Malaria

Resident – A donor who has ever been present in a malaria risk area (or areas), for a continuous period of 6 months or more (at any point in their lifetime)

Visitor – A donor who has visited or travelled through a malaria risk area (or areas) within the past 12 months

Unexplained febrile illness – A donor who had undiagnosed fever (that could have been malaria) while present in, or within four months of leaving, a malaria risk area.

Previous diagnosis of malaria – A donor who previously had a confirmed diagnosis of malaria, at any point in their lifetime.

Malaria risk area – Risk area for country as defined by the GDRI

MAT: Malarial Antibody Test

NAT: Nucleic Acid Test (for malaria)

Must not donate (if no testing is available):
Applies to all groups as defined above

1a) Previous Malaria:

If less than 4 months have passed since anti-malaria therapy has been completed and symptoms caused by malaria have resolved, refer to DCSO. See ‘Additional Information’ section.

If more than 4 months have passed since anti-malaria therapy has been completed and symptoms caused by malaria have resolved, obtain a blood sample for MAT and NAT test. See information below in this section.

1b) Unexplained Febrile illness:

If less than 4 months from the date of recovery of symptoms of unexplained febrile illness that could have been malaria: refer to DCSO. See ‘Additional Information’ section.

If more than 4 months from the date of recovery of symptoms of unexplained febrile illness that could have been malaria:  Obtain a blood sample for MAT and NAT. See information below in this section.

1c) Resident:

If less than 4 months since date last present in a malaria risk area:  Obtain a blood sample for MAT and NAT. See information below in this section.

If more than 4 months since date last present in a malaria risk area: Obtain a blood sample for MAT and NAT. If MAT negative, NAT is not required to release stem cells. See information below in this section.

1d) Visitor:

If less than 4 months since return:  Obtain a blood sample for MAT and NAT. Donors may be accepted with individual risk assessment with expert advice. See information below in this section.

If more than 4 and less than12 months since return: Obtain a blood sample for MAT and NAT. If MAT negative, NAT is not required to release stem cells. See information below in this section.

If more than 12 months since return: testing not required, accept

NB.  Please consider T. cruzi or a tropical virus risk if the area is also identified as a risk area for these infections

The results of MAT and NAT tests must be reviewed as a part of donor medical clearance to determine the suitability of stem cells for clinical use. If the exposure or, for donors with a history of malaria where treatment was completed and symptoms have resolved, is less than four months prior to donation, NAT must be done and shown to be negative, irrespective of MAT results. If the exposure or, for donors with a history of malaria where treatment was completed and symptoms have resolved was more than four months prior to donation and MAT is negative, NAT is not required. In case of positive MAT results with a confirmed negative NAT test, a risk assessment can be performed for accepting stem cells for clinical release after seeking expert opinion.

Geographical Disease Risk Index for countries with a current endemic malaria risk.

Symptoms and signs of possible malaria include: fever, flu-like illness, (including shaking chills, headache, muscle aches, and tiredness), anaemia, jaundice, nausea, vomiting, diarrhoea and cough.

Cases of malaria transmission have occurred many years after the donor was last at risk of becoming infected with malaria. This is mainly a problem in people who have had repeated episodes of infection with malaria. This is uncommon, but before allowing someone who has had, or may have had malaria to donate, it is safer to test for malaria antibodies rather than to wait a specific length of time. Malaria may be fatal.

For bone marrow/stem cell donors, if it is an emergency and due to the live saving nature of the treatment, donors may be accepted with individual risk assessment and expert advice for interpretation of MAT and NAT results, at any time point following exposure/recovery. If the donor informs of active malaria infection at donor assessment, they could be treated before donation. If the stem cells are not required for life saving treatment immediately, a four-month deferral should apply. Between 4 months and 12 months following recovery, either a negative MAT or a positive MAT/negative malaria NAT and risk assessment should be applied.

Some countries have malaria as well as tropical viral risk. Both risks have to be considered if the donor had symptoms after travel or stay.

This guidance was updated based on advice from the SACTTI parasitology sub-group.