Malaria after international travel: A GeoSentinel analysis, 2003-2016

• Type of Material: Article
• Authors: Kristina Angelo, Emory University; Michael Libman, McGill University; Eric Caumes, Universite Pierre et Marie Curie; Davidson H. Hamer, Boston University; Kevin C Kain, University of Toronto; Karin Leder, Royal Melbourne Hospital; Martin P. Grobusch, Academic Medical Centre, University of Amsterdam; Stefan H Hagmann, Steven and Alexandra Cohen Children's Medical Center of New York; Phyllis Kozarsky, Emory University; David G. Lalloo, Liverpool School of Tropical Medicine; Poh-Lian Lim, Tan Tock Seng Hospital; Calvin Patimeteeporn, National Center for Emerging and Zoonotic Infectious Diseases; Philippe Gautret, Aix Marseille Universite; Silvia Odolini, Universita degli Studi di Brescia; François Chappuis, Hopitaux universitaires de Geneve; Douglas H. Esposito, National Center for Emerging and Zoonotic Infectious Diseases
• Language: English
• Date: 2017-07-20
• Publisher: BioMed Central
• Publication Version: Final Published Version
• Copyright Statement: © 2017 The Author(s).
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1186/s12936-017-1936-3
• Title of Journal or Parent Work: Malaria Journal
• ISSN: 1475-2875
• Volume: 16
• Issue: 1
• Start Page: 293
• End Page: 293
• Grant/Funding Information: GeoSentinel is supported by a cooperative agreement (U50CK00189) between the CDC and International Society of Travel Medicine; funding was also received by GeoSentinel from the International Society of Travel Medicine and the Public Health Agency of Canada.
• Keywords: Malaria; International travel; Plasmodium spp; GeoSentinel
• Research Categories: Public Administration; Health Sciences, Public Health

Abstract

Background: More 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. Methods: Records 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. Results: There 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. Conclusion: Malaria 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.