Abstract
BackgroundImported malaria is a frequent diagnosis in travellers and migrants. The objective of this study was to describe the epidemiological and clinical characteristics of patients diagnosed with imported malaria within a Spanish collaborative network registering imported diseases (+REDIVI). In addition, the possible association between malaria and type of case, gender, age or area of exposure was explored.MethodsCases of imported malaria were identified among all cases registered in the +REDIVI database during the period October 2009–October 2016. Demographic, epidemiological and clinical characteristics were analysed.ResultsIn total, 11,816 cases of imported infectious diseases were registered in +REDIVI’s database between October 2009 and October 2016. Immigrants seen for the first time after migration accounted for 60.2% of cases, 21.0% of patients were travellers, and 18.8% were travellers/immigrants visiting friends and relatives (VFRs). There were 850 cases of malaria (850/11,816, 7.2%). Malaria was significantly more frequent in men than in women (56.8% vs 43.2%) and in VFR-immigrants (52.6%) as compared to travellers (21.3%), immigrants (20.7%) and VFR-travellers (5.4%) (p < 0.001). Although this data was not available for most patients with malaria, only a minority (29/217, 13.4%) mentioned correct anti-malarial prophylaxis. Sub-Saharan Africa was found to be the most common region of acquisition of malaria. Most common reason for consultation after travel was a febrile syndrome although an important proportion of immigrants were asymptomatic and presented only for health screening (27.3%). Around 5% of travellers presented with severe malaria. The most prevalent species of Plasmodium diagnosed was Plasmodium falciparum (81.5%). Malaria due to Plasmodium ovale/Plasmodium vivax was frequent among travellers (17%) and nearly 5% of all malaria cases in immigrants were caused by Plasmodium malariae.ConclusionsMalaria was among the five most frequent diagnoses registered in +REDIVI’s database. Some significant differences were found in the distribution of malaria according to gender, type of case, species. Among all malaria cases, the most frequent diagnosis was P. falciparum infection in VFR-immigrant men.
Highlights
Imported malaria is a frequent diagnosis in travellers and migrants
Malaria cases were especially prevalent among visiting friends and relatives (VFRs)-immigrants as compared to other types of cases: more than 50% of malaria infections were in VFR-immigrants (p < 0.001)
Malaria due to Plasmodium ovale/Plasmodium vivax, was frequent among travellers (17%) and nearly 5% of all malaria cases in immigrants were caused by Plasmodium malariae acquired in sub-Saharan Africa
Summary
Imported malaria is a frequent diagnosis in travellers and migrants. The possible association between malaria and type of case, gender, age or area of exposure was explored. Norman et al Malar J (2017) 16:407 favourable outcome is associated with timely diagnosis and initiation of specific correct treatment. Malaria transmission in non-endemic areas is infrequent, isolated cases of congenital, transfusion and transplantation-associated malaria have been described [6,7,8,9]. Vector-borne transmission in non-endemic areas is unlikely but possible if, due to global climate changes, competent Anopheles species are introduced and become established in new areas. Imported malaria could lead to autochthonous cases if competent vectors are present in specific areas. Awareness and surveillance of imported malaria is essential for the individual patient and from a public health point of view
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