Imported malaria cases: the connection with the European ex-colonies

Marta Domínguez García,Elena Melús Palazón,Rosa Magallón Botaya,Cristina Feja Solana,Cruz Bartolomé Moreno,Alberto Vergara Ugarriza

doi:10.1186/s12936-019-3042-1

Abstract

BackgroundImported malaria is increasing in non-endemic areas due to the increment of international travels, migration and, probably, other unknown factors. The objective of this study was to describe the epidemiological and clinical characteristics of malaria cases in a region of Spain; analyse the possible association between the variables of interest; compare this series with others; and evaluate the characteristics of imported malaria cases according to the country of origin, particularly cases from Equatorial Guinea (Spanish ex-colony) and from the rest of sub-Saharan Africa.MethodsA descriptive observational study was carried out with a retrospective data collection of cases of malaria reported in Aragon from 1996 to 2017. Univariate and bivariate analysis of clinical–epidemiological variables was performed. In addition, an analysis of cases from sub-Saharan Africa was carried out using logistic regression, calculating odds ratio with its 95% confidence interval.Results609 cases of malaria were recorded in Aragon from 1996 to 2017. An autochthonous case in 2010. 50.33% were between 15 and 39 years old. 45.65% of the cases were notified of the 4-weeks 9 to 12. 82.6% reside in the main province, urban area, of which 65.4% were VFR (Visiting Friends and Relatives), 23.8% new immigrants and 10.9% travellers. The infectious Plasmodium species par excellence was Plasmodium falciparum (88%). Analysing the cases from sub-Saharan Africa (95.2% of the total), 48.1% were from Equatorial Guinea. Comparing these with the cases from the rest of sub-Saharan Africa, it was observed that the cases from the Spanish ex-colony have association with the female gender, being under 5 years old, residing in the main province (urban area) and being a new immigrant.ConclusionsThe epidemiological profile of imported malaria cases can be defined as VFR between 15 and 39 years old, coming from sub-Saharan Africa, particularly from Equatorial Guinea. Immigrants education about the importance of chemoprophylaxis when travelling to visit friends and relatives, emphasizing on those who are originally from the ex-colonies of destination country, is necessary; as well as to raise awareness among health professionals to make advice in consultations, specially before summer vacations.

Highlights

Imported malaria is increasing in non-endemic areas due to the increment of international travels, migration and, probably, other unknown factors
More than 50 countries managed to eradicate the disease; malaria has ceased to be an endemic disease in these countries, the increase in trips to endemic areas in recent decades means that imported malaria cases are becoming more common [1,2,3], as is the case in Spain where every year there are more than 500 cases of imported malaria
The general objective of this study is to know the most relevant epidemiological characteristics of the malaria cases reported in a region of Spain (Aragon) during the years 1996 to 2017; the possible association between the variables of interest, and to know possible differences between the cases coming from Equatorial Guinea and those of the rest of sub-Saharan Africa trying to identify the possible causes of the higher prevalence of cases from this ex-colony

Summary

Introduction

Imported malaria is increasing in non-endemic areas due to the increment of international travels, migration and, probably, other unknown factors. The objective of this study was to describe the epidemiological and clinical characteristics of malaria cases in a region of Spain; analyse the possible association between the variables of interest; compare this series with others; and evaluate the characteristics of imported malaria cases according to the country of origin, cases from Equatorial Guinea (Spanish ex-colony) and from the rest of sub-Saharan Africa. According to the World Health Organization [1], in 2016, 91 countries reported a total of 216 million cases of malaria, an increase of 5 million cases in relation to the previous year. In October 2010, an autochthonous case of malaria was registered in Spain, of a 48-year-old woman who fell ill due to Plasmodium vivax infection [6]

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