This case of vivax malaria in a 13-year-old boy raises several issues that should be considered when patients travelling to, or returning from, malarious areas seek advice.
First visit, three months before travel
A 13-year-old boy presented for the first time for pretravel health advice three months before a school excursion to Papua New Guinea (PNG). For two weeks he would be living in a hut in a rural village about two hours from the north coast and at an altitude of roughly 1200 m. He had a past medical history of benign focal childhood epilepsy and varicella. Otherwise he was in good health and general examination was unremarkable. His standard polio, measles–mumps–rubella and meningococcal C vaccinations were reported to be up to date according to NHMRC recommendations and he had had a tetanus– diphtheria–pertussis vaccination three years previously.