Abstract
BackgroundAutochthonous malaria has been eliminated from Réunion in 1979. To prevent secondary transmission and re-emergence of autochthonous malaria, permanent epidemiologic and entomological surveillance and vector control measures are conducted around imported malaria cases. Results of local malaria surveillance (clinical data and results of epidemiological and entomological investigations around cases) were collected for 2013–2016 and were analysed according to historical data and to the exchanges with malaria-affected areas (estimated by airport data).ResultsForm 2013 to 2016, 95 imported malaria cases have been detected in Reunion Island: 42% of cases occurred in the area of repartition of Anopheles arabiensis, but Anopheles mosquitoes were present only around seven cases including one gametocyte carrier. No autochthonous or introduced case has occurred during this period. The lack of chemoprophylaxis or poor adherence was found in the majority (96%) of malaria cases between 2013 and 2016, regardless of trip type. Affinity tourism in Madagascar and Comoros was the cause of 65% of imported malaria cases.DiscussionThe incidence of imported malaria and the incidence rate per 100,000 travellers has continuously decreased since 2001. Now with the drastic decrease of malaria transmission in the Comoros archipelago, most of imported malaria cases in Reunion Island have been contaminated in Madagascar. Immigrants regularly resident in Reunion Island, which travel to malaria endemic countries (mainly Madagascar) to visit their friends and relatives (VFRs) represent a high-risk group of contracting malaria. VFRs, low adherence to pre-travel recommendations, in particular, the compliance on the use of chemoprophylaxis are the main drivers of imported malaria in Reunion Island. Furthermore as previously described, some general practitioners in Reunion Island are always not sufficiently aware of the official recommendations for prescriptions of prophylactic treatments.ConclusionSocial mobilization targeted on the Malagasy community in Reunion Island could help to decrease the burden of imported malaria in Reunion Island. Because of the low number of gametocyte carriers and the absence of an Anopheles mosquito population when most malaria cases were imported those last 4 years, the risk of the appearance of introduced malaria cases and indigenous malaria cases appears low in Reunion Island.
Highlights
Autochthonous malaria has been eliminated from Réunion in 1979
Because of the low number of gametocyte carriers and the absence of an Anopheles mosquito population when most malaria cases were imported those last 4 years, the risk of the appearance of introduced malaria cases and indigenous malaria cases appears low in Reunion Island
Due to the presence of an effective vector (Anopheles arabiensis), the island is considered potentially vulnerable to the reintroduction of malaria, or at least introduced malaria cases or even an indigenous case [3]
Summary
To prevent secondary transmission and re-emergence of autochthonous malaria, permanent epidemiologic and entomological surveillance and vector control measures are conducted around imported malaria cases. The secondary goals of the programme are to describe the clinical characteristics and the prevention practices surrounding malaria infections occurring in people travelling to Réunion. Each case of malaria must be declared to the Regional Health Agency (Agence Régionale de Santé—ARS), triggering an epidemiological and entomological investigation by the Vector Control Service (Service de lutte antivectorielle—LAV) that could be followed by anti-mosquito operations. Anopheles mosquitoes are present only in certain regions on the island [6] Their density is not conducive to transmission except in a small area during certain periods of the year [6]. Several past studies have shown that a certain number of these malaria cases could be due to a low rate of medical consultation before departure, a low rate of compliance with prevention measures (chemoprophylaxis and personal protection from disease vectors), and inappropriate advice and medication issued by the medical community in Réunion [7, 8]
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