SearchRemember Malaria: Advice to GPs seeing newly arrived refugees and travellers
October 20, 2025
Recently there has been an increase in the cases of malaria being reported in some groups of newly arrived refugees.
Investigations for malaria should be done on anyone who has travelled from/through an endemic malaria area within 3 months of arrival, even if they are asymptomatic. If a person is symptomatic, especially if they have arrived from a country where there is a risk of malaria in the last 12 months, then it is appropriate to test for malaria if they have a fever (regardless of previous malaria testing or treatment). PCR testing is the preferred initial investigation for Plasmodium Falciparum, and this can be arranged by most labs, however thick and thin blood films remain the gold-standard for all types of malaria. Antigen-based rapid diagnostic tests (RDTs) are not significantly sensitive to detect all infections.
If a person has malaria, then the case should be discussed with an infectious diseases service. Patients with malaria may deteriorate quickly, especially children, pregnant women and those with low immunity. Conversely, some recent arrivals may be partly protected by acquired immunity from their home country, meaning that they present surprisingly well.
It is important that malaria be considered as a priority diagnosis in any recent humanitarian arrival or returned traveller from a malaria endemic area with symptoms. This is especially important in the first 3 months post arrival.
Symptoms can initially be vague and non-specific and may include fever, chills, myalgias, headache, loss of appetite, nausea and GIT symptoms and cough. Fever is not always present initially.
Progression to severe malaria can occur quickly so it is recommended that clinicians have a low threshold for discussing possible cases with Infectious Diseases physicians and referral to emergency department for investigation and treatment. Current Australian recommendations are that all patients with falciparum malaria should be admitted to hospital at least for the initial part of their treatment.
If a person has been treated for malaria (either in Australia or off-shore) then current recommendations are for a post treatment check with malaria thick and thin films and PCR testing at 28 days to ensure successful treatment. Some ID teams will recommend earlier testing.
