While malaria is not a medical problem one would typically associate with workers on North Sea oil rigs, it is nevertheless a condition that warrants a degree of awareness. Indeed, just last month, we assisted an offshore worker who had a case of imported malaria.
The individual had returned off a rotation through West Africa and despite taking precautions had been infected.
This could have been avoidable, as preventive medication reliably prevents malaria in over 95% of people who take it correctly. In this circumstance, after taking a detailed history and asking about recent foreign travel, the offshore medic put two and two together, and then used the topside support service to confirm the availability of a malaria test at Aberdeen Royal Infirmary.
The patient was swiftly evacuated off the platform and had a formal diagnosis within a few hours. Early confirmation and intervention is critical to avoid serious consequence.
The ever more demanding foreign travel requirements and the multinational footprint of many North Sea operators means that people are at an increased risk of acquiring malaria in one region, where it may be prolific, and returning home to the UK, sometimes before symptoms commence.
UK general practitioners may not immediately suspect fever and body aches as symptoms of a case of malaria as the disease is not something they see manifest itself every day. In the context of recent travel to Sub-Saharan Africa or another malaria-stricken area, they may be more inclined to make the diagnosis, but the unwell person all too often neglects to mention recent travel and more worryingly the doctor fails to enquire.
In a non-immune individual, a delayed diagnosis can ultimately have fatal consequences. Each year an estimated 30,000 business travellers contract Malaria Worldwide (WHO – 2012) and around 1,300 UK travellers came home infected last year (NHS – April 2014).
In terms of the tell-tale signs of malaria infection, symptoms typically occur seven days or more after the mosquito bite, and it presents with a fever in the first instance. Associated symptoms include headache, chills and vomiting – they may be mild and can be confused with flu. Left untreated, some forms of malaria can progress to severe illness often leading to death.
The good news is that malaria is treatable and almost entirely preventable. Simple measures to avoid getting bitten by mosquitoes, when working on oilfields in more exotic locales, combined with preventive tablets where advised, offer good protection.
Although only a small minority, North Sea workers are increasingly moving in and out of territories, where malaria is rife, as their companies grow and skills are required elsewhere.
Companies with such exposure should consider developing a malaria policy, which will not only benefit employees and demonstrate the required duty of care towards their workforce, but could also prevent costly downtime, where employees are in mission-critical roles.
Select employees may require education on malaria. For the individual, WHO advises an ABCD approach:
Awareness is key.
Bite prevention works.
Chemoprophylaxis (prevention tablets) for countries with a high risk is necessary.
Diagnosis – prompt early access to a malaria test reduces the incidence of serious complications.
Although rare, imported malaria represents a risk that UK multinational companies and business travellers can avoid. Complacency may be harder to guard against given our low index of suspicion. For further information on the symptoms and preventive measures to protect against the disease please follow
http://www.patient.co.uk/doctor/malaria-pro
Dr Jonathan O’Keeffe, Medical Director – Medical Services, International SOS and Abermed
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