Deaths Caused by Malaria in Switzerland 1988–2002

Abstract

Despite sophisticated intensive medicine, between one and three malaria-associated deaths occur annually in Switzerland. In this retrospective study, 33 deaths (25 men and 8 women) caused by falciparum malaria reported in Switzerland from 1988 to 2002 were analyzed. The case fatality ratio (CFR) for the falciparum infections for the 15-year period was 1.2%, with a peak of 2.2% in 1991. Sub-Saharan Africa was the source of all the imported fatal infections. Non-immune Europeans had a significantly higher case fatality ratio than the non-Europeans (1.7% versus 0.2%; P < 0.001). Careless use or non-use of prophylaxis, sometimes because of physicians giving unsatisfactory pre-travel advice, and initially missed diagnosis post-travel were factors that contributed to the development of severe infections leading to death. Travelers should be sensitized to the risk of malaria by well-informed general practitioners. Updated information is readily available (www.safetravel.ch). Regarding diagnosis and treatment, greater physician awareness of the disease is needed, and expert advice should be sought without hesitation. Rapid malaria tests may be a useful diagnostic adjunct in centers where microscopic expertise is lacking. Falciparum malaria in a non-immune patient is an emergency requiring immediate treatment.

Severe Imported Malaria in Adults: Retrospective Study of 20 Cases

“…This findings reflect the higher risk of malaria acquisition in this area compared with other areas, 2,3,6 and strengthens current recommendations about chemoprophylaxis. All patients were from areas not endemic for malaria and were considered non-immune.…”

“…This finding might be related to their acquired semi-immunity (after repeated exposures to malaria), which has been associated with a lower risk of complications and death. 2,3,12 This protection is generally thought to disappear in a few years after non-exposure, but conflicting findings about this issue have been published, 13,14 and it is still a matter of debate that warrants further investigations. Previous studies have suggested that age is a risk factor for severe P. falciparum malaria.…”

“…Incomplete or lack of chemoprophylaxis is a known risk factor for severe malaria. 3,4,6,7,12 Most patients hesitate several days before seeking medical attention. Moreover, in some cases, the diagnosis of malaria was not achieved on the first visit and correct diagnosis and treatment were delayed.…”

“…2 Because significant under-reporting is assumed, the actual figures are probably higher. Mortality rates for imported malaria range from 0.3% to 2.2% globally [2][3][4][5] and from 11% to 30% in person with severe malaria episodes. [4][5][6][7][8] The criteria defining severe malaria were established by the World Health Organization (WHO) in 1990 9 and revised in 2000.…”

Malaria in travellers returning or migrating to Canada: surveillance report from CanTravNet surveillance data, 2004-2014

“…About two-thirds of malaria cases in this analysis occurred in men, a phenomenon noted previously. 11,12 Higher rates of malaria and deaths due to malaria among male travellers may reflect both biological (e.g., attractiveness to vectors) and behavioural (e.g., adherence to chemoprophylaxis) risk factors, 11,[13][14][15][16][17] although their continued over representation in epidemiologic analyses speaks to the need for better, targeted prevention initiatives.…”