Abstract
BackgroundMalaria is a notifiable disease in the Netherlands, a non-endemic country. Imported malaria infections occur regularly among travellers, migrants and visitors. Surveillance data were analysed from 2008 to 2015. Trends in amounts of notifications among risk groups were analysed using Poisson regression. For asylum seekers, yearly incidence was calculated per region of origin, using national asylum request statistics as denominator data. For tourists, denominator data were used from travel statistics to estimate incidence per travel region up to 2012.ResultsA modest increase in overall imported malaria notifications occurred in 2008–2015 (from 222 in 2008 to 344 in 2015). Notably, in 2014 and 2015 sharp increases were seen in malaria among travellers visiting friends and relatives (VFR), and in asylum seekers. Of all Plasmodium falciparum infections, most (1254/1337; 93.8%) were imported from Africa; 1037/1337 (77.6%) were imported from Central and West Africa. Malaria in VFR was mostly caused by P. falciparum infection after visiting Ghana (22%) or Nigeria (19%). Malaria in asylum seekers was mostly caused by Plasmodium vivax infection from the Horn of Africa. The large number of notifications in asylum seekers resulted from both an increase in number of asylum seekers and a striking increase of malaria incidence in this group. Incidence of malaria in asylum seekers from the Horn of Africa ranged between 0.02 and 0.3% in 2008–2013, but rose to 1.6% in 2014 and 1.3% in 2015. In 2008–2012, incidence in tourists visiting Central and West Africa dropped markedly.ConclusionsImported malaria is on the rise again in the Netherlands, most notably since 2013. This is mostly due to immigration of asylum seekers from the Horn of Africa. The predominance of P. vivax infection among asylum seekers warrants vigilance in health workers when a migrant presents with fever, as relapses of this type of malaria can occur long after arrival in the Netherlands.
Highlights
Malaria is a notifiable disease in the Netherlands, a non-endemic country
Patients who were recorded as being asylum seekers or Incidence of imported malaria in tourists, 2008–2012 During the period of 2008–2012, incidence in tourists was calculated by using denominator data per country of travel from the Continuous Holiday Survey (NIPO), which were at the time of this study only available up to 2012 [3]
A slight decline in absolute numbers of imported malaria was seen over the whole study period up to 2015 (IRR per year 0.95, 95% CI 0.91–0.99)
Summary
Malaria is a notifiable disease in the Netherlands, a non-endemic country. Imported malaria infections occur regularly among travellers, migrants and visitors. Nowadays malaria in the Netherlands occurs only as an imported disease in returning travellers or in visitors from endemic countries. Almost half of all 2847 cases were travellers visiting friends and relatives (VFR) in Middle and West Africa During this time period, malaria notifications among VFR had decreased as well (from 210 in 2000 to 77 in 2007) [2]. The aim of this study is to analyse trends in malaria notifications in the Netherlands, to assess whether the decline has persisted since 2007 and to identify risk groups. The number of Dutch travellers to malaria endemic countries has increased [3] and since 2014 large numbers of asylum seekers from the Horn of Africa have arrived in the Netherlands. The incidence among asylum seekers was not studied separately in the previous study [2], in light of the recent increase in refugees seeking asylum in the Netherlands, the additional aim is to quantify the incidence of imported malaria in asylum seekers
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