Introduction The COVID-19 pandemic has caused disruptions in prevention and management strategies for malaria globally. Currently, data analysing trends in travel-related infections during the pandemic years are scarce. The objective of this analysis was to describe the epidemiological and clinical characteristics of patients with imported malaria within the +Redivi network in Spain, focusing on yearly trends from pre-pandemic years to date. Methods Cases recorded in +Redivi from October 2009 to December 2021 were analysed and patients with a diagnosis of malaria (standard diagnostic methods using thick/thin peripheral blood smears, with/without a malaria rapid diagnostic test and/or Plasmodium spp. PCR) were identified. The total number of malaria cases, cases according to type of patient and severe cases, per year, were analysed. Results In total, 1751 cases of malaria (1751/26601, 6.6%) were identified. The majority occurred in males (1041, 59.5%), median age was 36.3 (IQR: 27–44.7) years and most occurred in VFR-immigrants (872, 49.8%). Most infections were acquired in sub-Saharan Africa (1.660, 94.8%) and were due to P. falciparum (81.3%). There were 64 cases of severe malaria (3.7%) and 4 patients died (0.2% mortality, all in pre-pandemic years). A significant increase in cases of severe malaria was observed during the study period (p < 0.001)(attributable to the increase in 2021). There were 16/93 severe cases in 2021 (17.2%), all due to P. falciparum, (compared with ≤ 5% in previous years), which mainly occurred in travellers and VFR-immigrants (10/16, 62.5% and 5/16, 31.3%, respectively). Conclusions After an initial decline associated with travel restrictions due to the ongoing COVID-19 pandemic, an increase in imported malaria and a significant increase in cases of severe malaria was observed. Patients with imported malaria may present and/or be diagnosed late during this public health crisis and health care professionals should be alerted to the recent increase in severe cases.

Introduction: The objective of this study was to describe the main characteristics of migrants diagnosed with HTLV infection within the +Redivi Spanish network. Methods: Patients with a diagnosis of HTLV type 1 or 2 in +Redivi from October 2009- December 2020 were included. Diagnosis was based on positive HTLV serology (ELISA/CLIA) with LIA/Western blot with/without PCR. Results: A total of 107/17007 cases (0.6%) had a final diagnosis of HTLV infection: 83 (77.67%) HTLV-1 infections, 6 (5.6%) HTLV-2 infections, and 18 (16.8%) non-specified. The majority (76, 71%) were female, median age was 42 years, and median time from arrival to Spain until consultation was 10 years. The group included 100 (93.5%) immigrants, and 7 (6.6%) VFR-immigrants. Most patients were from South America (71, 66.4%), followed by Sub-Saharan Africa (15, 14%) and Central America-Caribbean (13, 12.1%). Around 90% of patients were asymptomatic at presentation and diagnosed as part of screening programs. Median duration of follow-up was 5 years (IQR 2-7). Regarding HTLV-associated conditions, 90 patients (84.2%) had none, 7 (6.5%) had tropical spastic paraparesis (TSP), 5 (4.7%) had other associated conditions (dermatitis, uveitis, pulmonary disease), 3 (2.8%) had other neurological symptoms, and 2 (1.9%) had adult T-cell leukaemia/lymphoma (ATL). No patients with HTLV-2 had HTLV-associated conditions. Four patients (3.7%) died. Concomitant diagnoses were found in 41 (38.3%) patients, including strongyloidiasis in 15 (14%) and HIV co-infection in 4 (3.7%). In 70% of patients screening of potential contacts was not performed/recorded. Conclusions: HTLV infections (the majority due to HTLV-1) were mainly diagnosed in asymptomatic migrants from Latin America. (generally long-settled immigrants and the majority female with the consequent implications for screening/prevention). A high rate of association with strongyloidiasis was found. In the majority, screening of potential contacts was not performed, representing a missed opportunity for decreasing the under-diagnosis of this infection.

Background: Rickettsioses are emerging zoonotic diseases with worldwide prevalence, recognised as a cause of imported fever in travellers and migrants. Our objective is to describe the microbiological, clinical, and epidemiological characteristics of imported rickettsioses in travellers and migrants included in a Spanish collaborative network database. Methods: This multicentre retrospective observational study was nested in +Redivi, the Cooperative Network for the Study of Infections Imported by Immigrants and Travellers. We asked collaborating centres for microbiological, clinical, and epidemiological data on the rickettsiosis cases from the inception of the network in 2009 to December 2020. Results: Fifty-four cases of imported rickettsioses were included; 35 (64.8%) patients were men, and the median age was 37 years (interquartile range 26, 51.2). Only 7.4% of patients were travellers visiting friends and relatives (VFRs), and 5.6% were migrants. The most frequent travel destination (38.9%) was South Africa, and 90.7% engaged in a high-risk activity. Twenty-seven patients (50.0%) started presenting symptoms after their return to Spain. The most frequent symptoms were febrile syndrome (55.6%) and cutaneous manifestations (27.8%). Most diagnoses (63.0%) were confirmed by serology. Only a few cases (9.3%) required hospitalisation. All participants had a full recovery. Conclusions: Clinicians should suspect rickettsial diseases in travellers coming from high-risk areas, especially Southern Africa, who have engaged in activities in rural areas and natural parks. Doxycycline should be considered in the empiric treatment of imported fever of travellers coming from those areas or who have engaged in high-risk activities. There is a need to improve access to molecular diagnosis of rickettsiosis in Spain.