Malaria after international travel: a GeoSentinel analysis, 2003-2016.

Kristina Angelo (1) , Michael Libman (2) , Eric Caumes (3) , Davidson H. Hamer (4) , Kevin Kain (5) , Karin Leder (6, 7) , Martin Grobusch (8) , Stefan Hagmann (9) , Phyllis Kozarsky (1, 10) , David Lalloo (11) , Poh-Lian Lim (12, 13) , Calvin Patimeteeporn (1) , Philippe Gautret (14) , Silvia Odolini (15) , François Chappuis (16) , Douglas Esposito (1)

1 Division of Global Migration and Quarantine [Atlanta, GA, USA]
2 TDC - Centre for Tropical Diseases [Montréal]
3 Service de Maladies Infectieuses et Tropicales [CHU Pitié-Salpêtrière]
4 Department of Global Health and Center for Global Health and Development [Boston, MA, USA]
5 Tropical Disease Unit [Toronto, Canada]
6 Victorian Infectious Diseases Service [Victoria, Australia]
7 School of Public Health and Preventive Medicine [Monash University-Melbourne]
8 Academic Medical Center - Department of Infectious Diseases [Amsterdam, Netherlands]
9 Cohen Children’s Medical Center
10 Department of Medicine [Atlanta, GA, USA]
11 LSTM - Liverpool School of Tropical Medicine
12 Institute of Infectious Diseases and Epidemiology [Singapore, Singapore]
13 Lee Kong Chian School of Medicine
14 URMITE - Unité de Recherche sur les Maladies Infectieuses Tropicales Emergentes
15 Department of Infectious and Tropical Diseases [Brescia, Italy]
16 Geneva University Hospitals - HUG [Switzerland]

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.

Keywords: Malaria; International travel; Plasmodium spp; GeoSentinel

Domains: Life Sciences [q-bio]; Santé publique et épidémiologie; Life Sciences [q-bio]; Human health and pathology; Infectious diseases; Life Sciences [q-bio]; Human health and pathology; Emerging diseases

Kristina Angelo, Michael Libman, Eric Caumes, Davidson H. Hamer, Kevin Kain, et al.. Malaria after international travel: a GeoSentinel analysis, 2003-2016.. Malaria Journal, 2017, 16 (1), pp.293. ⟨10.1186/s12936-017-1936-3⟩. ⟨hal-01788675⟩