Abstract
BackgroundMore than 30,000 malaria cases are reported annually among international travellers. Despite improvements in malaria control, malaria continues to threaten travellers due to inaccurate perception of risk and sub-optimal pre-travel preparation.MethodsRecords with a confirmed malaria diagnosis after travel from January 2003 to July 2016 were obtained from GeoSentinel, a global surveillance network of travel and tropical medicine providers that monitors travel-related morbidity. Records were excluded if exposure country was missing or unascertainable or if there was a concomitant acute diagnosis unrelated to malaria. Records were analyzed to describe the demographic and clinical characteristics of international travellers with malaria.ResultsThere were 5689 travellers included; 325 were children <18 years. More than half (53%) were visiting friends and relatives (VFRs). Most (83%) were exposed in sub-Saharan Africa. The median trip duration was 32 days (interquartile range 20–75); 53% did not have a pre-travel visit. More than half (62%) were hospitalized; children were hospitalized more frequently than adults (73 and 62%, respectively). Ninety-two per cent had a single Plasmodium species diagnosis, most frequently Plasmodium falciparum (4011; 76%). Travellers with P. falciparum were most frequently VFRs (60%). More than 40% of travellers with a trip duration ≤7 days had Plasmodium vivax. There were 444 (8%) travellers with severe malaria; 31 children had severe malaria. Twelve travellers died.ConclusionMalaria remains a serious threat to international travellers. Efforts must focus on preventive strategies aimed on children and VFRs, and chemoprophylaxis access and preventive measure adherence should be emphasized.
Highlights
More than 30,000 malaria cases are reported annually among international travellers
More than half (53%) were travellers visiting friends and relatives (VFRs)
Eighty per cent of children were VFRs (Table 2); 167 (65%) of the 257 children VFRs were born in the country their parents immigrated to and 231 (90%) travelled to sub-Saharan Africa
Summary
Despite improve‐ ments in malaria control, malaria continues to threaten travellers due to inaccurate perception of risk and sub-optimal pre-travel preparation. There have been improvements in global malaria control since 2000, malaria remains a threat to international travellers. Despite the risk of malaria when travelling to an endemic country, and the ability to prevent malaria with proper chemoprophylaxis and mosquito-bite precautions, most international travellers do not have a pre-travel clinical visit with a healthcare provider [6]. The increasing connectivity of malaria-endemic countries with non-endemic countries via air travel [4, 8], the lack of adequate pre-travel preparation, and personal behaviour that may increase Anopheles mosquito exposure [9] may keep malaria as a continued threat to travellers’ health
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