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Guidance

Appendix 1d. UKMEAG methodology

Updated 17 June 2026

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This publication is available at https://www.gov.uk/government/publications/malaria-prevention-guidelines-for-travellers-from-the-uk-2026/appendix-1d-ukmeag-methodology

Purpose

To provide guidelines for health professionals on the prevention of malaria for travellers from the UK, updated annually or as soon as there is a significant change in the distribution or behaviour of malaria, or the need to consider new advice on drugs and anti-insect measures.

Assessing in-country risk

The location, level of endemicity (parasite rate, entomological inoculation rate) and species of malaria parasites present are evaluated using data from:

  • World Health Organization (WHO) Global Malaria Programme, World Malaria Report
  • estimates of the P. falciparum parasite rate and entomological inoculation rate published by the Malaria Atlas Project
  • the number of cases and deaths in-country from published and unpublished sources
  • Centers for Disease Control and Prevention (CDC) information for Central and South America, a region where the CDC has local knowledge
  • local, expert contacts of the London School of Hygiene and Tropical Medicine Malaria Centre as necessary

Returned traveller data

The UKHSA Malaria Reference Laboratory, London (MRL) database captures 56% of cases (66% for P. falciparum) (140).

Numbers of cases are also converted to attack rates where good denominator data are available. Details of the data requested on all imported malarias can be seen in the MRL case report form.

Enhanced surveillance of malaria cases from a country or region is undertaken following a major change in UK Malaria Expert Advisory Group (UKMEAG) recommendations for travellers to that location.

Information on case numbers, species of parasite and special groups (for example, pregnant travellers) is sought.

Deaths are all subject to a detailed confidential audit.

MRL data on molecular markers of resistance to anti-malarial agents is reviewed.

Available preventive measures

New information on methods of malaria prevention for travellers, in relation to both efficacy and any unwanted effects is reviewed. Information on efficacy, adverse events and interactions with concomitant medication is reviewed for:

  1. Bite prevention products using data from the published literature and the WHO Pesticide Evaluation Scheme (WHOPES).
  2. Chemoprophylaxis and Standby Emergency Medication, using data from:
    • Medicines and Healthcare Products Regulatory Agency (MHRA) literature on chemoprophylaxis and stand-by treatment
    • efficacy and tolerance reports
    • specific drug trials
    • comparative studies
    • surveillance data and case-control studies
    • post-marketing surveillance
    • systematic reviews (Cochrane)
    • adherence and use

Other jurisdictions

Guidelines produced by WHO, CDC, Health Canada, Switzerland, Germany and Austria and Italy are compared with the conclusions reached by UKMEAG. The actual malaria situation in a particular country is the same whoever looks at it, yet published guidelines for malaria prevention written for travellers from non-endemic countries can and do differ. When malaria data is least good or limited, recommendations are extremely dependent on subjective expert opinion which results in different recommendations for chemoprophylaxis. This reflects the different health systems present in those countries, their experts’ tolerance of malaria risk versus the side effect profile of antimalarial chemoprophylactic drugs and the medicolegal climate in which they practice.

Reaching a decision

These sources are assessed by the country recommendations sub-group then submitted for discussion and decision by the full UKMEAG as the basis for malaria prevention policy for each country. Data quality may not be uniform for the countries considered, so a single formula to decide policy is not possible and different weighting may need to be applied to the information sources used.

The future

Large-scale field diagnostics are likely to be widely used, especially in those countries moving to the pre-elimination phase of malaria eradication. Data generated both on species present and on drug-resistance markers, will give a much closer picture of the true in-country malaria situation and strengthen the evidence base for the UKMEAG guidelines.

Reference

This reference number refers to the complete list of references found in the References section.

140. Cathcart S, Lawrence J, Grant A, Quinn D, Whitty C, Jones J and others. ‘Estimating unreported malaria cases in England: a capture–recapture study’ Epidemiology and Infection 2010: volume 138, issue 7, pages 1,052 to 1,058

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