Area of exposure and treatment challenges of malaria in Eritrean migrants: a GeoSentinel analysis

Patricia Schlagenhauf,Michael Libman,Mogens Jensenius,William Stauffer,Hilmir Asgeirsson,Davidson H Hamer,Emmanuel Bottieau,Martin P Grobusch,Gilles Eperon,Carsten Schade Larsen,Paul Kelly,Perry Van Genderen,Eli Schwartz,Camilla Rothe,Jan Fehr,Philippe Gautret,Egon Isenring,Anne Mccarthy,Elizabeth D Barnett

doi:10.1186/s12936-018-2586-9

Abstract

BackgroundRecent reports highlight malaria as a frequent diagnosis in migrants who originate from Eritrea. A descriptive analysis of GeoSentinel cases of malaria in Eritrean migrants was done together with a literature review to elucidate key attributes of malaria in this group with a focus on possible areas of acquisition of malaria and treatment challenges.ResultsA total of 146 cases were identified from the GeoSentinel database from 1999 through September 2017, with a marked increase in 2014 and 2015. All patients originated from Eritrea and the main reporting GeoSentinel sites were in Norway, Switzerland, Sweden, Israel and Germany. The majority of patients (young adult males) were diagnosed with malaria following arrival in the host country. All patients had a possible exposure in Eritrea, but may have been exposed in documented transit countries including Ethiopia, Sudan and possibly Libya in detention centres. Most infections were due to Plasmodium vivax (84.2%), followed by Plasmodium falciparum (8.2%). Two patients were pregnant, and both had P. vivax malaria. Some 31% of the migrants reported having had malaria while in transit. The median time to onset of malaria symptoms post arrival in the host country was 39 days. Some 66% of patients were hospitalized and nine patients had severe malaria (according to WHO criteria), including five due to P. vivax.ConclusionsThe 146 cases of mainly late onset, sometimes severe, P. vivax malaria in Eritrean migrants described in this multi-site, global analysis reflect the findings of single-centre analyses identified in the literature search. Host countries receiving asylum-seekers from Eritrea need to be prepared for large surges in vivax and, to a lesser extent, falciparum malaria, and need to be aware and prepared for glucose-6-phosphate dehydrogenase deficiency testing and primaquine treatment, which is difficult to procure and mainly unlicensed in Europe. There is an urgent need to explore the molecular epidemiology of P. vivax in Eritrean asylum-seekers, to investigate the area of acquisition of P. vivax along common transit routes and to determine whether there has been re-introduction of malaria in areas, such as Libya, where malaria is considered eliminated, but where capable vectors and Plasmodium co-circulate.

Highlights

Recent reports highlight malaria as a frequent diagnosis in migrants who originate from Eritrea
Several reports have highlighted that malaria is a frequent diagnosis in migrants, who originate in Eritrea [1,2,3] and who transit countries in sub-Saharan and northern Africa
A Information available for 100 patients out of 146 b P. vivax infection with severe anaemia (n = 3), P. vivax infection with renal failure (n = 1), P. vivax infection with cardiovascular failure (n = 1), P. falciparum infection with severe anaemia (n = 1), P. falciparum infection with hyperparasitaemia and respiratory failure (n = 1), unknown malaria species infection with neurological symptoms (n = 1) and unknown malaria species infection with cardiovascular failure (n = 1). This descriptive analysis of malaria cases ex Eritrea notified to GeoSentinel shows that the majority of cases were P. vivax (84%) and the median time to presentation after arrival in the host country was 39 days

Summary

Introduction

Recent reports highlight malaria as a frequent diagnosis in migrants who originate from Eritrea. Migrants present to local medical facilities in host countries with unfamiliar infectious diseases that may require unlicensed treatments. These circumstances have implications for screening, diagnostics, medication procurement and adherence to treatment. Several reports have highlighted that malaria is a frequent diagnosis in migrants, who originate in Eritrea [1,2,3] and who transit countries in sub-Saharan and northern Africa. Migrants from Eritrea encompass both refugees and asylum-seekers. An asylum-seeker is an individual who has sought international protection and whose claim for refugee status has not yet been determined [5]. Countries are responsible for determining whether an asylum-seeker is a refugee or not. Eritrea ranks 5th in the top ten origins of persons applying for asylum in the European Union [5]

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