim Ghafoor, Behrouz Nezavat, Anna Silva Ferreira; Whittington Hospital, London: Erum Jamall; Birmingham Children’s Hospital: Sarah Hadfield, Karen Davies, Stuart Hartshorn; St George’s Hospital, London: Heather Jarman.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Contributions

CB, TF, PT and GH conceived and designed the study. TF made the study power calculations and undertook the statistical analyses. CB, TF, PT, ML and GH analysed and interpreted the data. DW, VM, ML and NM ensured PERUKI network involvement, generated data and provided clinical perspectives. CB drafted the manuscript, which was edited by TF, ML and GH. CB and TF had full access to the data in the study and had final responsibility for the decision to submit for publication.

Additional information

Funding

The research was supported by the National Institute for Health and Care Research (NIHR), Community Healthcare MedTech and In Vitro Diagnostics Co-operative at Oxford Health NHS Foundation Trust. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. Thomas Fanshawe receives funding from the NIHR Applied Research Collaboration Oxford and Thames Valley at Oxford Health NHS Foundation Trust.