The epidemiology of imported malaria in Taiwan between 2002-2013: the importance of sensitive surveillance and implications for pre-travel medical advice.

Shou-Chien Chen,Kow-Tong Chen,Hsiao-Ling Chang

doi:10.3390/ijerph110605651

Abstract

The purpose of this study was to assess the epidemiology of imported malaria in Taiwan between 2002 and 2013. We analyzed the national data recorded by the Taiwan Centers for Disease Control (Taiwan CDC). Malaria cases were diagnosed by blood films, polymerase chain reaction, or rapid diagnostic tests. The risk of re-establishment of malarial transmission in Taiwan was assessed. A total of 229 malaria cases were included in our analysis. All of the cases were imported. One hundred and ninety-two cases (84%) were diagnosed within 13 days of the start of symptoms/signs; 43% of these cases were acquired in Africa and 44% were acquired in Asia. Plasmodium falciparum was responsible for the majority (56%) of these cases. Travel to an endemic area was associated with the acquisition of malaria. The malaria importation rate was 2.36 per 1,000,000 travelers (range 1.20–5.74). The reproductive number under control (Rc) was 0. No endemic transmission of malaria in Taiwan was identified. This study suggests that a vigilant surveillance system, vector-control efforts, case management, and an educational approach focused on travelers and immigrants who visit malaria endemic countries are needed to prevent outbreaks and sustain the elimination of malaria in Taiwan.

Highlights

IntroductionMalaria is a major global infection present in 108 countries inhabited by approximately 3 billion people; and causes approximately 216 million infections and 655,000 deaths worldwide annually [1]
Malaria is a major global infection present in 108 countries inhabited by approximately 3 billion people; and causes approximately 216 million infections and 655,000 deaths worldwide annually [1].It causes avoidable deaths every year from imported malaria in non-endemic countries, mainly in people who are otherwise healthy [2]
The risk of infection during travel can be reduced by the use of anti-malaria prevention measures (AMPM) (e.g., wearing long-sleeve clothing and pants at night that provide full coverage, using insect repellents, sleeping under insecticide-impregnated bed nets (IIBN), and taking an appropriate chemoprophylaxis) [5,6,7]

Summary

Introduction

Malaria is a major global infection present in 108 countries inhabited by approximately 3 billion people; and causes approximately 216 million infections and 655,000 deaths worldwide annually [1]. It causes avoidable deaths every year from imported malaria in non-endemic countries, mainly in people who are otherwise healthy [2]. The risk of infection during travel can be reduced by the use of anti-malaria prevention measures (AMPM) (e.g., wearing long-sleeve clothing and pants at night that provide full coverage, using insect repellents, sleeping under insecticide-impregnated bed nets (IIBN), and taking an appropriate chemoprophylaxis) [5,6,7]. The risk of resurgence is determined by the prevailing vectorial capacity (receptivity), the malaria importation rate (vulnerability), and the malariogenic potential [10,11,12]

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