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International trends in malaria morbidity and niortality are causing increasing concern in the medical community. These areas of concern relate to maintenance of control, adherence to preventive measures in many countries, and the worldwide emergence of resistance to drugs used both for treatment and prevention of malaria. In recent years, there has been a considerable increase in travel to malarial areas of the world (particularly air travel) both for business and leisure purposes. Consequently an increased risk of exposure to malaria now exists for many individuals of races and nationalities nornially resident in nonnialarial areas of the world. The risk of acquiring malaria depends on where one travels and the duration of the stay. Another major factor is what (if any) prophylaxis has been taken. The severity of any illness resulting from travel relates to the strain of malaria acquired and the promptness and effectiveness of available treatment. Prevention by mosquito eradication programs, barrier methods, and prophylactic drug measures is always preferable to the need for subsequent treatment of infection. Advice is available in published guidelines, and more country-specific and individualized advice can be accessed through on-line databases, these sources of information being designed to assist physicians give appropriate advice to their patients.’ Revised U.K. guidelines have now been published. In keeping with the increase, both in travel abroad and, more specifically, in travel by substantial numbers of U.K. residents and expatriates to malarial areas, the number of individuals who have acquired malaria has shown an increase over recent years, although year-by-year variation is evident as with many infections. There may be variations in levels of notification and laboratory Changes in the types of malaria being reported have also been noted.4 In Scotland, although the number of notifications has not substantially increased since the 1984 peak, both notifications and hospital discharges indicate overall an

Malaria: Trends Affecting Scotland